Torn gastrocnemius

Findings

Presents with a history of acute pain in the calf, and this is the classical “who hit me with a ball in the back of the leg” story. The calf then becomes acutely swollen and may bruise extensively. There is pain and tenderness over the medial gastrocnemius or its aponeurosis, and a haemathoma may be present. The healing, or less severely damaged, muscle hat persistent discomfort, usually over the medial gastrocnemius, although the lateral gastrocnemius can be involved. There is no pain on walking, jogging, going up stairs, and standing on tiptoe.

Cause

Usually an acute episode of a torn medial gastrocnemius but the lesion may be lower, having been caused by a tear of the gastrocnemius/soleus aponeurosis. The normal jump mechanism is for the quadriceps to contract first, and, when the knee is almost straight, plantar flexion from the gastrocnemius should follow. If this mechanism is reversed, that is if there is plantar flexion when the knee is bent or when standing on tiptoe with a bent knee, on straightening the knee, a tear may occur.

A calcified haematoma may remain in chronic cases.

Treatment

a)      RICE and crutches.

b)      Early aspiration, under ultrasound control, of any haematoma. This may require repeating weekly for a while.

c)      A heel raise will rest the gastrocnemius.

d)     Massage techniques, such as effluage, to remove tissue debris and swelling.

e)      Electrotherapeutic modalities to settle inflammation and hasten healing, such as laser and ultrasound.

f)       Gastrocnemius and soleal stretching to prevent scar contraction.

g)      Achilles ladder  

Sports

Sports where acceleration is generated from the plantar flexed foot and a bent knee, such a squash, tennis or a quick single to leg, played off a backward defensive shot at cricket, and soccer centerforward sprints when the ball passed in “empty space”, are particularly prone.

Aspiration of the haemathoma quickens the rate of healing. Full, pedantic rehabilitation is required to prevent scar tissue and repeat injuries occurring. Chronic calf strain requires pedantic rehabilitation, taking time over the early ladder stages, through to running and plyomethrics. This is an injury that, even when apparently better, requires ongoing calf exercises as a recurrence is common.

"Concise guide to sports injuries, 2^nd edition",Churchill Livingstone, Malcolm T.F. Read,  foreword by Bryan English