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

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.

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

2019 ◽  
Vol 22 ◽  
pp. S19
Author(s):  
B. Green ◽  
M. Lin ◽  
J. McClelland ◽  
A. Semciw ◽  
A. Schache ◽  
...  
Keyword(s):  
Calf Muscle ◽  
Return To Play ◽  
Muscle Strain ◽  
Muscle Strain Injury

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

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.

scholarly journals Acute Gastrocnemius-Soleus Complex Injuries in National Football League Athletes

2017 ◽  
Vol 5 (1) ◽  
pp. 232596711668034 ◽  
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.

Fifteen-week window for recurrent muscle strains in football: a prospective cohort of 3600 muscle strains over 23 years in professional Australian rules football

2020 ◽  
Vol 54 (18) ◽  
pp. 1103-1107 ◽  
Author(s):  
John W Orchard ◽  
Mohammad Chaker Jomaa ◽  
Jessica J Orchard ◽  
Katherine Rae ◽  
Daniel Tyler Hoffman ◽  
...  
Keyword(s):  
Risk Factor ◽  
Return To Play ◽  
Recent History ◽  
Hamstring Injury ◽  
Muscle Strain ◽  
Increased Risk ◽  
Australian Football ◽  
History Of ◽  
Muscle Strain Injury ◽  
Injury Recurrence

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.

Imaging of Acute Hamstring Muscle Strain Injuries

2017 ◽  
Vol 21 (04) ◽  
pp. 415-432 ◽  
Author(s):  
Simon Dimmick ◽  
James Linklater
Keyword(s):  
Tendon Injury ◽  
Return To Play ◽  
Myotendinous Junction ◽  
Imaging Findings ◽  
Hamstring Muscle ◽  
Muscle Strain ◽  
Muscle Fascicle ◽  
Grading Systems ◽  
Muscle Edema ◽  
Definition Of

AbstractAcute athletic hamstring muscle strain injuries are common and a cause of significant time off sport. An understanding of the anatomy of the hamstring muscle-tendon units is a prerequisite for interpreting the spectrum of structural abnormalities on imaging. The site of injury may range from proximal tendon, proximal myotendinous junction, with or without tendon injury, muscle, myofascial junction, distal myotendinous junction to distal tendon. Imaging findings in muscle injury range from intrafascicular and interfascicular muscle edema, blurring of fascicular margins, distortion of pennation angle, localized muscle fascicle discontinuity through to more extensive multi-fascicular discontinuity. Imaging findings in tendon injury include tendon edema, redundancy, zipper-like morphology, and partial-complete tendon discontinuity. Imaging findings in fascial injury include poor definition of fascial margins with perifascial edema through to a fascial defect. Published grading systems are presented, and their so far limited utility in predicting return to play is reviewed.

The uses and implications of standards in general practice consultations

2016 ◽  
Vol 21 (1) ◽  
pp. 3-20 ◽  
Author(s):  
Maria Laura Lippert ◽  
Susanne Reventlow ◽  
Marius Brostrøm Kousgaard
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Professional Practice ◽  
Chronic Care ◽  
Analytical Approach ◽  
Quality Standards ◽  
Clinical Approach ◽  
Quality Development ◽  
Structured Interviews ◽  
Patient Centredness

Quality standards play an increasingly important role in primary care through their inscription in various technologies for improving professional practice. While ‘hard’ biomedical standards have been the most common and debated, current quality development initiatives increasingly seek to include standards for the ‘softer’ aspects of care. This article explores the consequences of both kinds of quality standards for chronic care consultations. The article presents findings from an explorative qualitative field study in Danish general practice where a standardized technology for quality development has been introduced. Data from semi-structured interviews and observations among 17 general practitioners were analysed using an iterative analytical approach, which served to identify important variations in the uses and impacts of the technology. The most pronounced impact of the technology was observed among general practitioners who strictly adhered to the procedural standards on the interactional aspects of care. Thus, when allowed to function as an overall frame for consultations, those standards supported adherence to general recommendations regarding which elements to be included in chronic disease consultations. However, at the same time, adherence to those standards was observed to narrow the focus of doctor–patient dialogues and to divert general practitioners’ attention from patients’ personal concerns. Similar consequences of quality standards have previously been framed as manifestations of an inherent conflict between principles of patient-centredness and formal biomedical quality standards. However, this study suggests that standards on the ‘softer’ aspects of care may just as well interfere with a clinical approach relying on situated and attentive interactions with patients.

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

2021 ◽  
Author(s):  
Brady Green ◽  
Monica Lin ◽  
Anthony Schache ◽  
Jodie McClelland ◽  
Adam Semciw ◽  
...  
Keyword(s):  
Calf Muscle ◽  
Muscle Strain ◽  
Muscle Strain Injury

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

2021 ◽  
Author(s):  
Brady Green ◽  
Anthony Schache ◽  
Jodie McClelland ◽  
Adam Semciw ◽  
Tania Pizzari
Keyword(s):  
Expert Opinion ◽  
Calf Muscle ◽  
Muscle Strain

Connective tissue injury in calf muscle tears and return to play: MRI correlation

2017 ◽  
Vol 52 (14) ◽  
pp. 929-933 ◽  
Author(s):  
Ashutosh Prakash ◽  
Tom Entwisle ◽  
Michal Schneider ◽  
Peter Brukner ◽  
David Connell
Keyword(s):  
Connective Tissue ◽  
Muscle Injury ◽  
Tissue Injury ◽  
Clinical Suspicion ◽  
Calf Muscle ◽  
Return To Play ◽  
Muscle Tear ◽  
Grade 3 ◽  
Mean Time ◽  
Connective Tissue Structure

ObjectiveThe aim of our study was to assess a group of patients with calf muscle tears and evaluate the integrity of the connective tissue boundaries and interfaces. Further, we propose a novel MRI grading system based on integrity of the connective tissue and assess any correlation between the grading score and time to return to play. We have also reviewed the anatomy of the calf muscles.Materials and methodsWe retrospectively evaluated 100 consecutive patients with clinical suspicion and MRI confirmation of calf muscle injury. We evaluated each calf muscle tear with MRI for the particular muscle injured, location of injury within the muscle and integrity of the connective tissue structure at the interface. The muscle tears were graded 0–3 depending on the degree of muscle and connective tissue injury. The time to return to play for each patient and each injury was found from the injury records and respective sports doctors.ResultsIn 100 patients, 114 injuries were detected. Connective tissue involvement was observed in 63 out of 100 patients and failure (grade 3 injury) in 18. Mean time to return to play with grade 0 injuries was 8 days, grade 1 tears was 17 days, grade 2 tears was 25 days and grade 3 tears was 48 days (p<0.001).ConclusionThe integrity of the connective tissue can be used to estimate and guide the time to return to play in calf muscle tears.

Patient and clinician experiences of a computerised cognitive battery for use after concussion: a preliminary qualitative study

2020 ◽  
pp. 1-16
Author(s):  
C. Macleod ◽  
L. J. Surgenor ◽  
W. Levack ◽  
J. Hackney ◽  
A. Theadom ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Cognitive Testing ◽  
Qualitative Description ◽  
Future Research ◽  
Structured Interviews ◽  
Neuropsychological Battery ◽  
Negative Experiences ◽  
Select Group ◽  
Clinician Experiences ◽  
Neurological Research

Abstract Objective: The Cognition Battery of the National Institute of Health (NIH) Toolbox for Assessment of Neurological and Behavioural Function is a computerised neuropsychological battery recommended for clinical practice, neurological research and clinical trials. We investigated the utility of the NIH Toolbox Cognition Battery (NIHTB-CB) for people with concussion. Methods: In this small qualitative study, semi-structured interviews were conducted with five adults with concussion who were participating in a larger study using the NIHTB-CB. Three clinician participants and two cultural advisors familiar with the tool were also interviewed. Interview transcripts were analysed using a general thematic approach and qualitative description. Results: Participants described both positive and negative experiences with the NIHTB-CB and using qualitative description, their experiences were organised into three broad themes: (1) using technology for cognitive testing made sense, (2) there were some cultural relevance questions and (3) cognitive testing after concussion could have challenges. They were positive about the computerised format and range of domains assessed for the concussion context but identified the contextual relevance of some content as having potential to impact on performances. Conclusion: This was a small study examining the experiences of a select group of participants, but nevertheless does suggest a need for future research validating the NIHTB-CB for use in different cultural and clinical contexts.

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