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tamara asked...

My right knee clicked then my knee locked...

I was playing football and I turned to kick the ball really fast me my right knee clicked then knee locked, it was so painful then I limped of pitch. It has happened again what should I do?

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The answer

It certainly appears that you could have stretched or torn some of the muscle fibers in your calf from your description. The ‘snap’ or twinge’ that you are describing can certainly be a feature of Grade 1 or Grade 2 muscle strains, where some of the muscle fibers have torn.

Symptoms:

The symptoms of stretched or torn/ruptured calf muscle fibers can include the following depending upon the grade of strain.

  • A ‘pop’, ‘snap’ or ‘twinge’ at the time of the injury and this may have been heard
  • Spasm in the calf
  • Tightness, weakness or throbbing pains in the affected area
  • Pain and weakness in the leg when moving
  • Bruising
  • Unable to run or jump on the injured leg

Causes:

The causes of calf strain are typically due to sports that require sudden changes in the direction of play when undertaking the sport or when performing jumping activities related to the sport. The muscle fibers can become overstretched and muscle fibers can actually rupture or tear. Muscle strains are graded on a scale of 1-3, a Grade 3 tear is the most severe. The grading of the calf strain is dependent upon some of the following factors: symptoms present, recovery period, how many of the muscle fibers have ruptured with the grade of the strain. A Grade 3 strain has nearly 100% of the muscle fibers ruptured or torn within the calf muscle.

Grading of Strains:

Grade 1:

During the sports activity a ‘snap’ or ‘twinge’ may be heard or felt at the site of the injury. Often sports people can continue in their sporting activity and discomfort increases following the injury. In a Grade 1 calf strain, there will be tightness or aching in the calf muscles generally 24hrs after completion of the sport. This type of strain will take 2-4 weeks recovery and rarely needs a healthcare professionals input in its management. You would generally see a healthcare professional when you have tried the home management of the strain and there is no improvement in the symptoms, for example walking is difficult or when there is worsening of the symptoms ,which usually means more pain and swelling is being experienced in the calf. In this type of strain, most of the muscle fibers are overstretched rather than torn.

Grade 2:

A Grade 2 strain has significant pain at the time of the injury; it will result in difficulty walking and you may have bruising in the following days after the injury. A ‘snap’ may be heard or a ‘twinge’ may be felt. A Grade 2 strain may take 4-8 weeks to heal. In this type of strain there are a greater number of muscle fibers torn rather than overstretched.

Grade 3:

This is the most severe type of strain and it is where most of the muscle fibers have actually ruptured or are torn about 100%). It is unlikely that a sportsperson will be able to carry on playing their sport with a Grade 3 tear. With a Grade 3 tear it is likely that the sportsperson will hear a ‘pop’ rather than a snap or feel a ‘twinge’ in the calf. With a Grade 3 tear it is very difficult to use the leg following the injury. This type of injury needs an input from your general practitioner and physiotherapist to help you recover from the injury. The recovery period can be greater than 3 months in some cases for this grade of strain.

Suggested Management:

We would suggest that you contact your general practitioner or physiotherapist to confirm the diagnosis and the grade of the strain that you have. This assessment would be to confirm the management of your injury and strive to get you back to playing tennis as soon as is possible. Typically the management of strains includes the following:

  • protection, rest, ice, compression elevation of the strain (home management)
  • when to resume sports activities, obtain a massage, or use heat packs
  • when to use simple analgesia such as paracetamol (recommended for strains) or when to use additional analgesia such as codeine for the strain
  • assessing when to have a physiotherapy consult
  • when to start non-steroidal anti-inflammatory medication for the strain
  • when to use a cast, brace or splint to immobilise the injury
  • when would surgery for a Grade 3 strain be considered.

We hope that this information has helped.

Answered by the Health at Hand nurses