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“Muscle Strain” Rehab in the Twilight Zone (Member Post)

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Has this ever happened to you? You hurt yourself, but you’re not quite sure how. The problem just doesn’t seem to quite fit the description of any injury you understand. It seems odd. Eventually it goes away, and, if you ever think of it again, you think, “What the hell was that?

This happened to me this summer. I got injured (again), and it seemed a bit odd, (again). So now it’s time for another delightful episode of Relating to My Readers.

Welcome back to ultimate… and injury!

I strained a calf, I guess, playing ultimate. It was my fourth game since returning to the sport this summer after a sad sixteen-month pandemic gap. I was super excited to play again!

I was super disappointed to be sidelined almost immediately upon returning! Ugh.

And there was no glory either. No dive, no catch, no diving catch. No sprint even! The muscle ripped while jogging from one field position to another. Good grief. Stupid body, stupid age, stupid jogging.

Or did it tear? Rehab in the Twilight Zone

Nothing with this body of mine ever seems to be straightforward. This story doesn’t have a dramatic punchline like my recent kooky experience with mouth and face pain episode… but it’s still a good story with bit of a twist ending, rehab in the Twilight Zone. For damn sure it didn’t end like a tale of a minor muscle tear should.

You’d think I could diagnose a muscle strain (tear), a seemingly straightforward injury, because I have literally written a whole book about them. (And this personal case study will trickle down into that book and make it better… as many of my athletics injuries have in the past.)

If I had a muscle strain at all, it was the easy kind. But my symptoms did not send a clear enough signal to be sure what kind of injury this really was. Funny how often that happens.

It felt like a cramp at first

It seemed just like an exertional cramp. It was cramping weather for sure! Hot. (Cramping strongly correlates with heat.) I was jogging casually when it struck, not pushing hard, and that’s a bit odd, but not unheard of for cramps.

It felt like it painfully seized up, and I had a strong craving to elongate. Cramp!

And yet not like a cramp…

Unlike a cramp, there was no strong pulling. The muscle didn’t bunch up as it should with any self-respecting cramp. It didn’t just ease up and go away with a bit of stretching. I have had countless ordinary exertional cramps, from mild to severe. They usually pass like ice cream headaches.

But this pain didn’t pass: it kept right on twinging without any contraction at all, and throbbed at all times as though damaged. After twenty minutes of chilling on the sideline it was still howling and unusable. I thought “NOT GOOD. Maybe an actual strain.”

Another thing: the pain was also suspiciously focal. A typical calf cramp does not confine itself to one spot. This did.

Can cramps injure?

Yes. Although it isn’t the norm, you can definitely get a strain from a cramp. The cramp feeling didn’t feel extreme enough for that in this case, however. Maybe the muscle just tore… and my brain interpreted the sudden pain as crampy?

Or maybe I had a cramp… and my brain interpreted it as an injury? Never underestimate the power of brains to muddy the waters like this. The brain-factor is the number one reason that pain and injury aren’t simple.

My best guess at the time is that it was probably a grade 1 strain. It was not painful or debilitating enough for grade 2. Just a few highly stressed muscle fibres.

Comic relief: sideline samaritan prescribes mystery cream

A good samaritan on the sidelines tried hard to prescribe me a remedy. It was a white bottle with all Chinese characters, except for the word “antiphlogistine” — so a “rubefacient” then, a spicy A535-ish muscle-rub thing.

I’d barely limped off the field & he was all “you have to try this, it’ll fix anything!” Just gimme a second here, friend…

His enthusiastic desire to help was adorable, but it was amaing how hard he pushed, and exclusively using anecdote and hyperbole to “sell” it to me. It was a little microcosm of sports medicine (which isn’t much better even at the highest levels).

I did not indulge in the mystery medicine. I will try damn near anything … at a time and place of my choosing. Not so much when wounded on the sidelines and I still have to drive home.

Plus I knew it was probably just a spicy rub and … yeah, so what? That wasn’t going to make any important difference to anything.

Day one: an eyebrow is raised

At first, it mostly acted like I expect a mild strain to behave: twinging vigorously with any attempt to use the muscle. I couldn’t walk without a limp. But it was a slightly duller pain, less like a steak knife and more like a spudger.

But, notably and quite oddly, I could not find a sensitive spot when I poked around in my calf around the site of discomfort. And that really did not fit the working theory of “strain” well. Torn tissue is usually sensitive to poking.

And that was my first significant eyebrow raise about this incident. It was not to be the last.

The first two weeks: the mildest strain ever?

I seemed to recover extremely quickly. It did follow an injury healing curve, at roughly the same pace I’d expect to heal from slicing a finger a bit while chopping onions. Slow at first, the faster. There was no doubt I was damaged in some way, but it improved steadily, and I could barely feel a thing by the end of the first week.

After declaring it to the be the “mildest strain ever” on Twitter, I let three painless days go by before I began to test it, casually, with some heel raises and easy jogging.

There were some very minor twinges in my first couple tests, and no flare-up. So I upped the ante and went for a normal easy run. Nothing. It was like I was never injured.

Things get weird again with a very un-strain-like flare-up

After a quick recovery, with all initial tests passed easily, and completely pain-free for many days…

It flared up while I was walking! The exact same pain — the same quality, the same spot — just brief and relatively minor. I felt like I had to “shake it out” or walk it off.

Muscle strains are notorious for re-injury… but they don’t “flare up,” significantly but briefly, out of the blue, while walking. If you re-injure yourself, you’re re-injured, and the healing clock is reset. This was a couple minutes of pain and then I was fine again.

It was too mild for a re-injury, and also too intense for the nagging of an old injury. Eyebrow raise #2.

My predictable failure to return to ultimate two weeks after injury

I was fine tossing the disc around for 20 minutes before the game (which is more vigorous that it sounds). The peace did not last.

On the first sprint of the first point… bam, re-injured! Just like that.

It was not “sudden” like a trauma, but quick, coming into focus over about 20 seconds, peaking at about 60% of the original intensity, once again splitting the difference almost perfectly between the symptoms of a cramp and strain.

Whatever it was, there was no arguing with it. I was obviously done. I limped off the field, and through the rest of the evening. At least I got a clear warning, instead of a traumatic re-injury.

Weeks three & four: mostly normal recovery

The next day there was just an echo, hardly anything left. But I also had the fresh memory of how it came out of nowhere just the night before.

And on that walk.

I resumed rehab protocol, treating it like a strain, and the second fortnight was much like the first fortnight, just easier.

And then another attack.

But today? Today the pain came back… while walking slowly on the level. Just strolling along, and wham, a good dose. It didn’t bother me on runs. It didn’t bother me through many a heel raise. But it did bite me like a snake while strolling amiably.

The last chance to play ultimate in the summer of 2021

It was time for the final night of ultimate, my last chance to play in the short, disappointing 2021 summer season — which I’d missed half of. Except for that one snake bite, I had been completely pain-free for well over a week, and was seemingly on course.

I have been playing ultimate for 24 years, and I am now fifty years old in a sport where most players quit by the time they’re 40. For a decade, I’ve known that every beautiful night of summer ulti might be my last.

I went to the field wondering if I’d get one more.

Nothing happened… not at ultimate, anyway

My calf was perfect. Not one twinge. I played exuberantly. I played hard and well. I sprinted without fear. I forgot there was even a danger. I got one more night of beautiful summer disc sporting.

Three days later, the pain struck while I was sitting at my desk writing. I limped for hours. It was fine the next day… and I haven’t felt it again for more than two months now.

I’ve been studying musculoskeletal medicine for exactly as long as I’ve been playing ultimate — just shy of a quarter century. Despite all that study, cross my heart and hope to die, after more than two decades in this business, I have no clear idea why that would happen.

But this is exactly the kind of weirdness people encounter with their aches, pains, and injuries.

Have you had an injury that didn’t behave? Send me a note, tell me about it.