It should be noted that concomitant tears of both the soleus and gastrocnemius are possible. This can complicate the clinical picture. Imaging may also be useful in diagnosis and grading of calf injuries in elite athletes because of unique financial and strategic consequences of return to play decisions. Both can be used to confirm strain, localize the injured muscle and determine extent of injury.
Classification of the injuries
Symptoms include Sharp pain at time of injury or pain with activity. It’s usually able to continue activity with mild pain and localized tenderness. Mild spasm and swelling
No or minimal loss of strength and ROM
<10% muscle fiber disruption
2nd degree moderate
Unable to continue activity and Clear loss of strength and ROM
>10–50% disruption of muscle fibers
Edema and hemorrhage
3rd degree severe
Immediate severe pain, disability and complete loss of muscle function
Palpable defect or mass. Possible positive Thompson’s test
50–100% disruption of muscle fibers
How can calf muscle strain be treated by Physiotherapy?
Acute physiotherapy treatment is aimed at limiting hemorrhage and pain, as well as preventing complications. Over the first 3–5 days, muscle rest by limiting stretch and contraction, cryotherapy, compressive wrap or tape, and elevation of the leg are generally recommended. Acetaminophen or narcotic pain medication could also be used. Gentle active exercises of the ankle and calf should be started within the limits of pain.
Following successful acute treatment more active physiotherapy and rehabilitation strategies can be started. Rehabilitative exercises should isolate the soleus and gastrocnemius by varying knee flexion as described above. Passive stretching of the injured muscle at this stage helps elongate the maturing intermuscular scar and prepares the muscle for strengthening. As range of motion returns, strengthening should begin with unloaded isometric contraction.
Contractures suggest the presence of painful and restrictive adhesions that can be treated with Hawk or Garston release techniques.
Active release technique or Trigger point release is also helpful in treating the calf strains.
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