Member Case Study: Body Not Healing

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Do you have any ideas about why my body does not fully heal these many muscle injuries and is having an especially difficult time healing my calf?

Question from Ridgelake

I’m looking for insights into why my body has difficulty fully healing muscle/fascia injuries. At current, I have 7 separate injuries (both feet [plantar fasciitis], both calves though R much more severe, L hip/IT band, L hamstring, R hip flexor, L latissimus dorsi, L teres major) that are all “repeat offenders”. By that I mean that each injury has had months or even years to heal but has reappeared. They were originally injured through swimming, biking, running, and golf.

I can PARTIALLY explain some of the injuries. For the teres major and lat dorsi injuries, both resurfaced while rehabbing from shoulder surgery (torn labrum) this past November. The calves and plantar fascia are possibly related to rather tight hamstrings. However, I’ve been so restricted in terms of leg exercise over the last several months that they should be healing. But they are not.

My R calf has been especially problematic. I had a cortisone shot in February with no apparent effect. An MRI revealed nothing unusual. The sports medicine doctor who performed my shoulder surgery is stumped. The foot-and-ankle specialist he referred me to was not helpful. His recommendation was to take off a year or so and find another hobby/lifestyle.

Some other potentially relevant data includes: 1) At a recent massage therapy session, the LMT told me that I have more trigger points, over more body parts, than anyone he’s seen in 22 years of practice. 2) My physical therapist, who is also a certified athletic trainer, is also at a loss of what to do next. 3) I have a generally healthy diet. I eat a wide variety of fruits and vegetables, nuts, lean meats, fish, whole grains, dairy. Very little junk food. 4) I take no supplements currently.

So my question is this: Do you have any ideas about why my body does not fully heal these many injuries and is having an especially difficult time healing my calf? Do you have any thoughts on where or how to proceed to find answers?

 

Answer by Dr. Andrew Hunt, MD

Member AMSSM
 

Dear Ridgelake,

It sounds like there are a multitude of issues here and unfortunately, without knowing your specific soft-tissue injury diagnosis (i.e. not just a location) and your training regimen/volume, it is difficult to give you specific answers as to what is causing your pain in each of these respective areas. Nevertheless, it appears after reading your question, that you are having multiple “strains” of muscles in your lower and upper extremities that are either recurrent or chronic.

First, a few physiology lessons…

When an athlete trains, the act of repetitively contracting a muscle with varying amounts of force can cause micro-damage to the structure of the muscle-tendon unit. Recovery from a training stress load involves anabolic (building up rather than breaking down) processes designed to repair micro-damage. Adequate blood flow is required to accomplish this, as well as to clean out any inflammatory processes that may have occurred secondary to the micro-damage. Insufficient recovery means micro-damage is not repaired, and further training prior to recovery only means additive damage to the muscle-tendon unit if one is not careful.

 

In addition, chronic stress (be it overtraining or emotional stress) can put you into a catabolic state (increased cortisol levels) that prevents or slows the normal anabolic/rebuilding processes from occurring. Adaptation with ongoing training involves synthesizing more muscle protein and more connective tissue to accommodate the increased stress being put on muscles and tendons. The end result of accumulating micro-damage is macro-damage….an overt tear, strain etc. Sometimes, rest (albeit active rest below threshold) is just as important as training.

One other principle that is important here relates to the muscle/tendon stretch. A muscle-tendon unit has a certain amount of elasticity (ability to stretch) inherent to it. Exceed this, and the unit may fail mechanically by tearing. A flexible muscle has a resting tension that is not close to its mechanical failure point. Contraction of a flexible muscle still does not get it close to its failure point. A “tight” muscle, however, probably sits much closer to the mechanical failure point at rest, and contraction of this muscle is more likely to push it past failure.

If you are experiencing repetitive strains of your lower extremities, the cause could simply be insufficient recovery between workouts. It could be a matter of inherent muscle tightness that is predisposing you to repetitive strains – especially if your baseline flexibility is poor. Don’t underestimate how muscle tightness in your hamstring may set you up for repetitive issues with your calf, plantar fascia, and IT band. As far as the calf issue goes, I am not sure why your calf was injected, but the negative MRI is encouraging in terms of ruling out significant mechanical issues. The issue of multiple “trigger points” may suggest an underlying issue such as fibromyalgia, and further consult with a sports physician or rheumatologist might be in order.


My suggestion at this point outside of the above recommendation is to have a qualified coach look at your training/recovery volume to make sure you are not overdoing things, and to continue to work on your flexibility. Assuming your diet is as you say, I do not think that this is the problem. Hope all this helps.

Dr. Andrew Hunt, MD
Medical Director, USA Triathlon

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date: May 8, 2007

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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