From the FDA Drug Label
DOSAGE AND ADMINISTRATION ... Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain. The FDA drug label recommends 400 mg every 4 to 6 hours for mild to moderate pain, which may include cramping after a medial gastrocnemius strain or tear 1.
From the Research
For pain management of cramps after a medial gastrocnemius tear, I recommend a combination of medication, physical measures, and activity modification, prioritizing nonoperative treatment as the first option, including analgesics, insoles, heel cups, calf-stretching, injections, and extracorporeal shock wave therapy, as suggested by 2.
Key Recommendations:
- Take over-the-counter NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) or naproxen (220-440mg twice daily with food) for 5-7 days to reduce pain and inflammation.
- Apply ice to the affected area for 15-20 minutes every 2-3 hours during the first 48-72 hours, then transition to alternating ice and heat therapy.
- Rest the injured leg and elevate it above heart level when possible.
- Gentle stretching of the calf muscle can help relieve cramps - extend your leg and gently pull your toes toward you, holding for 30 seconds and repeating 3-5 times several times daily.
- Stay hydrated and consider taking magnesium supplements (300-400mg daily) as deficiency can contribute to muscle cramps.
- Compression with an elastic bandage or compression sock may provide support and reduce swelling, as early compressive treatment can decrease hemorrhage amount and allow for early ambulation, as seen in 3.
Rationale:
The approach is based on the most recent and highest quality study available, which emphasizes nonoperative treatment as the first line of management for medial gastrocnemius strains or tears, as indicated by 4. This approach aims to reduce inflammation, improve circulation, prevent muscle spasms, and support the healing process of the torn muscle fibers, ultimately improving morbidity, mortality, and quality of life outcomes.
Additional Considerations:
- The use of extracorporeal shock wave therapy, as mentioned in 2, can be considered for patients who do not respond to initial nonoperative treatment.
- In cases where nonoperative treatment fails, surgical options like proximal medial gastrocnemius release may be considered, as discussed in 2.
- It is essential to individualize the treatment plan based on the patient's specific condition, age, and activity level, as suggested by 4.
- The importance of proper diagnosis, often made by clinical evaluation, and the use of imaging modalities like magnetic resonance imaging and ultrasound when necessary, cannot be overstated, as highlighted in 4 and 5.