Is that a calf strain I see?

A client I recently saw tripped in the street, hurting his calf, and came to see me at Kensington Physio & Sports Medicine the same day for assessment and treatment.  When I first saw the client at KenPhysio in the Kensington Clinic he required walking sticks to help him walk. Following a full assessment, I concluded he had Grade 2 strain of his gastrocnemius (calf muscle). I followed the PRICE principles which are: Protected the area by taping it, applied a heel raise to each shoe, advised him to Rest from aggravating activities, Iced and provided Compression using a Game Ready and he Elevated the leg (ACPSEM PRICE Guidelines 2011).

When I saw the client six days later at the BodyWorks West clinic there had been no improvement. On examination, the calf had a “solid” feeling, the size was in line with the other calf and pain was restricted to the site of the tear. This was not in line with my expectations of the healing of a Grade 2 calf strain as a full return to activity is expected between 16 and 21 days after the initial injury(Brukner and Khan 2007). The client was on a number of medications which could mask other signs and symptoms. I sent the client for further investigations at St Mary’s Hospital in London with suspicion of a deep vein thrombosis (DVT). DVT can be caused by compression of the veins in the calf through swelling, whether it be fluid (oedema) or blood (haematoma)(Alessandrino and Balconi 2013). It is only occasionally seen following calf injuries and measures had been taken to reduce this through the PRICE principles (Brukner and Khan 2007). As I suspected, a DVT was confirmed on ultrasound and the client started on anticoagulant treatment. He saw Dr Miller at Notting Hill Medical centre the next day for referral for a further ultrasound of the calf for the initial strain was arranged.  The client was managed in a timely and thorough fashion according to medical guidelines.

A good outcome although unfortunately it meant the client missing a trip to Turkey but it highlights to us all how potentially fatal a simple trip can be.


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