Is it all about the quads? Implications of the calf musculature post-ACL injury in return to sport rehab

Review written by Dr Teddy Willsey info

Key Points

  1. The soleus contributes a posterior tibial translation force and acts as an agonist to the anterior cruciate ligament (ACL).
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BACKGROUND AND OBJECTIVE

Recent trends in anterior cruciate ligament (ACL) research have centered around restoring quadriceps strength and function (1). Despite continual research, evolving surgical techniques, and a growing adoption of return to play testing, long term ACLR outcomes have much room for improvement (2). Moreover, ACL injuries appear to be on the rise (3).

Interventions targeting or measuring calf musculature are rarely mentioned in ACL research (4). The triceps surae has always taken a back seat to the hips when it comes to looking up and down the kinetic chain to better understand the knee (5).

The authors of this clinical commentary sought to examine potential mechanisms surrounding the contributions of the triceps surae on tibial kinematics, the effects ACL injury has on calf musculature, and the potential clinical implications for prevention of subsequent injuries.

Recent trends in anterior cruciate ligament research have centered around restoring quadriceps strength and function, whereas interventions targeting the calf musculature are rarely mentioned.
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The calf muscle group should be trained in positions that encourage both soleus and gastrocnemius activation, with a variety of exercises and kinetic approaches ranging from heavy slow resistance to plyometric.

METHODS

This clinical commentary was written by two physiotherapist authors and represents the weakest level of evidence: level 5.

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