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Calf muscle injuries

...onset, recovery time and return to sports

  • Soleus more often injured than gastrocnemius
  • Over half of the calf injuries does not occur acute
  • Recovery time after reinjury almost twice as long as after first injury

In professional Australian Football players who sustain a calf injury, m. soleus is involved more frequently than m. gastrocnemius. Moreover, players need more recovery time after a reinjury than after the first calf injury, and a recurrence often occurs within two months after the first injury. This is the conclusion after analysis of data from almost two hundred calf injuries in the ‘Soft Tissue Injury Registry of the Australian Football League’ (STRAFL).

Recurrences

Of the 35 recurrences, 32 occurred in the soleus muscle. Over half of all the recurrences occurred within two months after the first injury, just before or after return to sports. The authors suspect that with early recurrences tissue damage still may have been present, while clinical symptoms, such as pain, limited range of motion and strength already were recovered. Older players and players with more game experience, had recurrences more frequently than younger and less experienced players. 

Australian football 

In terms of intensity and movement, Australian Football has similarities with rugby and soccer, but ball circulation is faster because the lack of outside rules. Players jump, land and sprint very often. On average they walk and run thirteen kilometers during one match of two hours, of which they run four kilometers at high speeds and accelerate approximately 200 times per match. 

> From: Green et al., Scand J Med Sci Sports 30 (2020) 174-184 . All rights reserved to John Wiley & Sons, Ltd. Click here for the online summary. Translation by Casper Martens

Expert opinion by Maarten Barendrecht

Calf muscle injuries have not been investigated often, despite the fact that they occur frequently and that they can lead to serious limitations for athletes. Due to the relatively fast reduction in pain during ADL, this injury is often underestimated, and athletes do not seek help until they sustain a reinjury. The results of this paper show that a significantly longer recovery time should be taken into account. Adequate education at primary injury is important!

Although results from Australian Football cannot be transferred directly to other sports, it seems important to keep in mind that in many cases the problem is not in the gastrocnemius, but in the soleus muscle. Revalidation should always target both muscles, but in case of provocation of (residual) complaints, one should be aware that the soleus can play a role. Given the deeper anatomical location of this muscle, soleus injuries may not be seen on ultrasound. 

In over half of the described calf injuries there was a history of calf and/ or ankle injury. Besides an adequate revalidation of calf injury, a good revalidation of ankle injury may reduce the chance of sustaining a calf injury in the future. To gain more insight into the most adequate treatment for soleus and gastrocnemius muscle injuries and possible differences between both, more research is required. 

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