Which factors are predictive of return to play and re-injury following calf muscle strain injury?

ObjectivesTo determine the rates of muscle strain injury recurrence over time after return to play in Australian football and to quantify risk factors.MethodsWe analysed Australian Football League player data from 1992 to 2014 for rates of the four major muscle strain injury types (hamstring, quadriceps, calf and groin) diagnosed by team health professionals. Covariates for analysis were: recent history (≤8 weeks) of each of the four muscle strains; non-recent history (>8 weeks) of each; history of hip, knee anterior cruciate ligament, knee cartilage, ankle sprain, concussion or lumbar injury; age; indigenous race; match level and whether a substitute rule was in place.Results3647 (1932 hamstring, 418 quadriceps, 458 calf and 839 groin) muscle strain injuries occurred in 272 759 player matches. For all muscle strains combined, the risk of injury recurrence gradually reduced, with recurrence risks of 9% (hamstring), 5% (quadriceps), 2% (calf) and 6% (groin) in the first match back and remaining elevated for 15 weeks after return to play. The strongest risk factor for each muscle injury type was a recent history of the same injury (hamstring: adjusted OR 13.1, 95% CI 11.5 to 14.9; calf OR 13.3, 95% CI 9.6 to 18.4; quadriceps: OR 25.2, 95% CI 18.8 to 33.8; groin OR 20.6, 95% CI 17.0 to 25.0), followed by non-recent history of the same injury (hamstring: adjusted OR 3.5, 95% CI 3.2 to 3.9; calf OR 4.4, 95% CI 3.6 to 5.4; quadriceps OR 5.2, 95% CI 4.2 to 6.4; groin OR 3.5, 95% CI 3.0 to 4.0). Age was an independent risk factor for calf muscle strains (adjusted OR 1.6, 95% CI 1.3 to 2.0). Recent hamstring injury increased the risk of subsequent quadriceps (adjusted OR 1.8, 95% CI 1.2 to 2.7) and calf strains (OR 1.8, 95% CI 1.2 to 2.6). During the ‘substitute rule’ era (2011–2014), hamstring (adjusted OR 0.76, 95% CI 0.67 to 0.86), groin (OR 0.78, 95% CI 0.65 to 0.93) and quadriceps (OR 0.70, 95% CI 0.53 to 0.92) strains were less likely than outside of that era but calf (OR 1.6, 95% CI 1.3 to 1.9) strains were more likely than before the substitute rule era.ConclusionRecent injury is the greatest risk factor for the four major muscle strains, with increased risk persisting for 15 weeks after return to play.

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035 Can we predict recovery and re-injury following calf muscle strain injury?

10.1136/bjsports-2021-ioc.33 ◽

2021 ◽

Author(s):

Brady Green ◽

Monica Lin ◽

Anthony Schache ◽

Jodie McClelland ◽

Adam Semciw ◽

...

Keyword(s):

Calf Muscle ◽

Muscle Strain ◽

Muscle Strain Injury

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Return to Play and Recurrence After Calf Muscle Strain Injuries in Elite Australian Football Players

The American Journal of Sports Medicine ◽

10.1177/0363546520959327 ◽

2020 ◽

Vol 48 (13) ◽

pp. 3306-3315

Author(s):

Brady Green ◽

Monica Lin ◽

Jodie A. McClelland ◽

Adam I. Semciw ◽

Anthony G. Schache ◽

...

Keyword(s):

Clinical Data ◽

Older Age ◽

Calf Muscle ◽

Return To Play ◽

Mechanism Of Injury ◽

Muscle Strain ◽

Mri Findings ◽

Risk Of Recurrence ◽

Australian Football ◽

History Of

Background: Calf muscle strain injuries (CMSI) are prevalent in sport, but information about factors associated with time to return to play (RTP) and recurrence is limited. Purpose: To determine whether clinical and magnetic resonance imaging (MRI) data are associated with RTP and recurrence after CMSI. Study Design: Case-control study; Level of evidence, 3. Methods: Data of 149 CMSI reported to the Soft Tissue injury Registry of the Australian Football League were explored to evaluate the impact of clinical data and index injury MRI findings on RTP and recurrence. Clinical data included age, previous injury history, ethnicity, and the mechanism of injury. Results: Irrespective of the anatomical location, players with CMSI with severe aponeurotic disruption (AD) took longer to RTP than players with CMSI with no AD: 31.3 ± 12.6 days vs 19.4 ± 10.8 days (mean ± SD; P = .003). A running-related mechanism of injury was associated with a longer RTP period for CMSI overall (adjusted hazard ratio [AHR], 0.59; P = .02). The presence of AD was associated with a longer RTP period for soleus injuries (AHR, 0.6; P = .025). Early recurrence (ie, ≤2 months of the index injury) was associated with older age (AHR, 1.3; P = .001) and a history of ankle injury (AHR, 3.9; P = .032). Older age (AHR, 1.1; P = .013) and a history of CMSI (AHR, 6.7; P = .002) increased the risk of recurrence within 2 seasons. The index injury MRI findings were not associated with risk of recurrence. Conclusion: A running-related mechanism of injury and the presence of AD on MRI were associated with a longer RTP period. Clinical rather than MRI data best indicate the risk of recurrent CMSI.

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Kinematic Characteristics of Male Runners With a History of Recurrent Calf Muscle Strain Injury

International Journal of Sports Physical Therapy ◽

10.26603/001c.22971 ◽

2021 ◽

Author(s):

Christopher Bramah ◽

Stephen J Preece ◽

Niamh Gill ◽

Lee Herrington

Keyword(s):

Calf Muscle ◽

Muscle Strain ◽

Kinematic Characteristics ◽

History Of ◽

Muscle Strain Injury

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The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians

Sports Medicine - Open ◽

10.1186/s40798-021-00364-0 ◽

2022 ◽

Vol 8 (1) ◽

Author(s):

Brady Green ◽

Jodie A. McClelland ◽

Adam I. Semciw ◽

Anthony G. Schache ◽

Alan McCall ◽

...

Keyword(s):

Accurate Estimate ◽

Calf Muscle ◽

Return To Play ◽

Clinical Approach ◽

Muscle Strain ◽

Structured Interviews ◽

Diagnosis And Prognosis ◽

Select Group ◽

Periodic Monitoring ◽

Injury Prevention Program

Abstract Background Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews. Results Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands. Conclusions Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes.

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Is It All About the Fascia? A Systematic Review and Meta-analysis of the Prevalence of Extramuscular Connective Tissue Lesions in Muscle Strain Injury

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119888500 ◽

2019 ◽

Vol 7 (12) ◽

pp. 232596711988850 ◽

Cited By ~ 1

Author(s):

Jan Wilke ◽

Luiz Hespanhol ◽

Martin Behrens

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Connective Tissue ◽

Meta Analysis ◽

Return To Play ◽

Muscle Strain ◽

Imaging Studies ◽

Level Of Evidence ◽

Potential Force ◽

Muscle Strain Injury

Background: The fascia has been demonstrated to represent a potential force transmitter intimately connected to the underlying skeletal muscle. Sports-related soft tissue strains may therefore result in damage to both structures. Purpose: To elucidate the prevalence of connective tissue lesions in muscle strain injury and their potential impact on return-to-play (RTP) duration. Study Design: Systematic review; Level of evidence, 3. Methods: Imaging studies describing frequency, location, and extent of soft tissue lesions in lower limb muscle strain injuries were identified by 2 independent investigators. Weighted proportions (random effects) were pooled for the occurrence of (1) myofascial or fascial lesions, (2) myotendinous lesions, and (3) purely muscular lesions. Study quality was evaluated by means of an adapted Downs and Black checklist, which evaluates reporting, risk of bias, and external validity. Results: A total of 16 studies (fair to good methodological quality) were identified. Prevalence of strain injury on imaging studies was 32.1% (95% CI, 24.2%-40.4%) for myofascial lesions, 68.4% (95% CI, 59.6%-76.6%) for myotendinous lesions, and 12.7% (95% CI, 3.0%-27.7%) for isolated muscular lesions. Evidence regarding associations between fascial damage and RTP duration was mixed. Conclusion: Lesions of the collagenous connective tissue, namely the fascia and the tendinous junction, are highly prevalent in athletic muscle strain injuries. However, at present, their impact on RTP duration is unclear and requires further investigation.

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Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967116680344 ◽

2017 ◽

Vol 5 (1) ◽

pp. 232596711668034 ◽

Cited By ~ 9

Author(s):

Brian C. Werner ◽

Nicole S. Belkin ◽

Steve Kennelly ◽

Leigh Weiss ◽

Ronnie P. Barnes ◽

...

Keyword(s):

Relative Frequency ◽

National Football League ◽

Fluid Collection ◽

Magnetic Resonance Images ◽

Calf Muscle ◽

Return To Play ◽

Imaging Findings ◽

Muscle Injuries ◽

Lower Extremity Muscle ◽

Imaging Characteristics

Background: Lower extremity muscle injuries are common in professional football. Although less common than hamstring or quadriceps injuries in National Football League (NFL) athletes, calf injuries occur with relative frequency and have not previously been studied. Purpose: To evaluate gastrocnemius-soleus complex muscle injuries over the past 13 years from a single NFL team to determine the incidence of such injuries, their imaging characteristics, and return to play after such injuries and any correlation between imaging findings and prolonged return to play. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all acute calf muscle injuries on a single NFL team from 2003 to 2015 was performed. Player demographics and return-to-play data were obtained from the medical records. All available magnetic resonance images (MRIs) were reviewed by a musculoskeletal radiologist for specific imaging findings that correlated with return to play. Results: A total of 27 calf injuries in 24 NFL players were reviewed, yielding an incidence of 2.3 acute calf injuries per year on a single NFL team. Of these 27 injuries, 20 (74%) were isolated injuries to the gastrocnemius muscle, 4 (15%) were isolated injuries to the soleus muscle, and the remaining 3 injuries (11%) involved both. Defensive players were more likely to sustain injuries ( P = .043). The mean time to return to play for all 27 players was 17.4 ± 14.6 days (range, 3-62 days). MRIs were available in 14 of the 27 injuries. The average size of the fascial defect ( P = .032) and the presence of a fluid collection ( P = .031) both correlated with return to play of longer than 2 weeks. Conclusion: Although less common than hamstring or quadriceps muscle injuries, calf muscle injuries occur with relative frequency in the NFL, and more so in defensive players. The majority of these injuries occur in the gastrocnemius and result in significant disability, with at least 2 weeks of missed playing time on average. MRI may have an important role in the evaluation of calf injuries in NFL players, as certain injury imaging characteristics, including the anteroposterior size of any fascial tear and the presence of a fluid collection, are associated with longer return-to-play times after injury.

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