What is the appropriate management for a patient with a pulled calf muscle?

From the Guidelines

The appropriate management for a pulled calf muscle involves rest, ice, compression, and elevation (RICE) for the first 48-72 hours after injury, as recommended by the 2010 American Heart Association and American Red Cross International Consensus on First Aid Science with treatment recommendations 1.

Key Components of Management

• Rest by avoiding activities that cause pain
• Apply ice for 15-20 minutes every 2-3 hours, with intermittent 10-minute cooling also acceptable if 20 minutes of cooling causes discomfort, as suggested by the 2010 American Heart Association and American Red Cross International Consensus on First Aid Science with treatment recommendations 1
• Use a compression bandage to reduce swelling
• Elevate the leg above heart level when possible

Pain Management

• Over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours with food, not exceeding 3200mg daily) or acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) can help manage pain and inflammation

Rehabilitation

• After the acute phase, gentle stretching and strengthening exercises should be gradually introduced, starting with calf raises and ankle pumps
• A gradual return to normal activities is recommended, typically over 2-6 weeks depending on injury severity
• Proper footwear with adequate support is important during recovery

Monitoring for Complications

• If pain persists beyond two weeks, worsens significantly, or is accompanied by severe swelling or inability to bear weight, medical evaluation is necessary to rule out more serious injuries, considering alternative diagnoses such as those outlined in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1

From the Research

Evaluation of a Pulled Calf Muscle

The evaluation and management of a pulled calf muscle involve several steps, including:

• Initial assessment of the injury to determine the severity and grade of the strain
• Use of conservative treatment methods such as rest, ice, compression, and elevation (RICE) to reduce pain and inflammation
• Implementation of rehabilitation exercises, including stretching and strengthening, to promote healing and prevent further injury

Treatment Options

Treatment options for a pulled calf muscle may include:

• Vibration therapy and radial pressure waves to stimulate healing and reduce recovery time 2
• Early stretching routines to promote flexibility and prevent disability 3
• Use of heat and cold therapies to reduce pain and inflammation, although the evidence for these modalities is limited 4
• Avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which may have adverse effects 5

Diagnosis and Management

Diagnosis and management of muscular calf injuries in runners may involve:

• Use of musculoskeletal ultrasound to rapidly diagnose the cause and extent of injury 6
• Implementation of treatment protocols based on the severity and location of the injury
• Emphasis on prevention of disability through early treatment, stretching, and exercises to increase strength in the calf 3