Am I through with top level Tennis-Injury Explained-Help requested

[charliefedererer]

Originally Posted by WildVolley

I had to look up what a plantaris muscle is. Never heard of it before.

Guess you hadn't heard of "tennis leg".


"An isolated injury to the plantaris tendon or myotendinous junction has been described as "tennis leg." Powell first described this clinical entity in 1883.4 While there has been controversy in the orthopedic literature as to whether the clinical entity of plantaris tendon rupture really exists,5 surgically confirmed cases of plantaris tendon rupture have been well documented.6 Tennis leg may be seen in young athletes or in sedentary older individuals. A tearing sensation or pop is often reported, with pain increasing over one to two days and with tenderness and swelling found at the calf.

The plantaris muscle is of questionable physiological importance. It is thought to be a vestigial structure and is absent in 7% to 10% of the population. Despite these facts, injuries to the plantaris are a not uncommon cause of patient pain, and can present with a confusing clinical picture, thus making an understanding of plantaris anatomy and related pathology important to those who utilize and interpret MRI."
- http://www.radsource.us/clinic/0608


PL = Plantaris muscle/tendon

[Mick3391]

Originally Posted by charliefedererer

You have lived long enough to realize that the vast majority of aches and pains, even if initially severe, usually get better on their own.

Vast majority of aches and pains - but not all.


You also have observed that most superficial wounds heal in about a weak - hence it is understandable that you took a week off and expected to see an improvement.



But from your response to WildVolley I assume you have pain in the area consistent with "golfer's elbow".




Golfer's elbow, just like tennis elbow that occurs on the other side of the forearm near the elbow, involves either one, or more commonly many, small tears in the tendon:






Tendon is very dense protein that almost resembles a strong rope.


The way the body repairs a tendon is by the process of "inflammation and repair".



Inflammation means that white blood cells are attracted to the site of the injury.
The white blood cells make chemicals (cytokines) that attract the type of cell (fibroblast) that will make the protein to repair the tear.



The trouble is that the protein strands that are made by these cells are incredibly small. It takes millions of these little strands to bind together to heal the tear.



These little protein strands resemble the protein strands that make up a spider's web.



From the Spiderman movies we all know that a spider's web is stronger than steel, ounce for ounce.

But we also all know that to break up a spider's web, we only need to wiggle our finger in it.




It takes many weeks for these isolated strands to become "crosslinked" and form a strong tendon again that is as strong as rope or cable.







What you are doing by continuing to play is break down the protein strands as you forcefully swing your racquet - this force is way more than the force of a finger in a spider's web breaking down thin, healing protein strands.




Every time you break these protein strands down, the body has to start all over to heal the area.

You elbow area is living the same problem over and over day after day, like in the movie Groundhog Day.




And why the continued pain?

The inflammation phase usually lasts just long enough for the white blood cells to recruit the cells that make the protein (fibroblasts) to the the injured site.
Again, they recruit the protein building cells by secreting chemicals (cytokines) to the area.
The main job of the chemicals is to attract the protein building cells there, but a side effect is that these chemicals are that they irritate nerve endings - hence pain.

Because you have broken down these healing areas so often, there is a much larger number of white blood cells making a lot more chemicals at the site to finally make enough protein strands to heal the area.



[Be warned: if the inflammation goes on too long, the chemicals will actually start to break down surrounding tissue, resulting in degeneration/fibrosis of the tendon, and it will never go back to normal.]:







So do yourself a favor and REST.

Go see that doctor who can give you individual care based on exactly what is wrong for you, and can outline a gradual increasing amount of physical therapy.




A few words on physical therapy.

The first sessions of "exercise" are not to strengthen the muscle/tendon area.

They are just to keep the tendons sliding past one another in a normal fashion.

Otherwise the process of inflammation ends up with tendons and muscles "glued together" by all those excess protein strands, so the tendons and muscles don't glide smoothly any more.

Only when almost all the pain goes away can actual strengthening begin.

And if there is a return of pain, you have hod off on exercise for a time, then begin again.



I hope this helps!

That's great and clearly you put alot of work in it, I truly appreciate that. It also explains why my Psoriasis has come back a bit, a boost in my already overactive immune system

[Mick3391]

Originally Posted by charliefedererer

Guess you hadn't heard of "tennis leg".


"An isolated injury to the plantaris tendon or myotendinous junction has been described as "tennis leg." Powell first described this clinical entity in 1883.4 While there has been controversy in the orthopedic literature as to whether the clinical entity of plantaris tendon rupture really exists,5 surgically confirmed cases of plantaris tendon rupture have been well documented.6 Tennis leg may be seen in young athletes or in sedentary older individuals. A tearing sensation or pop is often reported, with pain increasing over one to two days and with tenderness and swelling found at the calf.

The plantaris muscle is of questionable physiological importance. It is thought to be a vestigial structure and is absent in 7% to 10% of the population. Despite these facts, injuries to the plantaris are a not uncommon cause of patient pain, and can present with a confusing clinical picture, thus making an understanding of plantaris anatomy and related pathology important to those who utilize and interpret MRI."
- http://www.radsource.us/clinic/0608


PL = Plantaris muscle/tendon

Yea, it's a "Pop and drop" Very painful, see how that muscle goes down all the way of the leg, that's where the pain is. Yea it's better of course, my doctor said, and this sounds weird, but that it "Rolls up and goes away", whatever that means

[LeeD]

Can you still play if you dial it back some, maybe 70%, use new cushy shoes, and generally play with less ferocity?
Maybe you don't know your body's limits, and still think you're 14 years old....in a 30 year old body.

[charliefedererer]

Originally Posted by Mick3391

Yea, it's a "Pop and drop" Very painful, see how that muscle goes down all the way of the leg, that's where the pain is. Yea it's better of course, my doctor said, and this sounds weird, but that it "Rolls up and goes away", whatever that means

The plantaris is really a puny little muscle with that long tendon.

It is so small that many consider it a remnant of a muscle that was bigger in some prehistoric relative.

"In human beings, the plantaris tendon is a rudiment of a large muscle, which in some of the lower animals is continued over the calcaneus and inserted into the plantar aponeurosis. In cows and sheep, the plantaris is a major muscle, from which most xenograft material is obtained."
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC152834/

In fact it is considered so unimportant, that if a tendon elsewhere in the body is too severely damaged to be repaired, surgeons will remove the plantaris tendon from the leg, and use it as a living transplant to replace the injured tendon elsewhere in the body, most commonly for injured hand tendons.

"The plantaris tendon is an extremely tensile structure used for flexor tendon replacement in hand surgery, and it is not too thick for revascularization at the graft site."
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC152834/

But it even can be used to replace a torn heart valve!

"We now put forward a hypothesis, extrapolated from hand surgery, for use of the plantaris tendon in heart valve repair.This proposal, if implemented, would increase the supply of autogenous donor tissue for valve repair, thereby enhancing the surgeon's armamentarium. The report describes a novel technique that in our judgment warrants future clinical development. "
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC152834/




But despite how small and unimportant the plantaris muscle/tendon is, if you pop it, it really hurts.


[By the way, I developed inflammation in the plantaris muscle about 10 years ago.
I had to pick up my daughter after a class she was taking at a nearby university.
I had an hour to kill, so I practiced serving every day for much of that hour.
I kept trying to get into a bigger and bigger bow shape to increase power.
When it started hurting behind the knee, I mentioned it to a physical therapist who works with a lot of tennis players. She said it sounds like "tennis leg" involving the plantaris.
With some rest and a return to a less insane amount of serving practice it has never bothered me again.]

[charliefedererer]

Originally Posted by Mick3391

That's great and clearly you put alot of work in it, I truly appreciate that. It also explains why my Psoriasis has come back a bit, a boost in my already overactive immune system

Most of us tennis players are pretty stubborn.

If we weren't, we never would have made much progress, stopping for every little ache or pain.

But once a real overuse injury occurs, I think if we can understand what is going on, we can take some time off knowing it is the only way we can make progress to eventually get back to the sport we love.


Also, I would really encourage you to add in the Thrower's Ten to your weight lifting regimen to prevent future injuries.

You also might be interested in looking at this site to modify your current off court training. The rotational movements of the core on the legs are not ones that are targeted by most weight lifters. By incorporating more of the exercises like lunges, and the use of medicine balls, you can help prevent back, hip and knee injuries that seem to crop up in too many players.

The Elite Approach to Tennis Strength Training http://www.sport-fitness-advisor.com...-training.html



Best wishes for as speedy a recovery as possible!

[Mick3391]

Originally Posted by LeeD

Can you still play if you dial it back some, maybe 70%, use new cushy shoes, and generally play with less ferocity?
Maybe you don't know your body's limits, and still think you're 14 years old....in a 30 year old body.

Exactly, that's what it's like, I "think" I can do things maybe I can't anymore. I do dial it back when hurt, just hit with my son and train, then forget and go for it. Lately I'm too paranoid to jump on it as I'm afraid something will give. I had the honor of playing with the great Justin Bower a week or so ago and jumped on the gas, was exhausted for lack of training, so tired I was hyperventalating an hour after, you know numb face.

I'm going to rest for awhile, arms, legs, everything, heh, I have to teach my son a serve, maybe I'll just talk, it's hard though when you LOVE Tennis.

[Mick3391]

Originally Posted by charliefedererer

Most of us tennis players are pretty stubborn.

If we weren't, we never would have made much progress, stopping for every little ache or pain.

But once a real overuse injury occurs, I think if we can understand what is going on, we can take some time off knowing it is the only way we can make progress to eventually get back to the sport we love.


Also, I would really encourage you to add in the Thrower's Ten to your weight lifting regimen to prevent future injuries.

You also might be interested in looking at this site to modify your current off court training. The rotational movements of the core on the legs are not ones that are targeted by most weight lifters. By incorporating more of the exercises like lunges, and the use of medicine balls, you can help prevent back, hip and knee injuries that seem to crop up in too many players.

The Elite Approach to Tennis Strength Training http://www.sport-fitness-advisor.com...-training.html



Best wishes for as speedy a recovery as possible!

Thanks, yea I'm going to rest. If you saw me, I "Look" in great, well good shape, but it's like I'm "Mr. Potatoe Head", one thing falling off at a time. Trust me I'm no whiner, but I've been on pain killers out of necessity on and off for 8 months, feel like I'm 90!