Randon Hall, MD
KD's Injury is a Classic Calf Tear
If you are in to #sportsmedicine Kevin Durant’s injury last night in game 5 against the Houston Rockets was a devastating blow to arguably the teams best player in the playoffs. Analysis of multiple TV personalities was that he had injured his Achilles, which is one of the most feared injuries in basketball. However, there are a few classic features that highly suggest a muscle tear of the calf rather than an Achilles rupture.
If you look at the video, Durant lands from a jump shot where his calf enters what is called the eccentric phase contraction. Basically he has the weight on his foot but he has not started to push off and run down the court. As he starts to run down the court he looks back as if someone kicked him in the leg and grabs his calf. A key feature of a calf strain is the athlete will say or act as though someone kicked them in the back of the leg. At times athletes will be adamant or confused that someone struck them in the leg although the video will show the opposite. I have also heard athletes report that it felt like someone hit them with a bat in their leg. The second key point is that Durant grabs his calf not his ankle. Typically athletes with an Achilles tendon tear occur on an explosive move and are unable to walk. Take a look at the difference between Kobe Bryant's Achilles injury and KD's Calf injury. In the Kobe video he is exploding past another player and drops to the ground to grab his heel.
The calf is made up of three muscles. The largest muscle is the gastrocnemius which is made of mostly fast-twitch fibers. The gastroc has a medial (M) and lateral head (L), with the medial head being larger and longer therefore more susceptible to injury. Just beneath the gastroc is the soleus muscle which is smaller and made of slow-twitch fibers. Lastly, a small thin muscle that lies over top of the soles is called the plantaris muscle which does not have a significant role, but can be injured.
The diagnosis certainly can be made with history and clinical exam, however further imaging can be performed to confirm. An ultrasound at the venue can be used to easily make the diagnosis however typically the athlete will be evaluated with an MRI to help understand the extent of the injury.
MRI - Gastrocnemius Tear
In general, calf tears are treated with classic interventions in ice, compression and pain medication. If the athlete is struggling to walk a walking boot or crutches can be used. With a mild strain (grade 1) of the calf the athlete may be able to return in approximately 2 weeks. A grade 2 injury typically will sideline the athlete for about 4 weeks. Lastly, a complete grade 3 tear with significant separation of the muscle will likely require surgery and return is estimated around 6 months.