|Ironman finisher Pat McCann|
|Ironman finisher Mike Hemenway|
Aside from being well dressed local business men, what do these two Ironman Finishers have in common? They are both currently suffering from a calf strain. In what's become an all too common story, both of these superb athletes have moved away from triathlon because of injury but stay active in other endeavors. Pat trains daily with the area SEAL Team Training - yep, you've seen them in the park, lots of push ups and carrying logs around, you know the type (my type actually, so do I). Mike has had a hip replacement and so his options are a bit more limited. He bikes, walks and although he goes to the pool and says he's swimming, I'll be he spends more time talking to the life guards.
Successful, continuous running is all about balance. Only part of this, regardless of body habitus, is the ability to glide down the track while others lunge, lurch or plod. Paul Jagasich, a professor of modern languages at Hampden-Sydney College in Virginia, calls this working with the elements. He successfully swam the English Channel in 1988 but had a very hard go of it somewhere near the middle because of the waves and rough seas. He was struggling mightily with his environment...until he figured out the timing of the waves and how to stroke from wave top to wave top. It was "dancing on the waves" as he later put it.
As runners, if our brains are constantly in gear considering our running surface, foot wear, environmental factors, previous running load/stress/effort, then hopefully we'll minimize the potential for injury. In Born To Run, Christopher McDougall quotes the Sports Injury Bulletin, "Athletes whose sport involves running put enormous strain on their legs." The American Academy of Orthopedic Surgeons (of which I am a member) concluded that distance running is "an outrageous threat to the integrity of the knee." We need to be on top of this every day so that we're concentrating on our running successes, not visits to PT as we make our daily log book entry. We'll work with our elements.
Lets look at the pertinent anatomy of the calf.
The two main posterior muscles are the gastrocnemius, or gastrocs, and the soleus. More superficial, the gastroc crosses both the knee and the ankle joints and aids in both knee flexion and ankle extension - toe down. The soleus is deeper and contributes to your ability to stand on your toes.
When evaluating the patient with calf soreness, some will report the acute onset of pain near the center of the calf, "Like I got hit there with a golf ball!" Interestingly, others experience no sudden pain, only a localized soreness following exercise. Rarely they can remember over stretching the muscles. In the pre MRI days, this would have been classified as an injury to a tiny muscle deep in the calf called plantaris. But, we now know that the origin of pain is the medial (inside) head of the gastroc and that once noted, if the activity continues a complete tear of the muscle may follow. The athlete should be so warned. (Other sources of calf pain including stress fracture, blood clots, etc. should be considered.) That said, most calf strains only involve a small portion of the gastroc.
The junction between the gastrocnemius muscles and achilles tendon
Lastly, a Grade 3 strain can include a greater involvement of the muscle to the point of rupture, an inability to walk or contract the muscles, and significant swelling/bruising. These are frequently repaired.
Usually a Grade 1 injury resolves in 10 days, Grade 2, 4 - 6 weeks and a grade three 3-6 months. There have been reports of some permanent weakness after these. Fortunately, the Grade 1's and 2's are the most common.
And, in the words of General Patton, "Success is how high you bounce when you hit the bottom." I suspect that this can be said about more than triathlon.
Happy Memorial Day to all. Thank a veteran!
Sesamoiditis Update - I did a blog a while back on Sesamoiditis, pain under the ball of the foot, and recently found an interesting cause. One athlete, without trauma, was having the gradual onset of pain and after working this through, we determined that it's source was a recent bike fit! He had a habit of riding with his right knee closer to the top tube than the neutral position. The bike fitter put a wedge between the shoe and cleat but all it did was overload the medial foot. Thus...sesamoid pain! Wedge removed, pain gone, happy athlete...trying to "remember" to keep his limb neutralized.
Images 3, 4, 5, 6 Google Images