Dealing With Injury
What I learned from my most severe injury yet…
You could say I’m a jock, actually most of my friends would, maybe with nerd-like tendencies. I grew up in a world of competitive sports and have dealt with my share of injury. Mostly things like sprained ankles, sprained wrists, a chronic tendonosis in my right shoulder, and the occasional back pain. It might put me out for a few weeks at a time, but nothing overly serious.
I have seen teammates and competitors end up with knee surgery, pins in their ankles, plates in their collar bones and other serious stuff yet I've managed to escape any debilitating injuries myself; Knock on wood.
That is, until last year. In October 2012, I tore my right gastrocnemius, the largest, most superficial calf muscle, on the medial (inside — towards the midline of the body) aspect. It was in the middle of a warmup for a fun, rec league volleyball game and felt like someone had hit me in the calf as hard as they could with a hammer.
My first reaction was to look behind me to see who had hit me, until I took another step and dropped like a sack of potatoes. Realizing no one was behind me, I didn’t want to look down. For fear of seeing my calf rolled up into the back of my knee or down into the top of my ankle. My first thought was a complete tear, I’ve seen that happen (it’s disgusting) and the recovery process is a tedious one requiring surgery.
The pain never really sets in until you look, which unfortunately, I would have to eventually to hobble off the court. Having minorly pulled various muscles over my athletic career, I instantly knew this was something more serious. I looked down and the calf was intact, phew… Not a complete tear, something to be excited about I guess.
Could I plantarflex the ankle (push the toes down)? Yep, again…phew…so I tried again with a straight leg. Having an issue with a straight leg was likely to mean it was gastrocnemius, having a problem with a bent-knee meant likely a problem with soleus (the deeper calf muscle) but flexing hurt a lot no matter what I did with the knee. That was troublesome.
I probably should have gone to a hospital in hindsight. It may have been suitable to get the calf imaged to know for certain what had happened but having spent my fair share of time in emergency rooms with ankle, muscle and wrist injuries I was pretty sure an ER doctor would not order that kind of imaging at that time. The inflammation can alter the results that close to injury anyway.
Typically they get an X-Ray, if nothing is broken it’s home to rest, elevate, ice and compress (R.I.C.E.); I've done that dozens of times. When I was an athlete in school I could easily get into see a Sports Medicine Doctor, so that would be my preference but it had been years since I played competitive levels of sport and had that kind of access.
In my experience, Sports Med Doctors tend to be far more useful when it comes to sport injuries, but in my present situation it might take weeks for me to see one. I opted instead to start the rehabilitation process right away, and cancel all my own clients for the next 3 days. The next day I was in to see a sports physiotherapist to start getting treatment right away. I’d recommend sports physiotherapists in particular because it’s been my experience that they are generally better equipped to deal with injury management than most doctors outside of a few specialities (like orthopaedists, physiatrists and sports medicine doctors).
This close to injury there isn’t actually a ton to do but figure out what happened (assessment), a little manual massage and some EMS (electronic muscle stimulation) to keep the tissues moving. Come in a couple of days later, do the same, try to minimize the swelling and stay off the calf as much as possible for the first little while. Set yourself up for as smooth a recovery process as possible.
The Psychological Effects Are More Damaging
This isn't really a story about rehabilitation, it’s 12 months later and the calf is mostly healed. What remains broken isn’t my calf muscle, it’s my brain. Controlled environment training is fine, I’ll sprint between cones, change direction, skip, jump, bound and chase things down no problem.
It’s the chaotic sports environments are still a huge setback for me mentally. Sport isn't a controlled environment, and you never know when you might have to try and change direction suddenly and without conscious thought. No matter what, when I put myself in that environment, suddenly that leg doesn't feel as strong as it used to; Even though in many ways its now stronger than my other leg.
At the time I injured the calf I was more angry at myself than anything else. How could all of this have happened? I’m a trainer. I show people how to prevent this kind of stuff from happening to them. I train myself pretty effectively and pretty hard. I’m pretty strong, I'm mobile, I move well, and my muscles are pretty elastic. Oh no, how was I going to work? What would I tell my clients?
I was really angry. How could I miss this? Was this all just a freak accident? Or was there something I could have done to avoid this entire mess.
My thoughts immediately dwelled on what I might have ignored or missed in my training and preparation:
- I had been dealing with a huge knot (trigger point) in my right medial calf for at least six months leading up to the injury.
- At the same time I had a huge matching knot above the knee joint in my medial quad and into the leg adductors (the long groin musculature) .
- My movement through my right leg adductors had felt restricted for about the same time as well.
- I was getting medial knee pain every now and then for the first time in my life, particularly when I did certain moves in the gym like lateral lunging.
- I was not engaging in much explosive plyometric training and not getting it through athletics the way I used to. Too much focus on strength training alone, not enough on transfer or application.
What could I learn from this situation?
Well I had gone into to see a physio in regards to these issues and even tried for the first time a rare form of Chinese Therapy (almost like an ancient form of chiropractic). Both gave me relief initially, but it soon relapsed back into a similar pain.
Everybody had missed, what I missed it turns out. In fact, even during the rehabilitation process we were so focused on rehabbing the calf that we missed the potential cause for the first few months too; Perhaps a major reason why the rehab process didn’t initially go as smoothly as it otherwise might have (another being that I worked with 3 different physiotherapists due to unforeseeable circumstances).
Prior to the injury, we all assumed, based on our previous experiences that the problem was stemming from my hip. In a lot of cases weak hip abductors (gluteus muscles) translate into medial knee pain. I don't pronate much at my feet which can often also trigger medial knee pain so it made sense that my hip was the issue.
Except my hip was pretty strong and I was only making it stronger. I've never really had a knock knee problem in my life and it didn't really look or feel like that was a problem when I was training. I was a little less stable on my right hip, but nearly almost every righty I've worked with is (for various reasons). We didn't even think to look at the foot really because I wasn't pronating heavily.
I had probably sustained so many minor injuries in the ankle, the scar tissue had locked my foot into supination (the opposite of pronation) so my ankle wasn’t pronating at all.
Side Note: Some pronation is good, necessary even. People who ‘over-pronate’ is what often leads to medial knee pain.
Well the body has to pick up that lack of mobility from somewhere and that’s probably where my two big knots were coming from because my knee was moving more than it should to compensate for the lack of movement in my ankle. The body is a wonderful machine, extracting efficiency from where ever it has to.
The other potentially lacking issue was that I wasn't using much jumping, skipping, bounding or other elasticity-type exercises all that much in my training leading up to the injury. Had I more adequately prepared for dealing with such quick velocity movements found in volleyball, the less likely this injury was to have occurred.
What I Learned and What Might Save You a Lot of Trouble
- Listen to your body. I could have taken a more proactive approach by seeing more than 2 different therapeutic options for my knee. Sometimes, pain doesn't make sense (even to therapists) but chances are there is something wrong, you just have to find what. You’d be amazed what we've found with the help of some gifted medical professionals. Sometimes it’s in your head though, so be aware…
- Start using a foam roller or some other form of self-massage tool, regularly. Particularly if you engage regularly in physical activities. I under-estimated its benefit as a diagnostic tool but if you have painful knots regularly occurring in the same place, you are bound to get joint pain close by; Especially if you have them above and below a joint. Before that joint pain becomes serious, get your movement looked at, be proactive.
- Be mindful of movement changes. My restriction didn’t seem that obvious because I had been working a weak point in my flexibility (my adductors) at the time. I didn't know how restricted it was until my left one started to gain a lot of flexibility and my right one stopped improving. Other movement alterations could also be a signal.
- Always check upstream and downstream. Meaning, look above the problem and below the problem, even a few links away. Even if it seems obvious what the problem is, if you keep doing what you've always been doing and the situation doesn't change, you didn’t find the solution. Generally speaking you have either a stability issue or a flexibility issue (in my case it was a flexibility issue).
- Don’t give up in trying to find a viable solution. Even if the best thing you can do is manage the situation through training changes, train like you're fixing the problem and keep looking for a solution. Typically training regularly (just like the therapeutic modalities) will at least give you manageable relief and prevent it from getting worse.
- Everybody should train explosive power a little bit. I know a lot of people shy away from quick explosive training the older they get, but it’s exactly this kind of training that prepares your body better for the vigor of everyday life and sport. Had I been using more, I'm confident that the damage here would have been minimized.
Like I said before, I’m training for old age. How about you?
**I realize there are some big words in there, I tried to work my way around anatomy and kinesiology terms as best I could but sometimes there is no laymans term for explaining an injury like this in clear enough detail. Check out the links if some things confused you, I realize that not everybody knows their way around the musculoskeletal system. Thanks to the team who helped patch me back together.**
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