Allison’s right calf injury: Connecting the injury dots to explain his return & risks

Hey everyone, it’s Raj from 3CB Performance. In the 39th minute of Liverpool’s opening
Premier League match vs Norwich, a resounding 4-1 victory, the team’s world-class goalkeeper
Allison went down with a lower right leg injury. The team hasn’t doled out much information
other than manager Jurgen Klopp stating it was a serious injury that may keep Allison
out for an extended time and emphasizing it was a calf tear rather than an Achilles issue. In this video, I attempt to connect the dots
from the information we have to give a better idea about the injury, Allison’s potential
return timetable, and future risks. The injury occurred on a goal kick where Allison’s
left plant leg slipped while he was loading up his right leg to kick the ball. During
a kicking motion, the calf lengthens and contracts – known as eccentric contraction – to control
the lower leg while also shortening and contracting – known as concentric contraction – to plantarflex
the ankle and point the foot downwards. It’s a double stress on the calf but it’s a load
that Allison’s calf is accustomed to over thousands and thousands of reps of that same
movement. However, the slip on the plant leg during
the kick changed the equation. It altered his balance and therefore the stability and
coordination of the movement. That kind of instantaneous, unexpected change can completely
alter muscle activation, for example tensing up the calf or altering swing leg mechanics
resulting in the calf taking on excess stress. Whatever the case may be, the load on his
calf in that instant exceeded its capacity – the basic equation of muscle injury – leading
to overstraining and tearing of muscle fibers. The return timetable depends on a few factors,
namely the severity of the tear and the location of the tear. Muscle tears are classified into three categories:
a grade 1 tear which ranges from micro-tears to 25% of muscle fibers torn, grade 2 tear
which ranges from 25% to 75% tearing, and finally a grade 3 tear which means a complete
rupture of the muscle. My educated guess is that Allison has a grade
2 tear due to multiple indicators: The higher intensity mechanism of injury, Allison saying
he felt like something hit his calf, how severely his gait (walking) was affected
afterwards, Jurgen Klopp saying the injury was a serious one, and finally the fact that
Allison has been wearing a walking boot to limit any stress on the calf. All these in
combination point to a grade 2 severity. Typically the timetable for a grade 2 calf
tear ranges from two to six weeks. One main reason for that large variance is… A tear in the belly of the calf – most commonly
the medial (inner) gastrocnemius muscle – heals quicker than a tear at the junction between
the calf muscles and the tendon, called the musculotendinous unit, most commonly the junction
between the calves and the Achilles. For example, I believe former Golden State
Warriors forward Kevin Durant likely had the latter which would explain why he grabbed
lower down the calf – leading to armchair medical analysts diagnosing him with a torn
Achilles – and why he had a prolonged stint in rehab as well. Unlike KD however, Allison immediately grabbed
higher up his calf. That being said, there’s also a musculotendinous junction of the calf
near the knee as the gastrocs actually begin above the knee as a tendon and then feather
out into a muscle. However, tears at this junction are extremely rare – approximately
1% of all calf injuries – so that leads me to believe Allison has a muscle belly tear. The research shows that a grade 2 muscle belly
tear – on average – takes about three weeks to come back from. Considering the season
is so young and Liverpool have aspirations to compete deep into the Premier League season
and in multiple tournaments, they very well could extend his rehab and return timeline out farther. Two key positives for Allison in his return
timeline are that has a very good health history with no major injuries and overall possesses excellent
fitness. Both of those bode well for his recovery. That being said, there are some inherent risks
after this type of injury… The undeniable reality – and this is supported
very strongly by the research – is that the greatest indicator of future calf injury is
– by far – previous calf injury. Additionally, there’s a risk for compensatory
injuries where other body regions take on more stress to make up for the weaker calf.
Harkening back to KD, it’s quite possible that when he came back in game 5 of the NBA
finals, his Achilles took on more stress to make up for the calf muscle which resulted
in the Achilles rupture that ended his season and tenure with the Warriors. On a much brighter note, Allison has numerous
protective factors that decrease his re-injury risk. His position as a goalkeeper requires
considerably less physical exertion and his relatively young age of 26 have both been
shown to be protective factors. Further, as he returns from injury, he’ll
continue to work with Liverpool’s training staff on full body compound strengthening
with a specific individualized emphasis on strength, endurance, and flexibility of the
calf and Achilles complex, very likely via progressive eccentric loading. That’s a wrap for this video. Thanks for
watching. My goal is to provide you with in-depth, evidence based, narrative free analysis and
you can always find me on IG and Twitter @3CBPerformance. Make sure to sub to the channel for the latest
updates. 3CB out.

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