From the Guidelines
Management for a partially torn gastrocnemius should begin with the RICE protocol: rest, ice, compression, and elevation for the first 48-72 hours, as this approach has been shown to reduce swelling and pain 1. The RICE protocol is a widely accepted method for managing musculoskeletal injuries, including partial tears of the gastrocnemius.
- Rest involves avoiding activities that cause pain,
- Ice should be applied for 15-20 minutes every 2-3 hours to reduce swelling and pain,
- Compression with an elastic bandage or compression sleeve helps control swelling, and
- Elevation above heart level further reduces edema. Pain management typically includes over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) or naproxen (220-440mg twice daily) for 5-7 days, as they have been shown to effectively relieve tendinopathy pain 1. After the acute phase, gentle stretching and progressive strengthening exercises should begin, starting with isometric exercises and advancing to eccentric strengthening, as eccentric exercise has been proven beneficial in Achilles tendinosus and may be helpful in other tendinopathies 1. Physical therapy is recommended to guide rehabilitation, which typically lasts 6-8 weeks for moderate tears. Patients should gradually return to normal activities as pain allows, using a heel lift or supportive footwear to reduce strain on the calf. Surgery is rarely needed for partial tears. This approach works by initially controlling inflammation and pain, then gradually restoring muscle flexibility, strength, and function while preventing re-injury through controlled rehabilitation. It's also important to note that cryotherapy, such as icing, can be effective for short-term pain relief and may help reduce swelling and pain in cases of acute inflammatory tendinopathies 1, and the application of ice with water, with cooling time interrupted every 20 minutes, is a recommended treatment for musculoskeletal injuries 1.
From the Research
Management of Partially Torn Gastrocnemius
- The management of a partially torn gastrocnemius can be approached using the PRICE principles for symptomatic relief, followed by stretching, strengthening, proprioception, and conditioning exercises 2.
- A case study presented in the Journal of the Canadian Chiropractic Association demonstrated the importance of epidemiology, clinical assessment, and the use of diagnostic ultrasound and MRI imaging in the diagnosis of a tear of the medial head of the gastrocnemius muscle 2.
- While there is evidence for the use of platelet-rich plasma (PRP) in the treatment of partial tears of the ulnar collateral ligament 3, its use in the treatment of partially torn gastrocnemius is not well established.
- The mainstays of treatment for chronic tendon injuries, which may be applicable to partially torn gastrocnemius, include activity modification, relative rest, pain control, and protection, as well as early initiation of rehabilitative exercises that emphasize eccentric loading 4.
- Cryotherapy, nonsteroidal anti-inflammatory drugs, and corticosteroids may also have a role in controlling pain and increasing range of motion, although their use should be carefully considered due to potential risks and lack of high-quality evidence 4.
Treatment Options
- Physical therapy and exercise may be beneficial in the treatment of partially torn gastrocnemius, although the evidence is largely based on studies of other tendon injuries 4, 5.
- Shockwave therapy and therapeutic ultrasound may also be considered, although the evidence for their use in partially torn gastrocnemius is limited 5.
- Surgical procedures, such as tendon repair or augmentation, may be considered in severe cases or where non-surgical treatment has failed, although the evidence for their use in partially torn gastrocnemius is limited 5.