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.

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

Fig. 1

A framework to guide the match day assessment of calf muscle strain injuries based on information provided by experts

Fig. 2

Evaluating prognosis after a calf muscle strain injury. Numbered dot points refer to the primary themes and/or concepts that influence decision-making at each stage

Fig. 3

An overview of the optimal management of calf muscle strain injuries described by experts. NWB non weight bearing, WB weight bearing. Note Mild CMSI that do not result in time loss or have a prompt RTP do not require the complete process outlined

Fig. 4

Examples of exercises and principles experts used to guide the rehabilitation of calf muscle strain injuries. NWB non weight bearing, WB weight bearing, MOI mechanism of injury

Fig. 5

Determining readiness to run after a calf muscle strain injury

Fig. 6

The aetiology of calf muscle strain injuries as proposed by 20 experts. CMSI calf muscle strain injuries, MTPJ metatarsophalangeal joint

Fig. 7

The potential mechanisms for how age, injury history and exposure increase susceptibility to recurrent calf muscle strain injuries. CMSI calf muscle strain injuries

Fig. 8

Evaluating and managing susceptibility to recurrent calf muscle strain injuries

Fig. 9

A A typical hierarchy of implementation for prevention strategies for CMSI in healthy elite athletes from running-based sports. B An example of an adjusted hierarchy for an older athlete with a history of calf muscle strain injuries. Legend: Shaded boxes represent on-field activities/ focuses of injury prevention; white boxes represent off-field activities/ focuses of injury prevention