It is important to note that a qualifies opinion should be sought if these symptoms persist. Although less common, the tendon within the muscle or the Achilles tendon at the end of the muscle near the heel, can be damaged. This needs to be assessed and may require medical intervention. It should also be remembered that children and adolescents are less likely to have muscle tears and more likely to have a bone growth plate problem at the heel and also need assessment.

Factors that lead to calf tears may include age (older athletes are more at risk), lack of calf strength or endurance, and lack of sports-specific training (ie, starting to play touch football without any speed or agility training). One of the key risk factors is previous injury. As recurrence is a likely outcome, it is essential that subjects are given an appropriate strength and conditioning program to facilitate return to activity and minimise the chance of re-injury.

If you have pain in the back of the leg following a specific incident you are likely to have a calf tear. The likelihood is stronger if it is difficult to push off during walking or running. A professional, such as a physiotherapist, will carry out several more tests to confirm the diagnosis. Your physiotherapist will put the muscle on stretch to find which muscle is affected and how tight the muscle is. You may have already noticed that it is hard to stretch the calf. Your physiotherapist will ask you to ‘contract’ the muscle using several tests that assess your strength and determine which muscle is damaged. Again, you may have noticed pain with tasks that require you to rise up on to your toes or hop. Finally, your physiotherapist will feel the muscle to locate a sore spot and confirm the diagnosis.

Initially, your physiotherapist will give you a clear diagnosis regarding which muscle is torn and how badly. They will then give you an indication of how long it will take to return to sport or your chosen activity. A plan should then outline the following:

Initial management—this normally includes RICE

• Rest—do nothing that hurts your calf.
• Ice—20 minutes every two hours, during waking hours, for the first two days.
• Compression—use a compressive sleeve or bandage from the ankle up to the knee when not icing.
• Elevation—put the leg above the level of the heart where practical.

Although the muscle is already torn, the first four days are an important time to prevent further damage and compromised healing.

Strengthening—a progressive program of exercises to regain the strength of the calf.

Running—a graduated program to build speed, agility, sport-specific skills and then return to training and finally sport.

Return to sport or physical activity guidelines and expectations

Physiotherapy can be very effective for the management of calf tears. Your physiotherapist will have seen many patients with this presentation and can put your mind to rest regarding diagnosis and planning. Your physiotherapist is best placed to know the evidence supporting the initial management of calf tears and the type of exercise prescription that is relevant to allow functional recovery and the prevention of recurrence.

The most important thing you can do as a patient after injury is protect the region from further injury until you seek a professional opinion. Avoid alcohol and anti-inflammatory medication, as local bleeding is increased and healing is slowed. Simple pain medication is adequate if required. It is also important not to stretch in the first 10 days.

Begin the RICE regime

• Rest—do nothing that hurts your calf.
• Ice—20 minutes every two hours, during waking hours, for the first two days.
• Compression—use a compressive sleeve or bandage from the ankle up to the knee when not icing.
• Elevation—put the leg above the level of the heart where practical.

Traditionally, a calf tear will take 2–6 weeks to get better, although variations occur. Initial rest and appropriate treatment is followed by a graduated strength and running program. If the patient is competing in sport, they should train for a period of time, usually a week, before returning to competition.