Quick summary: A muscle tear (also called muscle strain or "tennis leg" when affecting the calf) is classified into three grades based on severity. Grade I: 1-2 weeks recovery. Grade II: 3-4 weeks. Grade III: 6-8 weeks or more. The POLICE protocol (not the outdated RICE) is the recommended initial treatment. 30% of muscle tears recur without proper rehabilitation.
What is a muscle tear
A muscle tear, also known as a muscle strain or pulled muscle, is an injury that occurs when muscle fibres partially or completely rupture. It is one of the most common injuries in sports, accounting for between 10% and 55% of all muscle injuries depending on the discipline.
When affecting the calf muscle, it is often called "tennis leg" due to its frequent occurrence in tennis players. The athlete typically describes a sudden, sharp pain at the moment of injury, as if something struck the back of their leg.
Muscle tears usually occur through two mechanisms:
- Sudden contraction: The muscle contracts forcefully and suddenly, exceeding its resistance capacity. This is typical in sprints, jumps, or kicking movements.
- Excessive elongation: The muscle stretches beyond its limit while contracted. This happens during direction changes or sudden stops.
Factors such as muscle fatigue, insufficient warm-up, strength imbalances, or dehydration increase the risk of this injury.
Classification by grades
The classification of muscle tears into grades helps establish the prognosis and appropriate treatment. It is based on the percentage of affected muscle fibres and clinical findings.
| Grade | Fibres affected | Recovery time | Characteristics | |-------|-----------------|---------------|-----------------| | Grade I (Mild) | Less than 5% | 1-2 weeks | Mild pain, no visible bruising, function preserved | | Grade II (Moderate) | Between 5% and 50% | 3-4 weeks | Moderate pain, bruising present, functional limitation | | Grade III (Severe) | More than 50% or complete rupture | 6-8 weeks or more | Intense pain, extensive bruising, functional impairment |
Grade I (Mild)
In grade I, there is elongation or micro-tearing of a small number of fibres. The athlete feels discomfort or mild pain that usually appears at the end of activity or afterwards. Palpation may reveal a tender point, but there is no bruising or palpable defect in the muscle. Function is practically preserved.
Grade II (Moderate)
Grade II involves a partial tear of the muscle, affecting between 5% and 50% of the fibres. The pain is more intense and appears during activity, forcing the athlete to stop. Bruising may be observed at 24-48 hours, and there is clear functional limitation. Palpation may reveal a small defect or "notch" in the muscle tissue.
Grade III (Severe)
A grade III tear is a serious injury that can result in complete muscle rupture. The pain is very intense and sudden, with immediate functional impairment. The bruising is extensive, and a palpable defect may appear in the muscle. In some cases, surgical evaluation may be required.
When to see a doctor: If you experience very intense pain, visible deformity in the muscle, rapidly growing bruising, or total loss of function, go to the emergency room to rule out complete rupture or other complications.
Most common locations
Muscle tears can occur in any muscle, but certain areas are particularly vulnerable due to their function in sports activity.
Calf (gastrocnemius)
The calf is the most common location for muscle tears, especially in middle-aged athletes. This is the classic "tennis leg" injury. It typically occurs when jumping, accelerating, or changing direction. Pain appears in the back of the lower leg, below the knee.
Hamstrings (back of the thigh)
Hamstring tears are very common in sports involving sprints, such as football, athletics, or rugby. They are located at the back of the thigh and usually occur during the acceleration phase or when kicking. Recovery can be prolonged due to the difficulty of complete rest.
Quadriceps (front of the thigh)
Quadriceps tears are common in kicking sports (football) and jumping activities. They usually occur in the distal part of the muscle, near the knee. The rectus femoris (central portion) is most commonly affected.
Adductors (inner thigh)
The adductors are frequently injured in sports with direction changes and lateral movements. When the injury is close to the pubis, it may be confused with or coexist with athletic pubalgia.
Symptoms of muscle tear
Symptoms vary according to the grade of injury, but there are common signs that suggest a muscle tear:
- Sudden sharp pain at the moment of injury, described as "a blow" or "being struck"
- Functional impairment immediate or progressive, with difficulty using the affected muscle
- Visible bruising appearing at 24-72 hours (in grades II and III)
- Swelling of the injured area
- Popping sensation at the moment of tearing (not always present)
- Pain on palpation at a specific point in the muscle
- Pain when stretching or contracting the affected muscle
Difference between muscle tear and muscle cramp
It is important to distinguish a muscle tear from a muscle cramp or spasm, as treatment differs:
| Characteristic | Muscle tear | Muscle cramp | |----------------|-------------|--------------| | Pain onset | Sudden, exact moment | Progressive, diffuse | | Intensity | Moderate to very intense | Mild to moderate | | Bruising | Present (grades II-III) | Absent | | Tender point | Localised | Diffuse, tight band | | Functional impairment | Yes (depending on grade) | Mild or absent |
Urgent: Go to the emergency room if there is visible deformity in the muscle, total loss of function, rapidly growing bruising, or pain that does not subside with rest.
First 48 hours: POLICE protocol
The initial management of muscle tears has evolved. The classic RICE protocol (Rest, Ice, Compression, Elevation) has been replaced by the POLICE protocol, which incorporates the concept of "optimal loading" instead of complete rest.
Why POLICE and not RICE: Current evidence indicates that prolonged complete rest is detrimental to muscle recovery. Controlled movement and progressive loading stimulate healing and prevent atrophy.
P - Protection
Protect the injured area by avoiding activities that reproduce pain. This does not mean total immobilisation, but avoiding actions that overload the damaged muscle.
OL - Optimal Loading
Introduce movement and load gradually and in a controlled manner. Gentle movements within the pain-free range help to:
- Maintain joint mobility
- Stimulate circulation
- Promote organisation of scar tissue
- Prevent strength loss
I - Ice
Applying cold in the first 8-12 hours can help reduce pain and limit initial inflammation. Recommendations:
- Applications of 10-15 minutes
- With protection (towel between ice and skin)
- Do not apply directly to skin
- Do not use continuously beyond the first 24-48 hours
C - Compression
A gentle elastic bandage helps limit swelling and provides support to the area. It should not be too tight. It can be maintained during the first few days.
E - Elevation
Keeping the area elevated when possible promotes venous return and reduces fluid accumulation.
What NOT to do in the first 48 hours:
- Do not apply heat (increases inflammation and bleeding)
- Do not massage the injured area directly
- Do not force stretching or movement
- Do not take anti-inflammatories without medical prescription (may interfere with initial healing)
Physiotherapy treatment
Physiotherapy treatment is essential for complete recovery and to prevent recurrence. It is structured in progressive phases according to the evolution of the injury.
Phase 1: Acute (0-72 hours)
The goal is to control inflammation and pain, protecting the injury while healing begins.
- Controlled cryotherapy: Cold applications following the POLICE protocol
- Compression and elevation: Functional or compressive bandaging as needed
- Gentle passive mobilisation: Assisted movements in pain-free range
- Electrotherapy: TENS for pain control, pulsed ultrasound
Phase 2: Subacute (3-14 days)
The goal is to promote healing, recover mobility, and begin low-intensity muscle work.
- Massage therapy in adjacent areas: Gentle massage of surrounding muscles, avoiding the direct injury zone in the early days
- Isometric exercises: Muscle contractions without joint movement, progressing in intensity
- Gentle stretching: Progressive elongations without causing pain
- Advanced electrotherapy: Ultrasound, electrical stimulation, laser as appropriate
- Manual therapy techniques: Joint mobilisations, myofascial techniques
Phase 3: Remodelling (2-6 weeks)
The goal is to recover strength, complete flexibility, and prepare the muscle for activity.
- Progressive eccentric work: Exercises that work the muscle while it lengthens. These are fundamental for proper organisation of scar tissue
- Concentric strengthening: Conventional strength exercises
- Active stretching: Elongations with greater amplitude and intensity
- Proprioception and balance: Postural control and stability exercises
Phase 4: Return to sport (variable)
The goal is a safe return to sporting activity with minimum risk of recurrence.
- Specific functional exercises: Movements that mimic the sporting gesture
- Progressive running: Starting with gentle jogging and increasing speed and intensity
- Plyometric training: Jumps and direction changes (final phase)
- Gradual return to sport: First adapted training, then full sessions
Note: This article does not include medication recommendations. Pharmaceutical prescription is the responsibility of the doctor.
Rehabilitation exercises for calf tears
The following exercises are aimed at rehabilitation of calf muscle tears, the most common location. Before performing them, consult your physiotherapist to confirm they are appropriate for your recovery phase.
1. Calf stretch against the wall
- Place your hands on a wall at shoulder height
- Position the injured leg extended behind you, with the heel on the ground
- The front leg is bent
- Lean towards the wall until you feel tension (not pain) in the calf
- Hold for 20-30 seconds, repeat 3 times
- Perform 3 times daily
2. Heel raises (progression)
Initial phase: With hand support using both legs
- Standing, support yourself on a wall or chair
- Raise your heels off the ground, going onto tiptoes
- Lower in a controlled manner
- 10-15 repetitions, 3 sets
Intermediate phase: With support, using only the injured leg
- Same technique, but raising only with one leg
- The other leg remains in the air
Advanced phase: Without support, using only the injured leg
3. Eccentric exercise on a step
This exercise is key for proper tissue remodelling.
- Stand on the edge of a step, with heels off the step
- Rise onto tiptoes using both legs
- Transfer weight to the injured leg
- Lower the heel slowly and in a controlled manner (3-4 seconds)
- 10 repetitions, 3 sets
4. Single-leg balance
- Stand on the injured leg
- Maintain balance for 30 seconds
- Progression: with eyes closed, on an unstable surface
- 3-5 repetitions
5. Progressive running
Only when previous exercises can be performed without pain:
- Fast walking (5-10 minutes)
- Gentle jogging in a straight line
- Running at moderate pace
- Progressive sprints (final phase)
Warning: These exercises are for guidance only. The progression, intensity, and timing should be supervised by a physiotherapist according to your specific case. If you experience pain during any exercise, stop and consult your professional.
Recovery times
Recovery time depends on the grade of injury, the affected area, and other individual factors.
| Grade | Average time | Return to sport | |-------|--------------|-----------------| | Grade I | 1-2 weeks | 2-3 weeks | | Grade II | 3-4 weeks | 4-6 weeks | | Grade III | 6-8+ weeks | 8-12+ weeks |
Factors influencing recovery
- Age: Younger athletes tend to recover faster
- Affected area: Some locations (hamstrings) have slower recovery
- Treatment received: Appropriate physiotherapy accelerates recovery times
- Adherence to rehabilitation: Following guidelines is fundamental
- History of previous injuries: Recurrences may take longer
Why not to rush the return
30% of muscle tears recur when rehabilitation is not properly completed. Returning too early dramatically increases the risk of:
- New tear in the same area
- More severe injury than the initial one
- Chronic problems
- Compensations leading to other injuries
Prevention of recurrence
Once recovered, it is essential to maintain habits that prevent new injuries:
- Proper warm-up: Dedicate at least 10-15 minutes before training. Include joint mobility, progressive muscle activation, and dynamic exercises
- Regular stretching: Work on flexibility regularly, not just after exercise
- Preventive eccentric strengthening: Maintain an eccentric exercise programme, especially if you have had previous injuries
- Gradual load progression: Do not increase volume or intensity abruptly. The 10% rule is a good reference
- Adequate hydration: Dehydration increases the risk of muscle injury
- Rest and recovery: Respect recovery times between intense sessions
Frequently asked questions
How long does a muscle tear take to heal?
Healing time depends on the grade of injury. Grade I (mild) tears recover in 1-2 weeks. Grade II (moderate) need 3-4 weeks. Grade III (severe) may require 6-8 weeks or more. Return to sport usually adds 1-2 additional weeks of progressive readaptation.
How to know if it is a muscle tear or cramp?
The main difference is in the onset of pain. A muscle tear produces sudden, intense, and localised pain, with an exact moment of onset ("I felt a sharp pain"). A cramp generates progressive, more diffuse pain, without a specific moment of onset. Additionally, a tear may present bruising and functional impairment, while a cramp usually does not.
Can you walk with a muscle tear?
It depends on the grade. With a grade I tear, you can generally walk with mild discomfort. In grade II, walking may be painful, and it is recommended to limit walking in the first few days. In grade III, functional impairment usually prevents normal walking, and crutches may be needed. In all cases, it is recommended to avoid activities that reproduce pain.
Does a muscle tear heal on its own?
The muscle has the capacity to heal, but "healing on its own" does not mean recovering correctly. Without physiotherapy treatment, scar tissue may form in a disorganised manner, leaving the muscle weaker and stiffer. The result: higher risk of recurrence (up to 30%) and possible loss of performance. Guided rehabilitation is essential.
When can I start running again?
You can start running when you meet these criteria: walking without pain, performing strengthening exercises without discomfort, having full mobility, and having completed the rehabilitation phases. The return should be progressive: first gentle jogging, then running at moderate pace, and finally speed and intensity. Your physiotherapist will tell you when you are ready.
Can the injury recur?
Yes, the risk of recurrence is significant. Statistics indicate that approximately 30% of muscle tears recur, especially when rehabilitation is not completed or when returning too early. To minimise the risk, it is essential to complete all phases of treatment, maintain a preventive strengthening programme, and respect recovery times.
This article is for informational purposes and does not replace consultation with a healthcare professional. If you experience persistent pain or serious symptoms, consult your doctor or physiotherapist for a personalised diagnosis and treatment.
Article reviewed by Gemma Pastor Vila, Certified Physiotherapist No. 15434 at the Col·legi de Fisioterapeutes de Catalunya.
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