263 Expert opinion on the assessment and management of calf muscle strain injuries in sport

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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