Provider Name & Treatment Location: Winback Clinical Case Study Series (provider and treatment location not specified in source documentation)
Key Words: Grade II calf muscle tear; gastrocnemius-soleus complex; ankle dorsiflexion; TECAR therapy; dry needling; progressive loading; gait retraining
Summary (Abstract)
This case study describes the rehabilitation of a 62-year-old recreational pickleball player presenting with an MRI-confirmed grade II left calf muscle tear. The patient demonstrated severe pain, impaired gait, significant ankle-foot hypomobility, reduced strength, decreased ankle dorsiflexion, and fear-avoidance behaviors affecting functional mobility and activities of daily living.
A comprehensive rehabilitation program was implemented including manual therapy, joint mobilization, dry needling, gait retraining, therapeutic exercise, progressive calf loading, and Winback TECAR therapy. TECAR therapy was integrated throughout multiple phases of rehabilitation to reduce pain, improve circulation, facilitate restoration of ankle dorsiflexion, decrease soft tissue guarding, improve tolerance to manual therapy, and assist with early calf muscle reactivation and loading progression.
The patient demonstrated improved tolerance to weight-bearing, improved mobility, reduced pain, and progression toward functional recovery. What is unique about this case is the use of TECAR therapy across multiple distinct rehabilitation goals — tissue healing, dorsiflexion restoration, and early neuromuscular reactivation — within a single episode of care.
Key take-away lessons:
- TECAR therapy was used adjunctively across multiple rehabilitation phases — pain modulation, dorsiflexion restoration, and early calf reactivation — rather than as a single fixed application.
- Addressing global ankle-foot hypomobility (not just the calf tear itself) was central to reducing strain on the healing musculature during gait.
- Lower-intensity TECAR settings were intentionally selected during the subacute healing stage to balance tissue stimulation with irritability.
- TECAR combined with manual therapy improved tolerance to dorsiflexion-focused mobilization and progressive loading activities.
Introduction
Calf muscle injuries are common in sports involving explosive acceleration, multidirectional movement, and rapid changes in direction. Recreational pickleball participation among older adults has increased significantly, contributing to a higher incidence of lower extremity soft tissue injuries involving the gastrocnemius-soleus complex.
Grade II calf muscle tears typically involve partial disruption of muscle fibers and are often associated with pain during loading, impaired gait, reduced ankle mobility, muscular weakness, protective guarding, and difficulty returning to sport and functional activities. Early rehabilitation requires a balance between tissue protection and progressive restoration of movement, circulation, muscular activation, and loading tolerance.
This case study presents the clinical management of a grade II calf muscle tear utilizing an integrated physical therapy approach with emphasis on the use of TECAR therapy as an adjunctive intervention throughout multiple stages of rehabilitation.
Patient Information / Diagnosis
Demographics: 62-year-old male; recreational pickleball player.
Diagnosis: MRI-confirmed grade II left calf muscle tear.
Time Since Injury: Approximately 2 weeks at initial evaluation.
Mechanism of Injury: Injury occurred during pickleball participation when the patient rapidly reached laterally to the left attempting to return a shot, experiencing sudden sharp pain in the left calf followed by immediate difficulty weight-bearing. Initial self-management included rest, ice, and reduced activity; symptoms progressively worsened, prompting medical evaluation and MRI confirming a grade II calf muscle tear.
Relevant Medical/Family History: Not specified in source documentation.
Past Interventions and Outcomes: Self-managed with rest, ice, and reduced activity prior to evaluation, with progressive worsening of symptoms.
Clinical Findings
Subjective
| Location | Pain Description | Pain Severity | Aggravating Factors | Alleviating Factors | Symptom Frequency |
| Left posterior calf region | Sharp; stabbing | Worst: 8/10; Current: 6/10; Average: 6/10 | Walking; weight-bearing activity | Rest; ice; lying down | Constant |
Functional limitations: difficulty with walking, transfers, standing, sleeping, exercise, work-related activities, and recreational sports participation. The patient additionally demonstrated fear of movement, anxiety regarding re-injury, reduced confidence during ambulation, and frustration related to functional limitations.
Objective
Gait assessment: significant antalgic gait, minimal weight-bearing through the left lower extremity, reduced push-off, shortened stance phase, and dependence on bilateral crutches for ambulation.
Ankle active range of motion:
| Motion | Right | Left |
| Dorsiflexion | 25° | 2° |
| Plantarflexion | 45° | 5° |
| Inversion | 15° | 2° |
| Eversion | 25° | 5° |
All left ankle motions reproduced pain. A substantial restriction in dorsiflexion was considered a major contributor to altered gait mechanics and impaired loading capacity.
Left lower extremity strength:
| Motion | Strength |
| Dorsiflexion | 2/5 |
| Plantarflexion | 2/5 |
| Inversion | 2+/5 |
| Eversion | 2+/5 |
Joint mobility findings: significant hypomobility was identified throughout the left ankle and foot complex, including the talocrural joint, subtalar joint, distal tibiofibular joint, talonavicular joint, calcaneocuboid joint, and talocalcaneonavicular complex. These restrictions were believed to contribute to impaired tibial progression, altered force distribution, restricted dorsiflexion, persistent guarding, and increased stress through the healing calf musculature.
Detailed Treatment, Timeline, and Outcome
1. Timeline
The patient presented approximately 2 weeks post-injury (subacute stage) and progressed through initial pain/guarding management, ankle-foot mobility restoration, and early calf retraining and progressive loading phases, as detailed under Therapeutic Intervention below.
2. Diagnostic Assessment
Diagnostic methods: clinical examination including gait assessment, ankle active range of motion, lower extremity strength testing, and joint mobility assessment of the ankle-foot complex; MRI imaging (externally obtained) confirmed the grade II calf muscle tear.
Diagnosis: subacute grade II calf muscle tear (gastrocnemius-soleus complex) associated with severe ankle-foot hypomobility, reduced ankle dorsiflexion, impaired gait mechanics, muscular weakness, pain-related guarding, and fear-avoidance behaviors.
Prognostic characteristics: rehabilitation potential was considered good due to prior independent function, strong motivation, and good family support.
Therapeutic Intervention
1. Type of Intervention
Treatment interventions included manual therapy, dry needling, TECAR therapy, gait training, therapeutic exercise, and patient education, emphasizing pain reduction, restoration of ankle mobility, improvement of dorsiflexion, gradual calf loading, normalization of gait mechanics, and return to functional activity.
2. Protocol Steps
- Dry needling performed to address compensatory muscular overactivity and improve lower extremity mechanics.
- Joint mobilization: grade I-II posterior-anterior talocrural mobilizations, anterior-posterior subtalar mobilizations, transverse subtalar mobilizations, and distal tibiofibular mobilizations — to improve ankle-foot mobility, facilitate dorsiflexion, restore joint mechanics, improve gait efficiency, and reduce compensatory loading through the injured calf.
- TECAR therapy was utilized both prior to manual therapy and during the initial phases of movement retraining and calf activation, given the patient’s severe movement restriction and fear of weight-bearing.
- TECAR for dorsiflexion restriction: utilized in conjunction with joint mobilization techniques to facilitate soft tissue relaxation, reduction of muscular guarding, improved tissue compliance, and enhanced tolerance to ankle mobilization — aiming to improve talocrural mechanics, ankle mobility, gait mechanics, and lower extremity loading capacity.
- TECAR during early calf retraining: incorporated during the initial phases of calf muscle retraining and progressive loading to facilitate neuromuscular activation, improve patient confidence during loading, reduce pain inhibition, improve movement quality, and support transition toward active rehabilitation.
TECAR Parameters
| Setting | Duration | Intensity | Purpose |
| CET / Deep CET | 10 minutes | 40% | Improve circulation, decrease guarding, improve tissue extensibility, and prepare tissues for mobility restoration and movement retraining. |
| RET + Low Beat | 5 minutes | 10% | Target deeper musculotendinous structures, improve neuromuscular relaxation, and provide analgesic input without excessive tissue stress. Lower intensities intentionally selected due to the subacute healing stage and tissue irritability. |
| RET + SuperPulse | Final 5 minutes of a 20-minute session | 40% | Target deeper musculotendinous structures, residual calf stiffness, ankle mobility restrictions, and neuromuscular activation deficits — selected to provide deeper tissue stimulation while maintaining comfort during the subacute healing phase. Also integrated during early calf activation and loading progression to improve tolerance to movement and facilitate muscular engagement. |
3. Changes in Therapeutic Intervention
TECAR application progressed from primarily pain/guarding-focused settings (CET, RET + Low Beat at lower intensities) toward incorporation of RET SuperPulse during early calf activation and loading progression, paralleling the patient’s progression from protective movement patterns toward active rehabilitation.
Treatment Protocol and Follow-Ups
Session Frequency / Techniques: Not specified in source documentation beyond the phased TECAR/manual therapy protocol described above.
Clinician- and patient-assessed outcomes: Gait assessment, ankle active range of motion, lower extremity strength, joint mobility, and patient-reported tolerance to weight-bearing and movement.
Important follow-up diagnostic and other test results: Not specified beyond clinical response described below.
Intervention adherence and tolerability: Assessed via clinical observation of tolerance to manual therapy, TECAR, and progressive loading activities.
Adverse and unanticipated events: None reported.
Results after Treatment Completed
Following treatment interventions, the patient demonstrated improved tolerance to weight-bearing, reduction in perceived calf tightness, improved gait confidence, increased tolerance to ankle mobility exercises, and improved comfort during movement retraining activities. The combination of TECAR therapy and manual therapy appeared to improve tolerance to dorsiflexion-focused interventions and progressive loading activities.
Discussion
This case highlights the importance of addressing both the injured musculotendinous tissue and the associated ankle-foot mechanical restrictions commonly observed following calf muscle injuries. A major contributing factor to dysfunction in this case involved severe restriction in ankle dorsiflexion and global foot-ankle hypomobility, which likely increased strain through the healing calf musculature during gait.
The integration of TECAR therapy throughout multiple rehabilitation phases appeared clinically valuable for reducing guarding, improving mobility, facilitating manual therapy, supporting calf activation, and improving tolerance to progressive loading. Rather than functioning solely as a passive modality, TECAR therapy was integrated into a movement-based rehabilitation model emphasizing mobility restoration, neuromuscular retraining, progressive loading, and return to function.
Limitations include the absence of standardized outcome measures (e.g., repeat ROM/strength testing at discharge) and the single-patient design, which prevents isolation of TECAR’s independent contribution from the broader manual therapy and exercise program. Take-away: a comprehensive rehabilitation approach including manual therapy, joint mobilization, dry needling, gait retraining, therapeutic exercise, progressive calf loading, and Winback TECAR therapy contributed to improved ankle mobility, restoration of dorsiflexion, improved weight-bearing tolerance, reduction in pain and guarding, and progression toward functional recovery and return to activity.
Patient Perspective
Not provided in the source documentation for this case.
Informed Consent
Not specified in source documentation. Patient consent for use of de-identified clinical data in this case report should be obtained and documentation made available on request.