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

Brady Green; Jodie A McClelland; Adam I Semciw; Anthony G Schache; Alan McCall; Tania Pizzari

doi:10.1186/s40798-021-00364-0

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

Sports Med Open. 2022 Jan 15;8(1):10. doi: 10.1186/s40798-021-00364-0.

Authors

Brady Green¹, Jodie A McClelland², Adam I Semciw^{2

3}, Anthony G Schache², Alan McCall^{4

5}, Tania Pizzari²

Affiliations

¹ La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia. B.Green2@latrobe.edu.au.
² La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.
³ Northern Centre for Health Education and Research, Northern Health, Epping, VIC, Australia.
⁴ Arsenal Performance and Research Team, Arsenal Football Club, London, UK.
⁵ School of Applied Sciences, Edinburgh-Napier University, Edinburgh, UK.

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.

Keywords: Calf; Gastrocnemius; Injury; Recurrence; Rehabilitation; Return to play; Soleus.