Initial Management (Acute Phase – typically 1-3 days post-injury):

The R.I.C.E. protocol is fundamental in the early stages:

Rest: Avoid activities that aggravate the pain. This may involve using crutches or a walking boot for more severe injuries.

Ice: Apply ice packs (wrapped in a thin cloth) to the injured area for 15-20 minutes every 2-3 hours to reduce pain and swelling.

Compression: Use a compression bandage to help minimize swelling and provide support. Ensure it’s not too tight to avoid restricting blood flow.

Elevation: Keep the injured leg elevated above the level of your heart as often as possible to reduce swelling.

During this phase, avoid activities that increase blood flow to the injured area, such as hot showers, heat rubs, massage (initially), and excessive weight-bearing.

Rehabilitation Phase (Progressive Loading and Strengthening): Once initial pain and swelling subside, the focus shifts to restoring mobility, strength, and function. A physiotherapist will guide you through a progressive exercise program.

Components of physiotherapy include:

• Gentle Stretching:
  • Calf stretch (straight knee): Stand facing a wall, place hands on the wall. Step one leg back, keeping the back leg straight and heel on the floor. Bend the front knee and lean forward until you feel a stretch in the back calf. Hold for 15-30 seconds, repeat.
  • Calf stretch (bent knee): Similar to the straight knee stretch, but keep both knees slightly bent to target the soleus muscle.
  • Seated calf stretch: Sit with legs extended, loop a towel around the ball of your foot and gently pull your toes towards you, feeling a stretch in the calf.
• Mobility Exercises:
  • Ankle plantarflexion and dorsiflexion: Gently point your toes down and then pull them up towards your body.
  • Ankle circles: Slowly rotate your ankle in circles, clockwise and counter-clockwise.
• Strengthening Exercises (Gradual Progression):
  • Double-leg heel raises: Stand with feet shoulder-width apart, holding onto a support. Slowly lift up onto your toes, then lower back down with control.
  • Single-leg heel raises: Once double-leg raises are comfortable, progress to standing on one leg and performing heel raises.
  • Heel raises on a step: Stand on the edge of a step, allowing your heels to drop below the step for a greater range of motion, then raise up onto your toes.
  • Bent-knee calf raises: Perform heel raises with slightly bent knees to target the soleus more effectively.
• Plyometric exercises (later stages): Skipping, hopping, and jumping activities are introduced gradually to build explosive strength and prepare for sport-specific movements.
• Balance and Proprioception Exercises:
  • Single-leg standing.
  • Balance board exercises.
• Soft Tissue Techniques:
  • Massage (once the acute phase passes and there is no risk of Deep Vein Thrombosis ) to reduce muscle tension and scar tissue formation.

Other modalities like ultrasound or electrotherapy may be used in some cases to aid healing and pain reduction, though their effectiveness varies.