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Calf muscle strain injuries in sport: a systematic review of risk factors for injury
  1. Brady Green1,2,
  2. Tania Pizzari1,2
  1. 1 Department of Physiotherapy, La Trobe University, Bundoora, Victoria, Australia
  2. 2 La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
  1. Correspondence to Brady Green, Department of Physiotherapy, La Trobe University, Mill Park Physiotherapy, 22/1 Danaher Drive, South Morang, Victoria, Australia 3752; B.Green2{at}


Objective To systematically review the literature to identify risk factors for calf strain injury, and to direct future research into calf muscle injuries.

Design Systematic review

Data sources Database searches conducted for Medline, CINAHL, EMBASE, AMED, AUSPORT, SportDiscus, PEDro and Cochrane Library. Manual reference checks, ahead of press searches, citation tracking. From inception to June 2016.

Eligibility criteria for selecting studies Studies evaluating and presenting data related to intrinsic or extrinsic risk factors for sustaining future calf injury.

Results Ten studies were obtained for review. Subjects across football, Australian football, rugby union, basketball and triathlon were reported on, representing 5397 athletes and 518 calf/ lower leg muscle injuries. Best evidence synthesis highlights chronological age and previous history of calf strain are the strongest risk factors for future calf muscle injury. Previous lower limb injuries (hamstring, quadriceps, adductor, knee) show some limited evidence for an association. Numerous factors lack evidence of an association, including height, weight, gender and side dominance.

Summary/conclusion Increasing age and previous calf strain injury are the most predictive of future calf injury. The overall paucity of evidence and the trend for studies of a high risk of bias show that further research needs to be undertaken.

  • Calf
  • lower leg
  • strain
  • muscle injury
  • sport
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  • Contributors BG and TP made equal contributions to the work. Both authors gave permission for the final version to be submitted.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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