04/11/2025
Not all ACLR rehabs are equal and straightforward - while related to the ACLR, this post focuses on a calf injury during the recovery phase.
The road to recovery on a ACLR rehab is certainly not linear. ACLR Client (and now a valued colleague in Resilience Physiotherapy) Daithí, is 10 months down the road after a Left ACLR and Lateral stabilisation.
His return to running phase has not been straightforward - with a couple of calf strains in the previous 3 months on the unoperated leg. His most recent calf strain occurred after 500m of running, after a period of rest.
When David was assessed in the clinic, 6 weeks post injury he was pain free on most tests we did for the calf. No issues on a SL calf raise (straight knee and bent knee) were demonstrated and he could SL hop pain free. However he had some palpable tenderness along the medial calf, with what appeared like a reduced tone in this region.
His SL hopping quality seemed impaired, with an inability to control the heel consistently (lack of stiffness) on SL landing.
MRI confirmed an IMT (intramuscular tendon) of the Right Gastrocnemius, a nasty 3C - which was probably a repeat tear of an earlier injury.
The IMT acts as a key load-transfer structure during the eccentric-concentric contractions in running /jumping/change of direction. Think of it as a central scaffold/axle that the muscle fibres attach to. Injury to the IMT affects force transmission to the Achilles, which explains the impaired ability heel control/stiffness on landing.
IMT injuries are difficult to manage , as they can feel pain free relatively quickly, and can pass most objective testing (heel raise test, SL hopping tests, jogging). While MRI is the diagnostic tool of choice - as these can often be missed on an MRI.
We are lucky to have the resources of Prof. Eanna Falvey, Dr. Joe Jordan and Dr. Jon Patricios nearby in Cork to refer any suspect IMT injuries cases to.
This particular injury will take 12-14 weeks to fully recover structurally, hopefully not to be seen again for a long time.