What to do about a gastrocnemius (gastroc) muscle tear?

From the Guidelines

For a gastrocnemius (gastroc) tear, the most effective initial treatment is the RICE protocol, which includes rest, ice, compression, and elevation, as it helps reduce pain and inflammation, and promotes healing. The RICE protocol should be followed for the first 48-72 hours, with ice applied for 15-20 minutes every 2-3 hours, and the leg elevated above heart level when possible 1.

Initial Treatment

• Rest the injured leg to prevent further injury and promote healing
• Apply ice for 15-20 minutes every 2-3 hours for the first 48-72 hours to reduce pain and inflammation
• Use compression with an elastic bandage to reduce swelling
• Elevate the leg above heart level when possible to reduce swelling

Pain Management

• Take over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours with food) or acetaminophen (500-1000mg every 6 hours) to manage pain and reduce inflammation, as they have been shown to be effective in relieving tendinopathy pain 1
• Consider using topical NSAIDs to reduce tendon pain and eliminate the risk of gastrointestinal hemorrhage associated with systemic NSAIDs 1

Rehabilitation

• After the acute phase (2-3 days), begin gentle stretching and range of motion exercises, but avoid activities that cause pain
• Physical therapy is crucial for proper healing and typically includes progressive strengthening exercises, massage, and possibly ultrasound treatment
• Gradually return to normal activities only when you can walk without pain and have regained strength and flexibility

Severe Tears

• For severe tears, medical evaluation is necessary as they occasionally require surgical intervention
• The gastrocnemius muscle is particularly vulnerable to tears during explosive movements because it crosses both the knee and ankle joints and contains primarily fast-twitch muscle fibers 1

From the Research

Diagnosis and Treatment of Gastroc Tear

• A gastrocnemius tear can be diagnosed through physical examination and diagnostic ultrasound imaging, as seen in a case study where a 44-year-old male presented with acute calf pain and a palpable defect 2.
• The treatment of a gastrocnemius tear typically involves an initial approach using the PRICE principles (protection, rest, ice, compression, and elevation) for symptomatic relief, followed by stretching, strengthening, proprioception, and conditioning exercises 2.

Rehabilitation and Recovery

• A study found that patients who received platelet-rich plasma (PRP) injections for a gastrocnemius strain were able to start active exercise sooner than those who received standard treatment, with a significant reduction in pain and recovery time 3.
• The use of PRP injections, combined with active exercise therapy, may be a valid therapeutic approach for reducing the time and costs associated with reaching a complete functional recovery from a gastrocnemius tear 3.
• Rehabilitation for a gastrocnemius tear can last several weeks, with a case study showing a 6-week treatment period and a 9-month follow-up with no residual impairment in muscle function 2.

Comparison of Treatment Approaches

• A retrospective observational study compared the use of PRP injections with standard treatment for gastrocnemius strains, finding that PRP-treated patients had a significantly shorter time to return to walking without pain and to fully return to their previous sport activity 3.
• The study suggests that the use of PRP injections may be a more effective treatment approach for gastrocnemius tears, allowing for faster recovery and return to activity 3.