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

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.

Experimental study of standing and walking at work — What is compatible with physiological characteristics and human needs?

An experimental study with two scenarios S1 and S2 was conducted, in which the standing and walking proportions as well as movement dynamics were varied. Eleven participants have taken part in the study for 2.5 h each (cycle time: 90 s). By means of surface electromyography, the static and dynamic components of muscle strain as well as the muscle fatigue were recorded and compared with the results of water plethysmography and a structured subjective rating survey. The results of the EMG study showed significantly higher dynamic components of the EA at S2 compared to S1, while the static components for the same activities did not show any significant difference, as expected. S1 and S2 always led to an increase in volume of the lower leg. Standing with less walking (S1) resulted in a significantly higher increase than standing with a higher proportion of walking and stronger dynamic movements (S2). In scenario S2, compared to scenario S1, the participants reported weaker subjective complaints which were also reported later in time. The results on muscular fatigue indicated only partially significant differences between S1 and S2. The results make clear that the dynamics of movement are a decisive criterion for assessing standing activities.Practical Relevance: To relieve strain during standing work, “real” walking movement must be integrated into the workflow. It could be shown that only a small step to the side or a few “shuffling” steps are not sufficient. In contrast, it is compatible with human physiological characteristics to make correct steps and dynamically activate the leg muscles.

Pre-Draft Elbow Magnetic Resonance Imaging in Major League Baseball Pitchers (127)

Objectives: Evaluate pre-draft elbow MRI on baseball pitchers who were entering the MLB draft to determine the presence or absence of pathology, and the associations between these pathologies and UCL tears, and inter-observer reliability regarding common MRI pathology. Methods: Pre-draft elbow MRI and X-Rays on prospective MLB pitchers between 2011-2017 were deidentified and reviewed by two separate authors. The authors graded the X-Rays MRI on several factors including presence or absence of ulnar collateral ligament (UCL) ossification, UCL appearance (heterogeneous or not), UCL thickening (and location), UCL tear (partial vs. full thickness and location), muscle strain, flexor tendon tear, posteromedial osteophyte, sublime tubercle enthesophyte, and osseous stress reactions. Results: Overall, 245 pre-draft elbow X-Rays and MRI were reviewed. On X-Ray: 12 (4.9%) had ossification within the UCL; 34 (13.9%) had an olecranon osteophyte; 14 (5.7%) had a sublime tubercle enthesophyte. MRI abnormalities were found in 70% (171/245) of pitchers. UCL thickening was found in 20% of pitchers. Regarding UCL tears, 3% had a full thickness tear and 24% had a partial thickness tear. Of full thickness tears, 86% were distal and one was midsubstance. Of partial thickness tears, 41% (24/58) were distal, 12% (7/58) were midsubstance, and 47% (27/58) were proximal. Periligamentous edema was present in 36% of pitchers while 14% had a flexor pronator muscle strain. Stress reactions were seen in 27% and most commonly involved the sublime tubercle. Based upon the presence of periligamentous edema, distal UCL pathology was more likely to be chronic than acute while proximal UCL pathology was more likely to be acute. Conclusions: The majority (70%) of pitchers entering the MLB draft had abnormal findings on their MRI, most commonly involving changes to the UCL. Interobserver reliability was acceptable following definition of pathology when reading pre-draft elbow MRI on MLB prospects.