Runners in the Comrades Marathon, South Africa June 10, 2018. REUTERS/Rogan Ward
Lower leg pain often plagues runners. The trick is distinguishing pain from an acute injury, overuse, or an emergent problem. In today’s feature article, Pat Gilliam offers an overview of lower leg injuries and identifies the particular characteristics of each syndrome.
In most acute injuries, the athlete experiences a sudden onset of pain and disability, often accompanied with a tearing or popping sensation. Muscle and tendon tears are graded as to severity of injury either through clinical exam or magnetic resonance imaging (MRI) (see table 1). Up to 65% of all calf strains occur in the medial head of the gastrocnemius and over half of these extend into the soleus as well (see figure 1)(1). Strains to the gastrocnemius occur primarily during sprinting, jumping, hill training or changes in direction due to the preponderance of fast twitch fibers within the muscle. Soleus strains tend to happen during endurance events or overextended training schedules because the muscle consists mostly of slow twitch fibers.
Table 1: Grading system for calf injury
Grade
Symptom
Site
1
Pain during or after activity
ROM normal at 24hr
Normal power and initiation
Pain on contraction
Myofascial - injury in the peripheral aspect of the muscle
2
Pain during activity and restricts participation
Limitation with ROM
Pain on contraction
Reduced power on testing
Musculotendinous - Injury within the muscle belly most commonly at musculotendonous junction (MTJ)
3
Extensive tear
Sudden onset of pain
Significantly reduced ROM
Pain on walking
Obvious weakness on testing
Intratendinous - An injury which extends into the tendon
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