From Sam Kerr to Nathan Lyon to Will Skelton - calf injuries plagued our Australian sports stars through 2023.
Injuries to this muscle complex are in fact a very common sporting injury with only hamstrings and quadriceps being more frequently injured in sporting populations.
The superficial calf complex is known as the triceps surae and comprises of 3 muscles – the gastrocnemius, soleus and plantaris. Interestingly it has been found that injuries to the individual tricep surae muscles can be sport specific with American Football players mostly injuring the gastrocnemius and Australian Rules Footballers mostly injuring the soleus (1,2)
A gastrocnemius strain will occur with a sudden ballistic movement with the knee in full extension. This is because the muscle attaches above the knee joint and is therefore exposed when the knee is fully extended. The injury is more prone in the medial head of the muscle – due to this part of the muscle experiencing more loads.
A soleus strain is often associated as an overuse injury. This muscle attaches below the knee and is therefore loaded with the knee in flexion – although it is also loaded with knee extension.
On examination these tears can have a palpable defect at the site of the tear if they are high grade. They will have pain when stretching the calf and on resisted plantar flexion movements such as performing a heel raise.
These tears are categorized based on the degree of structural damage. Recently, with MRIs being more readily available, this process has become more specific which has allowed medical teams a more precise prediction of outcomes. One example of this is the British Athletic Classification, which is used globally, and groups muscle injuries based on the location of injury and the involvement of different soft tissue structures – along with the degree of structural damage. This is how the medical teams new that Nathan Lyon’s Ashes tour was over but that Sam Kerr had a chance of making the latter stages of the world cup – (Will Skelton new his tournament was over – but this was more due to the Wallabies form than his injury!!).
The rehabilitation of these injuries is split into different phases – with the initial phases focusing on protection and gradual restoration of ankle movement to the final stages of returning to running, jumping and ultimately sport.
Although a clinician can give an estimation of how long it will take an individual to progress through these phases based on the classification of the injury it is important that the individual meets set criteria before moving through the phases. For example, for a calf injury, being able to complete single leg heel raises is important before starting a return to running program in order to minimize the re-injury risk.
Once the patient has returned to their full capacity it is important that they maintain good strength and mobility through their calf complex in order to minimize the risk of future injury. This will often mean continuing with some of the later stage rehabilitation exercises and incorporating them into their training schedule.
