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

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.

A Novel Minimally Invasive Surgically Induced Skeletal Muscle Injury Model in Sheep

“…The use of large animal models in sheep to study skeletal muscle injury has been previously described, such as VML [ 28 ] and biceps femoris [ 29 ] injury models. However, their use for the study of calf injuries, which are highly prevalent among athletes and contribute negatively to their performance [ 35 , 36 ], has been overlooked. In our sheep muscle injury model, surgical incisions and opening tissue layers are not necessary to induce muscle injury.…”

Validity and intrarater reliability of a novel device for assessing Plantar flexor strength

“…For instance, recent research has highlighted the association between low Plantar flexor strength and Achilles tendinopathy patients [3,[5][6][7][8][9][10][11], whilst other studies have shown the importance of Plantar flexor function to patient-reported outcomes post Achilles tendon rupture [12][13][14]. The existing literature reports an association between these injuries and reduced Plantar flexor power, with some prospective studies reporting the existence of deficits pre-injury [3], supporting the notion that Plantar flexor weakness may increase the risk of certain lower limb disorders [3,15,16].…”

Form Matters—Technical Cues in the Single Leg Heel Raise to Failure Test Significantly Change the Outcome: A Study of Convergent Validity in Australian Football Players

“…Specific instructions and cues have been a key consideration in contemporary research and clinical settings to help standardise practice [11]. Performance and technique cues during the SLHR test may alter the number of repetitions to failure performed and potentially provide a more robust indication of an individual's capacity when screening athletes [12,13]. Although the longheld clinical hypothesis that cueing is warranted is yet to be substantiated in Australian football players [12].…”

“…Performance and technique cues during the SLHR test may alter the number of repetitions to failure performed and potentially provide a more robust indication of an individual's capacity when screening athletes [12,13]. Although the longheld clinical hypothesis that cueing is warranted is yet to be substantiated in Australian football players [12]. Whether cueing the SLHR test in this population significantly impacts test outcomes and the practical interpretation of theresults between conditions is unknown.…”

“…Clinicians value understanding how test procedures can impact (and potentially improve) their practice and patient outcomes [18]. This is especially apparent for practitioners aiming to use these data to help prevent or manage injuries involving the calf muscletendon unit, that could be associated with reduced strength-endurance, such as calf muscle strain injuries [12,19] and Achilles Tendinopathy [20,21]. Calf muscle-tendon unit injuries are problematic in athletes [22,23], and, particularly in Australian football, the consistent prevalence and susceptibility of players to recurrent calf muscle strain injuries represents a growing injury burden [24,25].…”