Sunday, October 25, 2009

Torn From My Sport

Playing beach volleyball on a poorly maintained sand court, which was not rototilled properly, I tore my calf muscle digging for a ball last month. About 2-3 inches under the surface of the sand the soft sand gave way to something as hard as concrete. I also broke both toe nails on my big toes jamming them into this hard-packed sand. When digging my foot initially gave way in the soft sand as expected, and then suddenly hit the hard unyielding "concrete" below.

I heard a loud *pop* and felt the muscle give way catastrophically. It seems all of the tension/strain sensors in the muscle realize at the same time something is terribly wrong, and every muscle fiber in the entire calf relaxes instantly. After waiting for the pain spike to subside I hobbled off the court with my arm around a friend's back, got in my car and went home.

Once home I immediately took 6 200mg Advil tables, took a shower to get the sand and sweat off of me, then laid down on the couch, elevated the leg and iced it with frozen peas. After about 6 hours I found my ACE bandage so I could add Compression to the R.I.C.E protocol. (Rest, Ice, Compression, Elevation). Before going to sleep I took 3 more Advil and two Aleve tablets so I would have something to suppress the swelling all night long. Based on many years of experience with my bad back, taking 6-8 Advil (ibuprofen) ASAP is critical - more so than ice or compression. For my back injuries the rehab time is cut from 3-4 weeks to 3-4 days.

After 3 days the blood from the torn calf begins to reach the surface of the skin and turn it red.

As you can see, at about 40 hours it was swollen to twice it's normal size, in spite of Advil, and R.I.C.E

The blood from the tear continues to migrate to the surface of the skin, and after 5 days it was fully bruised. It looked like this, more or less, for 4-5 days. In the mornings my urine would be very dark from removing the waste products at night when getting full rest. You can see the ACE bandage affects the blood's migration path.

After 14 days the tear had stopped bleeding and most of it had been absorbed by the surrounding tissues leaving it with a definite yellow hue but just a few remaining red splotches.

At about 20 days there was just a small amount of bruising along the Achilles tendon and just below the ankle joint on the anterior side.

At about 4 weeks there was no discoloration left of any kind anywhere, though when folding my leg under me the calf still feels swollen, with a definite ridge in the muscle running across the tear zone. I hope this is mostly scar tissue that will eventually disappear.

Based on the research I found taking a Google safari, my calf tear was a most severe Level-III, but a bit on the mild side of that. The expected time to rehab a Level-III is 2-3 months, and I went riding tonight after just over 5 weeks, so I think I did a pretty good job managing this wound. I only had one small re-injury pushing off taking a giant step up over some mud to get out of the way of a car, but otherwise have been able to avoid any re-injury to date.

I will say the fatigue was staggering the first 2-3 weeks. In fact, the first 2 weeks I was sleeping 12-18 hours a day. I also drank a lot of Welch's red grape juice for the vitamin C, a lot of Florida's Best OJ with calcium, ate a lot of Dannon yogurt, and almost 5 lbs of almonds. I'm still not sure what's in the almonds, but a lot of magnesium for sure. I was also taking a calcium, magnesium, zink supplement several times a day. Protein was unexpectedly something I didn't crave, although I ate a dozen or so eggs and drank a lot of milk just to be sure. Looking back, I think it was minerals more than anything my body was craving.

Initially the torn muscle fiber is replaced by collagen, which uses a lot of vitamin C. This holds the wound together more or less until the healing process is complete. At the point where the muscle started to reincorporate, I had the weirdest sensations like someone was loop-stitching each muscle fiber together, cinching the two ends back together one by one until the muscle was reattached to itself. (muscle fibers are very long and run the entire length of the muscle) I would wake up in the morning and have this tweaky sensation until I got up and started walking on it. Rest seemed to invoke this healing process, and use stop it, so I tried to rest it.

I went riding tonight and had trouble retraining my leg to fully extend after limping for 5 weeks. When my foot got near the bottom of the pedal stroke my calf and leg would start to pop back up to avoid rolling forward past the balls of my feet onto my toes. This isn't possible on a bicycle, as you can't put pressure forward of the balls of your feet where they rest on the pedals.

Within a couple of miles though I shifted into a higher gear and mashed a little on a hill to keep the leg from "kicking back". That strategy worked quite well. I MAY also have solved a persistent problem with my right knee sticking out as my foot now seems to want to point in, instead of out. That would be a very welcome change!

Best of all, my speed didn't suffer much at all. I completed the short 14 mile route within 2 minutes of my average time. Obviously I was hammering pretty hard by the time I got on the back half of the ride. I'm a lot more tired than I should be, but all in all, I don't seem to have lost much leg strength. I will need some time to get my cardio back and get toughened up again for long rides, but that will just mean good rest after riding and pushing myself to get out of the door and get some miles in.

I'm back! :D


Anonymous said...

Cool to see that healing process in pictures! Better that you didn't even lose any strength during the time of rest. Glad you can do you favorite sport again:-)

Gotta Run..Gotta Ride said...

I think you will be surprised to find how quickly your cardio comes back. You have drive and that alone helps.

As for a recovery drink.... Scott prefers a cold beer. Not sure if has help with his neck but it seems to relax him and that helps me :)