Symptoms and Treatment of Acute Calf Strain:

Acute strain of the gastrocnemius muscle occurs typically when the athlete attempts to accelerate from a stationary position with the ankle in dorsiflexion, or when lunging forward, such as while playing tennis or squash. Sudden eccentric overstretch, such as when an athlete runs onto a kerb and the ankle drops suddenly into dorsiflexion, is another common mechanism.

The exact moment of injury was caught on video in the case of a famous Australian batsman whose gastrocnemius strain occurred when has entire body weight was over his foot on the injured side with the center of mass well in front of the leg. The gastrocnemius muscle-tendon complex was at close to maximal length, and the muscle-tendon length was also constant at the time. Therefore, the injury probably occurred just as the muscle-tendon complex was moving from an eccentric to an isometric phase.

Signs and Symptoms

• The patient complains of an acute, stabbing or tearing sensation usually either in the medial belly of the gastrocnemius or at the musculotendinous junction.
• Examination reveals tenderness at the site of muscle strain.
• Stretching the gastrocnemius reproduces pain, as doe’s resisted plantar flexion with the knee extended.
• In grade III muscle tears, there may be a palpable defect.
• Assess functional competence of the injured muscle by asking the patient to perform a bilateral heel raise.
• If necessary, a unilateral heel raise, a heel drop or hop may be used to reproduce the pain.
• This places the muscle under progressively greater load concentrically and eccentrically.
• Calf muscle strain can be graded.
• The tightness of the muscle itself should be assessed as overuse may often lead to palpable ropelike bands or local tissue thickening, which may predispose to further injury.

Treatment

Initial treatment aims to reduce pain and swelling with the use of ice and electrotherapeutic modalities (e.g. TENS, magnetic field therapy, interferential stimulation).

• Crutches may be necessary if the patient is unable to bear weight.
• A heel raise should be used on both the injured and uninjured side.
• Gentle stretching of the gastrocnemius to the level of a feeling of tightness can begin soon after injury.
• Muscle strengthening should start after 24 hours.
• This involves a progression of exercises, commencing with concentric bilateral calf raise, followed by unilateral calf raise with the gradual addition of weights and, finally, eccentric calf lowering over a step gradually increasing speed, then adding weights.
• Low-impact cross-training such as stationary cycling or swimming can be commenced as soon as pain allows.
• When active weight-bearing muscle contraction is pain-free, sustained myofascial tension should be performed on the muscle belly with digital ischemic pressure to focal areas of increased tone and/or tenderness.
• Endeavor to correct possible predisposing factors, such as calf muscle tightness, that may arise from poor biomechanics.
• Athletes should undergo a graduated return to weight-bearing, progressing through walking, easy jogs and, as eccentric strength returns, include sprint and change of direction drills.

Tennis leg

• The term tennis leg refers to an acute muscle tear in the older athlete characterized by sudden onset of severe calf pain and significant disability.
• The injury is invariably associated with extensive bruising and swelling, and can be mistaken for a deep venous thrombosis.
• The most common site is the medial head of gastrocnemius, but occasionally the planters muscle is involved.