Blogs - Praxis Physiotherapy

“Old Man Calf”: Why Calf Tears Become So Common After 30

by Stephen Timms | May 24, 2026 | Uncategorized

Runner clutching lower leg in pain after a calf strain “I wasn’t even sprinting…” It’s one of the most common stories I hear in the clinic. “I pushed off to chase the football” “I accelerated after my dog.” “I was only halfway through my run.” “It felt like someone kicked me in the calf.” The diagnosis is usually the same: a calf strain.

In sporting circles, particularly AFL, this injury has become so common that it has earned its own nickname: “Old Man Calf.” The term is tongue in cheek, but the injury certainly isn’t. Calf strains are one of the most frustrating soft-tissue injuries affecting middle-aged athletes and recreational runners. They also have a well documented habit of recurring when they aren’t managed properly.

As someone who treats these injuries regularly, and who has experienced a few myself, I know how debilitating and frustrating they can be. The encouraging part is that they’re also one of the more preventable injuries once you understand why they happen.

Why does it happen?

Age itself isn’t really the problem. What ageing does is create a perfect storm of small physiological changes that gradually chip away at the calf’s ability to tolerate high speed loading.

These changes include a reduction in muscle mass, known as sarcopenia, driven largely by the progressive loss of motor neurons and the muscle fibres they supply (Larsson et al., 2019; Nishikawa et al., 2021). Achilles tendon stiffness also appears to decline with age. Research using ultrasound and biofeedback found that older adults produced up to 44% less tendon stiffness than younger adults at matched levels of muscle activation. That alters how efficiently force transfers from muscle to bone during push-off (Gray et al., 2024). Interestingly, when load rather than effort is matched, some studies find no real difference in tendon stiffness between younger and older adults. That suggests a good portion of this “stiffness loss” is really a downstream effect of age-related strength loss rather than the tendon tissue itself deteriorating (Jakubowski et al., 2024). Either way, the practical implication is the same: rebuilding strength is central to rebuilding tendon function. Alongside these structural changes, recovery between training sessions slows, maximal strength and power decline, and most people simply stop exposing their calves to genuine sprinting on a regular basis.

None of these changes is dramatic on its own. Together, though, they mean the calf has less “reserve capacity” available when a sudden, explosive movement is demanded of it. That’s why so many people tear a calf doing something they’ve done hundreds of times before without issue.

Why AFL players seem particularly vulnerable

If you’ve watched AFL over the past decade, you’ve probably heard the commentary: “another calf injury,” with veteran players seeming especially susceptible. This isn’t coincidence.

Older AFL players typically retain excellent aerobic fitness and game awareness. But they’re still required to produce repeated maximal accelerations, decelerations and changes of direction, and these explosive actions place enormous force through the calf complex. Data from the AFL’s Soft Tissue Injury Registry back this up. An early analysis of muscle strains across the competition found that age was an independent risk factor for calf strains even after adjusting for injury history, while it wasn’t a risk factor for quadriceps strains. That suggests there’s something specific about how the calf tolerates ageing under repeated high-speed loading (Orchard, 2001). A later 23-year cohort of more than 3,600 muscle strains across the AFL confirmed the pattern: older players had around 60% higher odds of a calf strain than younger players, even after accounting for injury history (Orchard et al., 2020). Older players who do sustain a calf strain also tend to take longer to recover (Gray et al., 2025). A history of calf strain combined with older age also substantially raises the risk of a further injury within the following two seasons (Green et al., 2020).

Elite sport doesn’t create this vulnerability; it simply exposes it more publicly.

Recreational runners aren’t immune

You don’t need to play AFL to be at risk. Many of the calf tears seen in clinic occur in park runners, masters athletes, weekend footballers, tennis and pickleball players, golfers walking steep courses, and parents chasing kids around the backyard. Pickleball in particular has seen a sharp rise in soft tissue injuries as participation among older adults has grown, with calf strains featuring among the most commonly recorded injuries at one US orthopaedic centre (Herzberg et al., 2025).

The common thread in all these cases is an athlete who remains active, but who isn’t regularly exposing their calves to high-speed loading. Your cardiovascular fitness might still be excellent. Your calf’s capacity to absorb a sudden sprint or lunge may not be.

Which muscle actually tears?

Detailed anatomical view of the calf muscles Most people simply say they’ve “done their calf,” but several distinct structures can be involved, and it’s worth knowing the difference.

Gastrocnemius is the larger, more superficial of the two major calf muscles. It’s typically injured during explosive acceleration, jumping or sprinting, and pain is often felt high in the calf and occurs suddenly. In a 10-year cohort of elite AFL players, gastrocnemius injuries most commonly affected the medial head (78% of cases), with acceleration being the single most common mechanism of injury (Gray et al., 2025).

Soleus sits deeper and functions more as an endurance muscle. It’s commonly injured during running or prolonged loading, and pain is usually felt lower in the calf, often starting as tightness before becoming more obviously painful. In the same injury registry, soleus injuries were actually more prevalent overall than gastrocnemius injuries, accounting for around 85% of all calf strains in elite AFL players. They were also far more likely to recur (Green et al., 2019). Because soleus symptoms tend to develop more gradually, they’re often under-recognised in older runners until the injury is well established.

Why do calf tears keep coming back?

This is probably the biggest source of frustration for patients. Many people feel “pretty good” after three to four weeks: they can walk, they can cycle, and they might even jog comfortably. Unfortunately, healing tissue isn’t the same as fully restored tissue.

The evidence on recurrence is sobering. In elite AFL players, a prior calf strain increased the risk of a further injury several-fold. Older age independently increased that risk further still (Green et al., 2020). A separate analysis of over 3,600 muscle strains across 23 AFL seasons found that the risk of recurrence stays elevated for around 15 weeks after return to play. It also found that a recent history of the same injury was, by a wide margin, the strongest predictor of injuring it again (Orchard et al., 2020). Put simply, unless strength, endurance, plyometric capacity and sprint exposure are specifically rebuilt, the calf returns to sport with reduced capacity, and eventually something gives again.

Can you prevent “Old Man Calf”?

The encouraging answer is yes. While age can’t be changed, capacity can.

Heavy calf strength. Strong calves tolerate greater force before they fail. Heavy seated and standing calf raises should be part of long-term training, not something reserved for rehab after an injury has already occurred. Eccentric loading in particular has been shown to drive meaningful adaptations in tendon properties. It may be especially well suited to older adults, since it can achieve those adaptations at comparatively lower relative demands than other contraction types (Quinlan et al., 2019).

Plyometric training. Skipping, hopping and bounding, performed in small, consistent doses, help the calf improve its ability to store and release elastic energy efficiently.

Runner in starting blocks preparing to sprint Sprint exposure. This is perhaps the most overlooked factor of all. Many recreational runners train at a single, moderate pace and then, once every few months, need to sprint for a bus, a ball or a toddler heading for the road. That’s the equivalent of expecting a shoulder to throw a ball at full pace without ever having practised it. Regular controlled strides, accelerations and genuinely faster running help maintain the calf’s resilience to sudden demand.

Consistent training volume. Sharp spikes in training load remain one of the most consistently identified injury risk factors. In professional footballers, a week of unusually high external workload, particularly involving high-intensity accelerations and decelerations, regularly preceded calf strain injuries. Injured players were, on average, older than their uninjured teammates too (Soler et al., 2024). The calf tends to prefer gradual, planned increases over heroic weekends bolted onto weeks of inactivity.

Recovery. Sleep, nutrition and ongoing strength training all matter more after 30, simply because recovery isn’t as forgiving as it once was.

Don’t ignore persistent calf tightness

One of the most common mistakes I see is assuming every tight calf just needs stretching. Persistent tightness can actually represent residual weakness, reduced tendon capacity, neural fatigue, or an incompletely healed muscle injury. Stretching alone rarely resolves any of these underlying issues.

A proper assessment should identify why the calf feels tight in the first place. Often, the answer is that it needs to get stronger, not longer.

When should you seek help?

It’s worth having the injury assessed if you experience sudden pain with a popping sensation, difficulty pushing up onto your toes, swelling or bruising, repeated calf strains, or calf tightness that never quite seems to resolve.

A detailed examination can usually determine which structure has been injured, whether imaging is required, and, most importantly, what needs to be rebuilt before you return to running or sport.

The bottom line

“Old Man Calf” might sound like a joke, but it reflects a genuine physiological phenomenon. As we age, our calves gradually lose reserve capacity. And without ongoing strength, power and speed exposure, they’re regularly asked to perform tasks they simply haven’t been prepared for.

Fortunately, this isn’t inevitable. With the right combination of strength training, progressive running, plyometrics and intelligent rehabilitation, many athletes continue running, competing and enjoying sport well into their 50s, 60s and beyond. Age may increase the risk, but it doesn’t have to define your future. If you have struggled (like I have) with calf tears derailing your activity participation, or you fear the return to running stage, book in with one of our physios today to get you back to your best!

Until next time, Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References

Larsson L, Degens H, Li M, et al. Sarcopenia: Aging-Related Loss of Muscle Mass and Function. Physiol Rev. 2019;99(1):427-511. DOI
Nishikawa H, Fukunishi S, Asai A, et al. Pathophysiology and mechanisms of primary sarcopenia (Review). Int J Mol Med. 2021;48(2). DOI
Gray AJ, Krupenevich RL, Batsis JA, Sawicki GS, Franz JR. Reduced Achilles tendon stiffness in aging associates with higher metabolic cost of walking. J Appl Physiol. 2024;137(6):1541-1548. DOI
Jakubowski KL, Ludvig D, Lee SSM, Perreault EJ. Aging Does Not Alter Ankle, Muscle, and Tendon Stiffness at Low Loads Relevant to Stance. Ann Biomed Eng. 2024;52(9):2556-2568. DOI
Orchard JW. Intrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med. 2001;29(3):300-303. DOI
Orchard JW, Chaker Jomaa M, Orchard JJ, et al. Fifteen-week window for recurrent muscle strains in football. Br J Sports Med. 2020;54(18):1103-1107. DOI
Gray C, Pizzari T, Murphy MC, et al. Gastrocnemius Muscle Strain Injury Characteristics in Elite Male Australian Football Players: A 10-Year Longitudinal Cohort Study. J Orthop Sports Phys Ther. 2025;55(10):681-688. DOI
Green B, Lin M, McClelland JA, Semciw AI, Schache AG, Rotstein AH, Cook J, Pizzari T. Return to Play and Recurrence After Calf Muscle Strain Injuries in Elite Australian Football Players. Am J Sports Med. 2020;48(13):3306-3315. DOI
Herzberg SD, Bowman EN, Hill KL. Evaluation of Pickleball-Related Injuries at a Single Institution From 2017 to 2022. Orthop J Sports Med. 2025;13(2). DOI
Green B, Lin M, Schache AG, McClelland JA, Semciw AI, Rotstein A, Cook J, Pizzari T. Calf muscle strain injuries in elite Australian Football players: A descriptive epidemiological evaluation. Scand J Med Sci Sports. 2020;30(1):174-184. DOI
Quinlan JI, Narici MV, Reeves ND, Franchi MV. Tendon Adaptations to Eccentric Exercise and the Implications for Older Adults. J Funct Morphol Kinesiol. 2019;4(3):60. DOI
Soler A, Agulló F, Hernández-Dávó J, Raya-González J, Del Coso J, González-Ródenas J, Moreno-Pérez V. Influence of the External Workload on Calf Muscle Strain Injuries in Professional Football Players: A Pilot Study. Sports Health. 2024;17(1):175-182. DOI

The Single-Leg Squat Test: The Hip Control Test That Predicts Your Next Knee Injury

by Stephen Timms | Apr 29, 2026 | Hip, Return to Sport

Athlete performing a lunge, loading the hip and gluteal muscles

Hip and gluteal control rarely gets tested properly before return to sport, largely because it’s easy to mistake for something else. An athlete with poor hip control can usually still run in a straight line without pain. That’s exactly why the deficit tends to only show up later, in a knee, a groin, or the same hip again, once the demands of cutting and landing expose what straight-line running never did. The single-leg squat and step-down tests are two of the simplest, best-evidenced ways to catch that gap early.

WHAT THE TEST ACTUALLY MEASURES

Both tests are performed standing on one leg, either squatting down as far as controlled technique allows, or stepping down from a small box or step. What’s being assessed isn’t just how deep the movement goes, but the quality of control through it. Does the knee track over the foot or collapse inward? Does the pelvis stay level or drop on the unsupported side? Does the whole movement look stable or wobbly? These patterns are driven largely by hip abductor and external rotator strength, particularly gluteus medius, which is why the test is as much a hip test as it is a knee test.

A 2011 study by Poulsen and James, published in Physiotherapy Theory and Practice, examined the reliability and validity of clinical evaluation of the single-leg squat and found it to be a reliable, valid way for clinicians to assess lower limb control, even when scored visually rather than with laboratory equipment. That’s a meaningful finding, because it means this test doesn’t require expensive gear to be clinically useful, just a trained eye and a consistent scoring approach.

WHY TESTING BEATS GUESSING

Hip control deficits are easy to miss because they often don’t cause pain in the hip itself. An athlete can walk, jog, and even sprint in a straight line with poor gluteal control and feel completely normal, right up until a cutting or landing task demands single-leg stability under load. Without a specific test for this, it simply doesn’t get picked up before return to sport.

This mirrors the broader return-to-sport literature: a 2016 Delaware-Oslo cohort study by Grindem and colleagues found an 84% lower reinjury rate in athletes cleared using objective discharge criteria rather than time alone, and a related study by Kyritsis and colleagues found a fourfold higher reinjury risk in athletes who didn’t meet full discharge criteria. The single-leg squat and step-down tests apply that same principle specifically to the hip and pelvis, an area that’s otherwise very easy to clear on the basis of “no pain” alone.

THE KINETIC CHAIN COST OF CUTTING CORNERS

Poor hip control is one of the clearest examples of a kinetic chain problem in sports medicine, because the knee, not the hip, is usually where the consequences show up. When the pelvis drops and the knee collapses inward during single-leg loading, it changes the angle and force through the knee joint on every step, cut, and landing. That’s a pattern strongly implicated in patellofemoral pain and non-contact ACL injury. The same redistribution effect is well documented after other underprepared joints return to sport. A 2016 systematic review by Wiggins and colleagues found that athletes returning to sport after ACL reconstruction reinjured the same knee and the opposite knee at almost identical rates. That’s a pattern consistent with hip control deficits driving risk into the knee on both sides rather than staying contained at the hip.

Left unaddressed over years of training and competition, this pattern of poor load control through the hip and knee is also implicated in the gradual development of joint degeneration. The joint surfaces end up repeatedly loaded in ways they weren’t designed for. Confirming genuine hip control before returning to full training is one of the more practical ways to interrupt that pattern. It stops the deficit becoming a long-term problem rather than a single injury.

WHAT WE DO AT PRAXIS

We use single-leg squat and step-down assessment alongside gluteal strength testing and landing mechanics screening. Together, these confirm the hip is genuinely controlling load before we clear an athlete back to cutting, jumping, or contact sport. If you’re recovering from a hip, groin, or knee injury, or you simply want to know how your hip control measures up, book a return-to-sport assessment with our team.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

The Single-Leg Hop Test: Why Most Ankle Sprains Are Cleared Before They’re Actually Ready

by Stephen Timms | Apr 22, 2026 | Ankle and Foot, Return to Sport

Trail runner landing on one leg, the movement pattern assessed by ankle hop testing

Ankle sprains are treated as minor injuries more often than almost anything else in sport, which is part of the problem. Most people are walking normally within days and back at light training within a couple of weeks. That’s often long before the ankle has actually regained the strength and control needed to land, cut, or change direction without giving way again. A single-leg hop test is one of the more practical ways to check that control has genuinely returned before an athlete finds out the hard way.

WHAT THE TEST ACTUALLY MEASURES

The test itself is straightforward. Standing on one leg, the athlete hops forward as far as possible and lands under control on the same foot, without the free leg touching down or the landing foot needing to step to regain balance. Distance is measured and compared side to side. The quality of the landing, whether it’s stable and controlled or wobbly and compensated, is assessed alongside the raw number.

A 2009 study by Caffrey, Docherty, Schrader, and Klossner, published in the Journal of Orthopaedic and Sports Physical Therapy, examined four different single-limb hopping tests in people with functional ankle instability and found that hopping tests were able to detect functional performance deficits that simpler balance and range-of-motion measures missed. The general benchmark used across the hop testing literature, consistent with lower limb testing more broadly, is a Limb Symmetry Index of at least 90% between the injured and uninjured ankle before returning to unrestricted sport.

WHY TESTING BEATS GUESSING

Because ankle sprains are so common and usually resolve pain quickly, they’re one of the injuries most likely to be self-managed without any formal testing before return to sport. That’s exactly why they’re also one of the most likely injuries to recur, with a well-established pattern where an initial sprain, especially if returned to sport too early, tends to be followed by a second and third, eventually settling into what’s recognised clinically as chronic ankle instability.

The broader evidence for objective testing over time-based clearance is consistent across joints. A 2016 Delaware-Oslo cohort study by Grindem and colleagues found an 84% lower reinjury rate in athletes cleared using objective discharge criteria rather than time alone, and a related study by Kyritsis and colleagues found a fourfold higher reinjury risk in athletes who didn’t meet full discharge criteria before returning to sport. A hop test applies exactly that principle to the ankle: confirm the capacity is actually there, rather than assuming it from the absence of pain.

THE KINETIC CHAIN COST OF CUTTING CORNERS

An ankle that returns to sport with reduced control rarely stays an isolated ankle problem. Athletes with chronic ankle instability commonly develop compensatory movement patterns up the chain. They alter knee and hip mechanics during landing and cutting to protect the unstable ankle, which shifts injury risk upward rather than removing it. This same load-redistribution pattern is well documented after other undertested joints return to sport: a 2016 systematic review by Wiggins and colleagues found that athletes returning to sport after ACL reconstruction reinjured the same knee and the opposite knee at almost identical rates. This illustrates how an underprepared joint changes the loading pattern of everything connected to it, not just itself.

Each recurrent ankle sprain also tends to leave the joint a little less stable than before. That compounds the risk of the next one and increases the long-term likelihood of chronic instability and early degenerative change in the joint. Confirming hop test performance before return to sport is one of the more effective ways to break that cycle rather than let it repeat every season.

WHAT WE DO AT PRAXIS

We use single-leg hop testing alongside balance and proprioception assessment and sport-specific cutting drills. Together, these confirm an ankle is genuinely ready for full training, not just pain-free at walking pace. If you’re recovering from an ankle sprain, or you’ve had more than one, book a return-to-sport assessment with our team.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

The Biering-Sørensen Test: The Trunk Endurance Number Your Back Rehab Is Probably Skipping

by Stephen Timms | Apr 15, 2026 | Lower Back, Return to Sport

Physiotherapist coaching a plank exercise for trunk extensor endurance

Low back pain is unusual among sporting injuries in that it rarely announces a clear moment of “reinjury” the way a hamstring or ankle does. Instead it tends to creep back in: a bit stiffer this week, a bit more guarded the next. Before long, an athlete is training below their capacity without anyone quite deciding they should be. The Biering-Sørensen test is one of the few simple, well-validated tools for putting a number on trunk extensor endurance before that pattern sets in.

WHAT THE TEST ACTUALLY MEASURES

The test is performed lying face down with the pelvis and legs fixed on a table, the upper body unsupported and held horizontal, in line with the legs. The time the position can be held before form breaks down is recorded. It’s a direct measure of isometric endurance in the back extensors. These are the muscles that keep the trunk upright and controlled during running, lifting, and repeated bending and twisting under fatigue.

The test was first described by Biering-Sørensen in a 1984 study published in Spine, which followed working adults for a year and found that a shorter holding time was a significant predictor of who would go on to develop low back trouble. A 1999 study by Latimer and colleagues, published in the same journal, confirmed the test’s reliability and its ability to discriminate between people with and without low back pain, reporting good to excellent reliability across asymptomatic and symptomatic groups.

WHY TESTING BEATS GUESSING

Because low back pain so often fluctuates rather than resolving in a straight line, athletes and clinicians can end up treating “no pain today” as the signal to return to full training, without ever confirming that trunk endurance has actually been restored. That’s a meaningful gap: an athlete can be pain-free at rest and still fatigue through their back extensors well before the end of a training session or a match, at which point technique breaks down and injury risk rises.

The same principle holds across other joints in the return-to-sport literature. A 2016 Delaware-Oslo cohort study by Grindem and colleagues found an 84% lower reinjury rate in athletes cleared using objective discharge criteria rather than time alone. A related study by Kyritsis and colleagues found a fourfold higher reinjury risk in athletes who didn’t meet full discharge criteria. Trunk endurance testing applies the same logic to the lower back: a number that has to be met, not a symptom that simply has to be absent.

THE KINETIC CHAIN COST OF CUTTING CORNERS

A fatiguing back extensor doesn’t fail in isolation. As trunk endurance drops, athletes typically lose postural control earlier in a session. That changes how load is transferred down into the hips and up through the shoulders during running, lifting, and repeated bending. This kind of load redistribution, where an underprepared segment pushes risk onto the joints around it, is well documented elsewhere in return-to-sport research. A 2016 systematic review by Wiggins and colleagues found that athletes returning to sport after ACL reconstruction reinjured the same knee and the opposite knee at almost identical rates. This illustrates how an untested weak link doesn’t just risk itself: it changes the loading pattern of everything connected to it.

Biering-Sørensen’s own findings make the long-term stakes clear: reduced back extensor endurance was directly predictive of who developed low back trouble over the following year. Confirming trunk endurance before returning to full training or competition is one of the more practical ways to interrupt that pattern. It stops a recurring, low-grade problem from following an athlete from one season into the next.

WHAT WE DO AT PRAXIS

We use the Biering-Sørensen test alongside movement screening and graded loading through the trunk and hips. Together, these confirm the back is genuinely ready for full training, not just quiet at rest. If you’re managing low back pain or returning from a back injury, book a return-to-sport assessment with our team.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

The Adductor Squeeze Test: The Groin Strength Number That Predicts Reinjury

by Stephen Timms | Apr 8, 2026 | Pelvis, Return to Sport

Football player lunging for the ball, loading the hip adductors

Groin and adductor strains are among the most persistent injuries in football codes. One of the biggest reasons is that they’re often cleared to return based on pain settling during light activity, well before the adductor can produce the forceful, high-speed contraction needed to kick, cut, or change direction at pace. The adductor squeeze test gives us a way to measure that gap directly, rather than guess at it.

WHAT THE TEST ACTUALLY MEASURES

The test is performed lying on your back with the hips and knees bent, squeezing a pressure cuff, dynamometer, or the assessor’s hands between the knees as hard as possible for a few seconds. It’s a simple, quick measure of maximal isometric hip adductor strength. It can be performed in both a short-lever position (knees bent) and a long-lever position (legs straighter), which stress the adductors slightly differently.

A 2019 prospective study by Moreno-Pérez and colleagues, published in Physical Therapy in Sport, followed 71 elite football players across a season and found that low adductor squeeze strength was directly associated with a higher probability of sustaining a groin injury. Players with maximal isometric adductor force below a specific threshold had a substantially higher chance of injury, and the association held even after accounting for body mass. That’s a genuinely useful, actionable number, not just a general impression of “tightness” or discomfort.

WHY TESTING BEATS GUESSING

Groin pain is notoriously slow and non-linear to resolve, and athletes and clinicians alike can be tempted to return to sport once pain-free walking, jogging, and even straight-line running have been achieved. The trouble is that a forceful cut, a kick, or a change of direction loads the adductors in a completely different way, at much higher speed and force, and that’s exactly where an undertested adductor tends to fail.

This mirrors return-to-sport research from other joints: a 2016 Delaware-Oslo cohort study by Grindem and colleagues found an 84% lower reinjury rate in athletes cleared using objective discharge criteria rather than time alone. A related study by Kyritsis and colleagues found a fourfold higher reinjury risk in athletes who didn’t meet full discharge criteria before returning. The adductor squeeze test is the groin’s equivalent of those objective markers: a number that has to be met, not a feeling that has to pass.

THE KINETIC CHAIN COST OF CUTTING CORNERS

Weak adductors don’t just risk a repeat groin strain. The adductors work closely with the hamstrings and the deep hip stabilisers to control the leg during sprinting and cutting. A deficit in one muscle group often shows up as compensatory overload in a neighbouring one. That’s part of why hamstring and groin injuries so often cluster together in the same athletes and the same seasons. The broader principle, that an undertested muscle group pushes load onto whatever is next in the chain, is well documented in ACL research. A 2016 systematic review by Wiggins and colleagues found that athletes returning to sport after ACL reconstruction re-injured the same knee and the opposite knee at almost identical rates. This illustrates how an underprepared joint or muscle group redistributes risk rather than eliminating it.

Chronic or recurrent groin pain, sometimes progressing to what’s described as athletic pubalgia, also becomes harder to fully resolve the more times it recurs. Each recurrence leaves more secondary compensation patterns to untangle. Confirming adequate adductor strength before full return to sport is one of the more effective ways to keep a single strain from becoming a recurring, season-defining problem.

WHAT WE DO AT PRAXIS

We use the adductor squeeze test alongside Copenhagen plank progressions and sport-specific cutting and kicking drills. Together, these confirm the groin is genuinely ready for full training, not just comfortable at jogging pace. If you’re managing groin or adductor pain, book a return-to-sport assessment with our team.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

The CKCUEST: The Shoulder Stability Test That Predicts Whether You’re Really Ready for Contact

by Stephen Timms | Apr 1, 2026 | Return to Sport, Shoulder

Athlete in push-up position, loading the shoulder in a closed kinetic chain position

Shoulder rehab tends to focus heavily on range of motion and pain. Both matter, but neither tells you whether a shoulder can actually take the repeated, high-load demands of throwing, tackling, or pushing off the ground in contact sport. The Closed Kinetic Chain Upper Extremity Stability Test, usually shortened to CKCUEST, is one of the few shoulder tests with solid evidence behind it as a return-to-sport measure.

WHAT THE TEST ACTUALLY MEASURES

The test is performed in a push-up position, hands on the floor a set distance apart. The athlete repeatedly reaches one hand across to touch the opposite hand and back, alternating sides, for 15 seconds. The number of touches is counted and compared side to side. Because the hands stay planted on the ground throughout, the shoulder has to stabilise under load while the trunk and opposite arm move around it. That mimics the demands placed on the shoulder during contact, tackling, and load-bearing sport far better than a simple range-of-motion or isolated strength test.

A 2014 reliability study by Tucci and colleagues, published in BMC Musculoskeletal Disorders, tested the CKCUEST in 108 people with and without shoulder impingement syndrome. It proved to be a reliable measure across both groups, with people who had shoulder pain scoring consistently lower than those without. The test has since been shown to correlate with grip strength and with isokinetic shoulder rotator strength, both established markers of shoulder capacity.

WHY TESTING BEATS GUESSING

Shoulder return-to-sport decisions are often made once pain has settled and range of motion has returned, without a load-bearing capacity test being part of the picture at all. That’s a gap. Pain resolution and true stability under load are not the same thing, and the CKCUEST is specifically designed to expose that gap before an athlete finds out the hard way in a match.

The broader principle here is consistent with return-to-sport research from other joints: a 2016 Delaware-Oslo cohort study by Grindem and colleagues found that athletes cleared using objective discharge testing, rather than pain and time alone, had an 84% lower rate of reinjury after ACL reconstruction. A related study by Kyritsis and colleagues found a fourfold increase in reinjury risk in those who didn’t meet full discharge criteria. Neither study is shoulder-specific, but the same logic applies directly: an objective, load-based test catches deficits that subjective readiness does not.

THE KINETIC CHAIN COST OF CUTTING CORNERS

A shoulder that returns to contact or overhead sport under-stabilised doesn’t just risk re-injuring itself. Athletes commonly compensate for shoulder instability by altering trunk and scapular mechanics. That can transfer load into the neck, the opposite shoulder, and the elbow over a season of repeated throwing or tackling. This same adjacent-site pattern is well documented after lower limb injury too. A 2016 systematic review by Wiggins and colleagues found that athletes returning to sport after ACL reconstruction had a roughly even split between reinjuring the same knee and the opposite knee. This illustrates how an under-tested joint tends to push the injury risk sideways through the kinetic chain rather than removing it.

Recurrent shoulder instability also has a well-established compounding effect. Each dislocation or subluxation tends to make the next one more likely, and chronic instability is a recognised pathway toward earlier degenerative change in the joint. A capacity test that catches inadequate stability before return to sport is one of the more practical ways to interrupt that cycle.

WHAT WE DO AT PRAXIS

We use the CKCUEST alongside rotator cuff strength testing and sport-specific loading progressions before clearing athletes back to contact, throwing, or overhead sport after shoulder injury or surgery. If you’re returning from a shoulder injury, dislocation, or rotator cuff repair, book a return-to-sport assessment with our team.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

The Hop Test Battery: Why 90% Symmetry Is the Number That Actually Matters After ACL

by Stephen Timms | Mar 25, 2026 | ACL, Knee, Return to Sport

Basketball player jumping, loading the knee in the way assessed by hop testing

Ask most people recovering from an ACL reconstruction when they’re “ready” to return to sport. The honest answer is usually a date on a calendar: nine months, twelve months, whatever their surgeon or coach mentioned early on. The evidence says that date should mean very little on its own. What predicts whether the knee will hold up is how it performs on a battery of hop tests, compared directly against the uninjured leg.

WHAT THE TEST ACTUALLY MEASURES

The standard hop test battery includes four tests: a single hop for distance, a triple hop for distance, a crossover hop for distance, and a six-metre timed hop. Each test is performed on one leg and compared to the other, producing a Limb Symmetry Index, the injured leg’s performance expressed as a percentage of the uninjured leg’s. This four-test battery was first described by Noyes and colleagues in 1991 and remains the backbone of return-to-sport testing after ACL injury today.

The generally accepted target is a Limb Symmetry Index of at least 90% across all four hop tests, alongside adequate quadriceps and hamstring strength. Below that threshold, the evidence is clear that the knee is not mechanically ready for the deceleration, cutting, and landing forces of full sport.

WHY TESTING BEATS GUESSING

This is one of the best-studied areas in all of sports rehabilitation. A 2016 Delaware-Oslo cohort study by Grindem and colleagues, published in the British Journal of Sports Medicine, followed ACL-reconstructed athletes. Those who passed a battery of objective discharge criteria, including hop testing, had an 84% lower rate of reinjury than those cleared on time alone. A related study by Kyritsis and colleagues found that athletes who returned to sport without meeting all six clinical discharge criteria were four times more likely to rupture their graft.

Despite this, surveys of ACL rehabilitation consistently find that a large proportion of athletes are cleared to return using time since surgery as the primary criterion. Formal hop testing is used far less often than the evidence would suggest it should be. Passing the hop battery does not guarantee a reinjury-free return. But failing it is one of the more reliable predictors we have that the graft or the other knee is at meaningfully higher risk.

THE KINETIC CHAIN COST OF CUTTING CORNERS

Perhaps the most sobering statistic in this area comes from a 2016 systematic review and meta-analysis by Wiggins and colleagues. It found an overall second ACL injury rate of around 15% in athletes who returned to sport after reconstruction, roughly split between the same knee (7%) and the opposite knee (8%). For athletes under 25 who returned to a high level of sport, that combined risk rose to around 23%. That contralateral figure is exactly the kinetic chain effect hop testing is designed to catch. An athlete compensating for a knee that isn’t fully ready places disproportionate load on the other leg, and it is often the other leg that fails first.

THE LONG-TERM PICTURE

The honest, harder-to-hear evidence concerns long-term joint health. A widely cited 2009 systematic review by Øiestad and colleagues was published in the American Journal of Sports Medicine. It found that osteoarthritis develops in a substantial proportion of knees within 10 to 15 years of an ACL injury, whether or not the ligament is surgically reconstructed. Reconstruction reduces the chance of the knee giving way and needing a total knee replacement later, but it does not, by itself, prevent osteoarthritis. What does appear to matter is minimising further trauma to the joint. Every additional graft rupture, meniscus tear, or cartilage injury adds to that long-term risk. Passing objective hop testing before return to sport is one of the few modifiable factors that reduces the odds of exactly that kind of additional trauma.

WHAT WE DO AT PRAXIS

Our sports physiotherapists run the full four-test hop battery alongside strength testing and movement quality screening before clearing anyone back to cutting, pivoting, or contact sport after an ACL injury. If you’re approaching return to sport after ACL reconstruction, book a return-to-sport assessment with our team and test the knee properly, rather than guessing from the calendar.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

The Standing Heel-Rise Test: The Calf Strength Number Too Many Athletes Skip

by Stephen Timms | Mar 18, 2026 | Return to Sport, Sports Injury

Sprinter in starting blocks, loading the calf before push-off

Calf strains have a habit of feeling better long before the muscle is actually ready to sprint again. The pain settles, walking feels normal, even light jogging feels fine, and then the same calf gives way again the moment real speed or a sudden change of direction is asked of it. The standing heel-rise test is one of the simplest ways to find out whether the gap between “feels fine” and “is fine” has actually closed.

It’s a test we come back to again and again in calf and Achilles rehab, because unlike a pain scale, it produces a number you can track and compare against normal values for your age and activity level.

WHAT THE TEST ACTUALLY MEASURES

The test is performed standing on one leg, typically on a slight incline or the edge of a step. The athlete rises up onto the toes as many times as possible until the calf fatigues or the heel can no longer clear full height. It is a direct measure of calf muscular endurance and strength, primarily the soleus and gastrocnemius, which are exactly the muscles responsible for propulsion during running, jumping, and changing direction.

A large 2017 study by Hébert-Losier and colleagues, published in Physiotherapy, tested 566 healthy adults aged 20 to 81 performing single-leg heel raises to fatigue on a 10-degree incline. The test proved highly reliable, with normative values that account for age, sex, body mass index, and activity level. That matters clinically. A 25-year-old club athlete and a 55-year-old weekend runner shouldn’t be judged against the same benchmark. This test gives us a legitimate way to compare someone against people like them, not against an arbitrary round number.

WHY TESTING BEATS GUESSING

Calf strains are notorious for being cleared on pain alone. Walking and even jogging can feel completely normal well before the muscle can tolerate the eccentric loading of a sprint or a sudden stop. This is the same trap that drives reinjury across almost every soft tissue injury in sport.

A 2016 Delaware-Oslo cohort study by Grindem and colleagues followed athletes recovering from ACL reconstruction. Those cleared using objective discharge criteria, rather than pain and time alone, had an 84% lower rate of reinjury. A related study by Kyritsis and colleagues found a fourfold increase in reinjury risk in athletes who returned without meeting all discharge criteria. Neither study is about the calf specifically, but the underlying lesson transfers directly. A muscle that feels fine and a muscle that tests fine are not always the same muscle, and testing is what tells the two apart.

THE KINETIC CHAIN COST OF CUTTING CORNERS

A calf that returns to sport under-strength rarely stays a calf problem. Reduced push-off power tends to shift load up into the Achilles tendon and down into the plantar fascia and foot, both common sites of secondary injury after an undertreated calf strain. It can also change stride mechanics enough to load the hamstring and knee differently on the same leg. The broader principle is well established in the return-to-sport literature. When one link in the chain returns underprepared, the sites next in line, whether the same joint or an adjacent one, absorb the shortfall. It’s the same pattern seen in ACL research. A 2016 review by Wiggins and colleagues found second injury rates split almost evenly between the same knee and the opposite knee in athletes who returned to sport too early.

Calf strains also become more likely to recur with each occurrence, as we’ve written about previously in relation to age-related calf tears. Confirming heel-rise capacity before clearing someone for sprinting isn’t just about this injury. It’s about breaking a pattern that, left unaddressed, tends to repeat every pre-season.

WHAT WE DO AT PRAXIS

We use the standing heel-rise test alongside calf and Achilles loading progressions and sprint mechanics screening to confirm a calf is genuinely ready for full training, not just pain-free at walking pace. If you’re coming back from a calf strain, or you want a baseline before pre-season starts, book a return-to-sport assessment with our team.

Calf raise variations we use in the clinic:

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

The Nordic Curl Test: Why Hamstring Strength Predicts Whether You’ll Tear It Again

by Stephen Timms | Mar 11, 2026 | Return to Sport, Sports Injury

Sprinter demonstrating hamstring capacity needed before return to sport

Hamstring strains have a reputation, and it’s not a good one. They are one of the most common injuries in running and field sports, and they are notorious for coming back. Depending on the sport, somewhere between one in five and one in three athletes who return after a hamstring strain re-injure the same muscle within the following year. That reinjury often happens within the first few weeks of full training. The usual culprit isn’t bad luck. It’s returning to sport on a calendar instead of on evidence that the muscle is actually ready to take the load again.

The Nordic hamstring curl test is one of the most useful tools physiotherapists have for closing that gap. It doesn’t just tell you whether a hamstring feels okay. It tells you how much eccentric strength the muscle can produce under load, which is the exact quality that gets punished in the final stride of a sprint.

WHAT THE TEST ACTUALLY MEASURES

The test is performed kneeling, with the ankles fixed by a partner, a strap, or a purpose-built device such as a NordBord. From an upright kneeling position, you lower your body toward the floor as slowly as possible under control, using the hamstrings to resist gravity. Then you catch yourself with your hands at the point you can no longer control the descent. What’s being tested is eccentric hamstring strength: the muscle’s ability to produce force while lengthening. That’s precisely what happens in the split second before a hamstring tears during the late swing phase of sprinting.

A 2016 prospective cohort study of elite footballers by Timmins and colleagues was published in the British Journal of Sports Medicine. It found that players with weaker eccentric hamstring strength and shorter biceps femoris fascicles were significantly more likely to sustain a hamstring strain over the following season. Both qualities can be measured directly with Nordic curl testing, and both respond well to targeted training.

WHY TESTING BEATS GUESSING

Comparing left leg to right leg is only part of the picture with hamstrings. Both legs can be underprepared after a period of reduced training. What matters more is whether force output has been restored to pre-injury levels and whether it holds up across multiple repetitions, not just a single good attempt.

This objective approach is backed by a growing body of return-to-sport literature. A 2016 Delaware-Oslo cohort study by Grindem and colleagues followed athletes recovering from ACL reconstruction. Those who passed a battery of objective discharge criteria, rather than being cleared on time alone, had an 84% lower rate of reinjury. A related study by Kyritsis and colleagues found that athletes who returned to sport without meeting all discharge criteria were four times more likely to re-rupture their graft. Hamstring rehabilitation follows the same principle: numbers, not calendars, should decide when someone returns.

In practice, we retest through the later stages of hamstring rehab, tracking both absolute force and side-to-side symmetry. That way, return-to-running and return-to-sprint decisions are based on a trend, not a single good day.

THE KINETIC CHAIN COST OF CUTTING CORNERS

An under-recovered hamstring rarely fails in isolation. When the primary decelerator of the leg is weak, the body finds load somewhere else. That’s often the adjacent hip and groin muscles, or the same hamstring on the opposite leg as it compensates for altered running mechanics. The clearest evidence for this adjacent-site effect comes from ACL research. A 2016 systematic review by Wiggins and colleagues found a 15% overall rate of a second ACL injury in athletes returning to sport, split almost evenly between the same knee and the opposite knee. Hamstring-specific data is less complete, but the underlying principle holds across the kinetic chain. A muscle that returns to sport underprepared changes how load is shared through the rest of the leg, and that redistribution is often where the next injury shows up.

Repeated hamstring strains also compound over time. Each re-tear tends to leave more scar tissue and more fascicle shortening behind. That produces a muscle that is mechanically less able to absorb high-speed loading, which is exactly the pattern that predicts the next strain. Testing before return isn’t just about avoiding a setback this season. It’s about protecting the tissue quality that determines how the hamstring performs for years afterward.

WHAT WE DO AT PRAXIS

Our sports physiotherapists use Nordic curl testing alongside sprint mechanics assessment and graded loading progressions to build an objective picture of readiness, rather than relying on pain or time since injury alone. If you’re recovering from a hamstring strain, or you simply want to know where your numbers sit before pre-season, book a return-to-sport assessment with our team.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

Return to Sport Testing: Why the Best Athletes Don’t Guess, They Test

by Stephen Timms | Mar 4, 2026 | Return to Sport, Sport

Sprinters in starting blocks, ready to return to competition

Ask most injured athletes when they’ll be back, and they’ll give you a date. Six weeks. Three months. Next pre-season. It’s a completely understandable way to think about recovery, and it’s also not how the tissue actually heals. A calendar tells you nothing about how much force a hamstring can produce eccentrically, how symmetrically a knee can absorb a landing, or whether a shoulder can stabilise under load. The athletes who come back faster, and stay back, aren’t the ones who wait the longest. They’re the ones who get tested.

This is the idea behind return-to-sport testing: replacing “does it feel okay?” with an objective number, measured against a normal value or against the uninjured side, before clearing someone for full training or competition. It sounds simple, and it is, but it consistently changes outcomes in ways that time alone doesn’t.

TESTING GETS YOU BACK FASTER, NOT JUST SAFER

There’s a common assumption that objective testing means a slower, more cautious return. In practice it often does the opposite. Athletes who are tracked against clear numeric targets, rather than a fixed timeframe, can sometimes be cleared earlier than a generic protocol would allow. That’s because the criteria are about capacity, not the calendar. Just as importantly, testing identifies specific deficits: a weak eccentric hamstring, a hip that collapses under single-leg load, a shoulder that fatigues early under closed-chain demand. It catches these early enough that they can be trained out before return, rather than discovered the hard way mid-season.

THE SAME-SITE RISK: WHY OBJECTIVE CRITERIA MATTER

The clearest evidence for testing over timelines comes from ACL research, simply because it’s the most heavily studied return-to-sport pathway in sports medicine. A 2016 Delaware-Oslo cohort study by Grindem and colleagues, published in the British Journal of Sports Medicine, looked at athletes who passed a battery of objective discharge criteria before returning to sport. They had an 84% lower rate of reinjury than those cleared on time alone. A related study by Kyritsis and colleagues found that athletes who returned without meeting all six clinical discharge criteria were four times more likely to rupture their graft again. These aren’t small effects. And there’s no reason to think the underlying principle, that objective testing outperforms subjective readiness, is unique to the knee.

THE ADJACENT-SITE RISK: WHY IT DOESN’T STAY WHERE IT STARTED

One of the more underappreciated findings in return-to-sport research is that an undertested injury doesn’t just risk reinjuring itself. It changes how load moves through the rest of the body. A 2016 systematic review and meta-analysis by Wiggins and colleagues, published in the American Journal of Sports Medicine, found an overall second ACL injury rate of around 15% in athletes returning to sport. That was split almost evenly between the same knee (7%) and the opposite knee (8%). For athletes under 25 returning to a high level of sport, that combined figure rose to around 23%.

That contralateral pattern reflects something we see across the kinetic chain more broadly. A joint or muscle that returns to sport underprepared forces the body to compensate somewhere else. That might be the opposite limb taking on more load, or a neighbouring muscle group, like the hip and groin picking up the slack for an undertested hamstring, absorbing force it wasn’t designed to manage. Testing every relevant joint, not just the obviously injured one, is how that hidden risk gets caught before it becomes the next injury.

THE LONG-TERM COST OF GETTING IT WRONG

The long-term picture is the hardest evidence to sit with, and also the most important reason to take testing seriously. A widely cited 2009 systematic review by Øiestad and colleagues, published in the American Journal of Sports Medicine, found that osteoarthritis develops in a substantial proportion of knees within 10 to 15 years of an ACL injury. This happens regardless of whether the ligament is surgically reconstructed. Reconstruction and rehabilitation reduce the chance of the knee giving way again and needing a joint replacement later, but they don’t eliminate the long-term joint risk that follows the original injury.

What does appear to be modifiable is the number of additional insults the joint takes along the way, each further graft rupture, each additional cartilage or meniscus injury, each recurrent strain that leaves more scar tissue behind. That’s true of the knee specifically and, in principle, of every joint and muscle group covered in this series. Testing before return to sport is one of the few genuinely modifiable factors in that long-term trajectory. It won’t undo an injury that’s already happened, but it meaningfully reduces the odds of adding to it.

ONE TEST FOR EVERY MAJOR JOINT

We’re building out this series with evidence-based capacity tests for eight of the most common injury sites in sport. Each one is grounded in peer-reviewed research on what actually predicts safe, durable return to sport. Explore the tests published so far below, or book an assessment and we’ll run the ones relevant to you.

Hamstring: The Nordic Curl Test

Why eccentric hamstring strength predicts reinjury, and how the Nordic curl test measures it.

Calf: The Standing Heel-Rise Test

The calf endurance number too many athletes skip before returning to sprinting.

Knee/ACL: The Hop Test Battery

Why 90% limb symmetry across four hop tests is the benchmark that matters most.

Shoulder: The CKCUEST

Testing true shoulder stability under load before returning to contact or overhead sport.

Groin: The Adductor Squeeze Test

The groin strength number shown to predict injury risk in elite footballers.

Lumbar Spine: The Biering-Sørensen Test

Measuring trunk extensor endurance before it becomes recurring low back pain.

Ankle: The Single-Leg Hop Test

Why most ankle sprains are cleared before control has actually returned.

Hip: The Single-Leg Squat Test

The hip control test that predicts problems in the knee before they happen.

WHAT WE DO AT PRAXIS

Our sports physiotherapists build return-to-sport testing around the specific demands of your sport and the specific joint or muscle you’re recovering from, using the evidence-based capacity tests outlined above rather than a generic timeline. If you’re heading back to sport after an injury, book a return-to-sport assessment with our team and test it properly before you trust it.

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Woolloongabba, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References

Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after anterior cruciate ligament reconstruction: the Delaware-Oslo ACL cohort study. British Journal of Sports Medicine. 2016;50(13):804-808.

Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine. 2016;50(15):946-951.

Wiggins AJ, Grandhi RK, Schneider DK, Stanfield D, Webster KE, Myer GD. Risk of secondary injury in younger athletes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. American Journal of Sports Medicine. 2016;44(7):1861-1876.

Øiestad BE, Engebretsen L, Storheim K, Risberg MA. Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. American Journal of Sports Medicine. 2009;37(7):1434-1443.

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