Gastrocnemius muscle strain
Gastrocnemius muscle strain

Case study: third degree gastrocnemius muscle strain of a volleyball player. The case of BBTS volleyball player.

The video summary of the case study is available here

Characteristics of the player:

Age: 23 years old
Height: 208 cm
Weight: 115 kg
Position: receiver

Injury: gastrocnemius muscle strain

Description of the injury

During a volleyball training, the player launched himself rapidly towards the coming ball, lost the grip on the slippery floor and fell. The player reported strong, prickling pain in the area of the calf and, within the next two hours, an extensive swelling (the circumference of the affected calf was two times as big as that of the healthy leg). The rapid movement and the slippage provoked the injury – a third degree muscle strain.

Diagnostic test

The USG image shows characteristics of third degree tear of the distal pole of the medial head of the gastrocnemius muscle of the left lower limb, with the formation of an extensive, 12-20 mm thick, mantled hematoma with fibrinous septa, which extends over 2/3 of the distal length of the muscle’s belly with its contraction.

Obraz USG - uraz - naderwanie mięśnia brzuchatego łydki
USG image – injury – gastrocnemius muscle strain
Kinesiotaping - uraz mięśnia gastrocnemius
Kinesiology taping – gastrocnemius muscle injury

Follow-up USG examination consulted with an orthopedist

One week after the injury another USG examination was performed. The image showed a consolidation of the hematoma, with extensive edema of the entire calf. The hematoma was punctured (25ml of yellowish, blood tinged liquid). The duration of the treatment before returning to sport training: 6 – 8 weeks.

Follow-up USG examination

After two and half week of treatment another follow-up USG examination was performed. The image showed a slight blurred outline and a heterogeneous echogenicity of the injured area; gastrocnemius muscle strain; post-traumatic changes; in comparison with the previous USG exam there was a visible improvement.

Badanie kontrolne mięśnia brzuchatego łydki - ultrasonografia
Follow-up examination of the gastrocnemius muscle – ultrasonography

Therapy – injury – gastrocnemius muscle strain

The intense, six-week-long rehabilitation of the BBTS player included:

  • 1st and 2nd week
    • compression therapy and cryotherapy with GAME READY
    • hydro massage of lower limbs,
    • magnetotherapy,
    • lymphatic drainage of the lower limb,
    • kinesilogy taping,
    • high power laser therapy with ASTAR POLARIS HPs (in the second week of treatment),
    • isometric exercises of the lower limb’s muscles.
  • 3rd and 4th week
    • high power laser therapy with ASTAR POLARIS HPs,
    • compression therapy and cryotherapy with GAME READY,
    • functional sport massage,
    • transverse massage of the scar,
    • electrostimulation of gastrocnemius muscle with ETIUS ULM – Kotz’s stimulation,
    • claw therapy,
    • isometric exercises of the calf,
    • stretching exercises of ischio-shin muscles.
  • 5th and 6th week
    • high power laser therapy with ASTAR POLARIS HPs,
    • shock wave therapy with ASTAR IMPACTIS M,
    • transverse massage of the scar,
    • functional sport massage,
    • flossing,
    • rolling,
    • stretching excercises of ischio-shin muscles,
    • medical training,
    • strengthening exercises of the muscles of the injured lower.

Treatment sessions, divided according to physiotherapy devices

High power laser therapy (POLARIS HPs) applied in the area of the scar (gastrocnemius muscle strain) and over the entire course of the gastrocnemius muscle.

Date Dose 808 nm / 980 nm [J/cm2] Output power 808 nm / 980 nm [W] Radiation mode 808 nm / 980 nm Frequency 808 nm/ 980 nm[Hz] Duty factor 808 nm/ 980 nm [%]: Treatment area 808 nm/ 980 nm [cm2]
13.09 30 / 30 6 / 6 Pulse/pulse 2500 / 2500 30 / 30 100
14.09 30 / 30 6 / 6 Pulse/pulse 2500 / 2500 30 / 30 100
15.09 30 / 30 6 / 6 Pulse/pulse 2500 / 2500 30 / 30 100
16.09 30 / 30 6 / 6 Pulse/pulse 2500 / 2500 30 / 30 100
17.09 30 / 30 6 / 6 Pulse/pulse 2500 / 2500 30 / 30 100
18.09 30 / 30 6 / 6 Pulse/pulse 2500 / 2500 30 / 30 100
19.09 30 / 30 6 / 6 Pulse/pulse 2500 / 2500 30 / 30 100
20.09 40 / 40 6,5 / 6,5 Pulse/pulse 2000 / 2000 45 / 45 100
21.09 40 / 40 6,5 / 6,5 Pulse/pulse 2000 / 2000 45 / 45 100
22.09 40 / 40 6,5 / 6,5 Pulse/pulse 2000 / 2000 45 / 45 100
23.09 40 / 40 6,5 / 6,5 Pulse/pulse 2000 / 2000 45 / 45 100
24.09 40 / 40 6,5 / 6,5 Pulse/pulse 2000 / 2000 45 / 45 100
25.09 40 / 40 6,5 / 6,5 Pulse/pulse 2000 / 2000 45 / 45 100
26.09 40 / 40 6,5 / 6,5 Pulse/pulse 2000 / 2000 45 / 45 100
27.09 50 / 50 7 / 7 Pulse/pulse 900 / 900 50 / 50 100
28.09 50 / 50 7 / 7 Pulse/pulse 900 / 900 50 / 50 100
29.09 50 / 50 7 / 7 Pulse/pulse 900 / 900 50 / 50 100
30.09 50 / 50 7 / 7 Pulse/pulse 900 / 900 50 / 50 100
01.10 50 / 50 7 / 7 Pulse/pulse 900 / 900 50 / 50 100
02.10 50 / 50 7 / 7 Pulse/pulse 900 / 900 50 / 50 100
03.10 50 / 50 7 / 7 Pulse/pulse 900 / 900 50 / 50 100
FIVE-DAY PAUSE
09.10 50 / 50 7 / 7 Pulse/pulse 700 / 700 60 / 60 100
10.10 50 / 50 7 / 7 Pulse/pulse 90 / 90 60 / 60 100
11.10 50 / 50 7 / 7 Pulse/pulse 700 / 700 60 / 60 100
12.10 50 / 50 7 / 7 Pulse/pulse 90 / 90 60 / 60 100
13.10 50 / 50 7 / 7 Pulse/pulse 700 / 700 60 / 60 100
14.10 50 / 50 7 / 7 Pulse/pulse 90 / 90 60 / 60 100
15.10 50 / 50 7 / 7 Pulse/pulse 700 / 700 60 / 60 100
16.10 50 / 50 7 / 7 Pulse/pulse 90 / 90 60 / 60 100

 

Polaris HPs - laseroterapia wysokoenergetyczna - uraz mięśnia brzuchatego łydki
High power laser therapy – gastrocnemius muscle injury

Shock wave therapy (IMPACTIS M) applied in the area of the scar on the muscle (gastrocnemius muscle strain) – medial head

Date Mode Frequency [Hz] Frequency [bar] Number of shocks
02.10 set frequency 18 3,0 4000
06.10 set frequency 15 3,2 4000
10.10 set frequency 12 3,4 4000
14.10 set frequency 12 3,6 4000

 

Zabieg - fala uderzeniowa (IMPACTIS M) zaaplikowana w okolicy blizny na mięśniu brzuchatym łydki, głowa przyśrodkowa
Shock wave treatment (IMPACTIS M) applied in the area of the scar on the muscle (gastrocnemius muscle strain) – medial head
Zabieg - fala uderzeniowa (IMPACTIS M) zaaplikowana w okolicy blizny na mięśniu gastrocnemius, głowa przyśrodkowa
Shock wave treatment (IMPACTIS M) applied in the area of the scar on the gastrocnemius muscle – medial head

Electrotherapy, Russian stimulation (ETIUS ULM)

Date Carrier/basic frequency[Hz] Duration of the treatment [min] Training parameters Remarks
26.09 2500/20 30 min Rise time 2 s,
Contraction phase 10 s,
Fall time 2 s,
Rest phase 50 s
Treatment twice a day
27.09 2500/20 30 min Rise time 2 s,
Contraction phase 10 s,
Fall time 2 s,
Rest phase 50 s
Treatment twice a day
28.09 2500/20 30 min Rise time 2 s,
Contraction phase 10 s,
Fall time 2 s,
Rest phase 50 s
Treatment twice a day
30.09 2500/20 40 min Rise time 2 s,
Contraction phase 10 s,
Fall time 2 s,
Rest phase 40 s
Treatment twice a day
01.10 2500/20 40 min Rise time 2 s,
Contraction phase 10 s,
Fall time 2 s,
Rest phase 40 s
Treatment twice a day
02.10 2500/20 40 min Rise time 2 s,
Contraction phase 10 s,
Fall time 2 s,
Rest phase 40 s
Treatment twice a day
03.10 2500/20 40 min Rise time 2 s,
Contraction phase 10 s,
Fall time 2 s,
Rest phase 30 s
Treatment twice a day
04.10 2500/20 60 min Rise time 2 s,
Contraction phase 10 s,
Fall time 2 s,
Rest phase 30 s
Treatment once a day
05.10 2500/20 60 min Rise time 2 s,
Contraction phase 10 s,
Fall time 2 s,
Rest phase 30 s
Treatment once a day
06.10 2500/20 60 min Rise time 3 s,
Contraction phase 15 s,
Fall time 3 s,
Rest phase 50 s
Treatment once a day
07.10 2500/20 60 min Rise time 3 s,
Contraction phase 15 s,
Fall time 3 s,
Rest phase 50 s
Treatment once a day
08.10 2500/20 60 min Rise time 3 s,
Contraction phase 15 s,
Fall time 3 s,
Rest phase 50 s
Treatment once a day
09.10 2500/20 60 min Rise time 3 s,
Contraction phase 15 s,
Fall time 3 s,
Rest phase 30 s
Treatment once a day
10.10 2500/20 60 min Rise time 3 s,
Contraction phase 15 s,
Fall time 3 s,
Rest phase 30 s
Treatment once a day

 

Zabieg elektroterapia - prądy Kotz'a
Electrotherapy treatment – Kotz stimulation

Follow-up USG examination consulted with an orthopedist

Four weeks after the injury a follow-up USG examination was performed. The image showed a visible hematoma with numerous inclusion bodies, dimensions 14 mm / 30 mm, further consolidation of the hematoma in the area of the injury (gastrocnemius muscle strain).

Follow-up USG examination

Six weeks after the injury the last follow-up USG examination was performed. The examination showed a normal image of the gastrocnemius muscle, with signs of full recovery. No effects of the injury – gastrocnemius muscle strain.

Conclusion

Intense rehabilitation of an injury (gastrocnemius muscle strain) and the player’s engagement in exercises shortened the treatment time from the expected 8 weeks to 6 weeks.
Thanks to the training adaptation carried out regularly during the process of rehabilitation, the the player quickly joined the sport training after the treatment was completed. Apart from the scar, the injury left no permanent damage such as decrease of the circumference of the gastrocnemius muscle, weakening of the muscle power, reduction of the mobility of the ankle joint.

The materials were facilitated by BBTS Bielsko-Biała, the volleyball club technically supported by ASTAR.

BBTS    By Radosław Krowiak, Physiotherapist

 

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