From the Guidelines
Treatment for a gastrocnemius strain involves the RICE protocol, including rest, ice application for 20-30 minutes, 3-4 times daily, compression with an elastic bandage, and elevation of the leg above heart level when possible, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The RICE protocol is the foundation of treatment for gastrocnemius strains, aiming to reduce pain, inflammation, and further injury.
- Rest: Avoid activities that aggravate the injury, but allow for gentle movement to prevent stiffness and promote healing.
- Ice: Apply ice for 20-30 minutes, 3-4 times daily, using a bag filled with ice and water surrounded by a damp cloth to achieve the greatest tissue cooling 1.
- Compression: Use an elastic bandage to provide support and reduce swelling.
- Elevation: Elevate the leg above heart level when possible to reduce swelling and promote blood flow. Additional treatments may include:
- Over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) to manage pain and reduce inflammation.
- Gentle stretching after the acute phase, typically after 48-72 hours, starting with calf stretches held for 20-30 seconds and repeated 3-5 times daily.
- Progressive strengthening exercises, including heel raises and resistance band exercises, as pain allows. It is essential to note that the treatment approach should prioritize reducing morbidity, mortality, and improving quality of life, and the most recent and highest-quality study, in this case, the 2024 American Heart Association and American Red Cross guidelines for first aid 1, should guide the treatment recommendations.
From the Research
Treatment for Gastrocnemius Strain
The treatment for a gastrocnemius strain typically involves a combination of nonoperative rehabilitation and, in some cases, surgical intervention.
- Nonoperative rehabilitation is the cornerstone of treatment for most cases of gastrocnemius strain, and can be performed as a 4-phase program tailored to the individual's needs 2.
- The treatment may also involve the use of platelet-rich plasma (PRP) injections, which have been shown to reduce the time and costs associated with reaching a complete functional recovery 3.
- In some instances, surgical treatment may be necessary, such as endoscopic evacuation of a hematoma resulting from a strain injury of the medial head of the gastrocnemius muscle 4.
- Gastrocnemius recession is a surgical technique that may be used to treat foot and ankle conditions in adults, including Achilles tendinopathy and midfoot-forefoot overload syndrome, although the evidence for its use is still limited 5.
Non-Surgical Treatment
Non-surgical treatment for gastrocnemius strain typically involves:
- Rest, ice, compression, and nonsteroidal anti-inflammatory drug therapy to manage pain and swelling 6.
- Physical therapy to restore flexibility and strength as pain and swelling subside 6.
- Avoiding excessive fatigue and performing adequate warm-up before intense exercise to prevent muscle strain injury 6.
Surgical Treatment
Surgical treatment for gastrocnemius strain may involve: