Odd Leg Injury

[slewisoh]

I've had calf issues for about a year now and spent the summer rehabbing two muscle strains. About a week ago I played all out at a doubles match. I was everywhere...ran down everything.

I was happy to come through the match with nothing more than muscle soreness. Stretched after the match, walked a bit that evening to get the muscles warm so that I could stretch again.

Played very light social tennis the next day and afterward had sudden, sharp pain on the inner portion of the tibia. No muscle pain, just pain along the length of the tibia. Bruising started along the tibia the next day, followed by muscle soreness in the calf.

As it turns out the vein that runs along the tibia burst. Because there was a lot of calf pain, my doc ordered an ultrasound to rule out deep vein thrombosis - negative.

My leg is hideous! The bruising along the tibia was greenish, but the ankle and foot are totally purple. It looks like I suffered a really bad sprain.

According to my doc, it's not that unusual and, given that it's a superficial vein, not terribly concerning. :shock:

 

[charliefedererer]

It sounds like you had a muscle tear.

Muscle tissue has a very high need for blood flow to provide the oxygen and nutrients to keep that muscle working. So there are huge numbers of small capillaries, venules and arterioles coursing throughout muscle tissue. When the muscle is torn, those small blood vessels are torn too. It is impressive how much bruising can occur from even a "minor" muscle tear. The blood oozes down the leg because of gravity. As the hemoglobin in the blood is broken down, it can turn that greenish color you describe.

In my tennis bag, I keep an ace wrap and an ice bag (you can get 3 for about $5 in a pharmacy - the kind where you activate by just compressing it).

During a hitting session on Sunday, my friend suddenly had a sharp calf pain running wide to hit a forehand. I activated the ice bag, placed it on the area, and kept in place with the ace wrap. I had him lie down and elevate his leg, "above his heart" just by putting it up on the tennis bag.

RICE. Rest, Ice, Compression, and Elevation.

RICE is the initial treatment for injuries.

Injuries are not super common in tennis, but do happen.

It doesn't take much to prepare for your own injury, or to help out one of your friends, or even someone else at an adjacent court.

So to the OP, I hope your bruising goes away fairly quickly, and your muscle heals. Thanks for posting to hopefuly spare others from suffering a similar fate.

 

[ollinger]

There's a very lucid discussion at CaringMedical.com entitled "RICE: Why we do not recommend it" that's worth reading. Ice and compression interfere with the inflammatory process which, after an acute injury, initiates the healing process. I'd like to see good controlled studies supporting the value of RICE in the ultimate outcome of injuries, particularly as some believe the tendency of Cipro and Levaquin to lead to tendon rupture may be a function of those drugs' documented antiinflammatory (in addition to antibacterial) effects.

 

[slewisoh]

Having suffered 3 separate calf muscle tears over the last few years, I feel comfortable stating that this was different. Perhaps I didn't describe it very well. The pain seemed to originate from the tibia itself. I was initially concerned that I had a stress fracture. There was no calf pain until the 3rd day.

It's been a week, and I'm out in the yard digging holes and planting shrubs. No way could I do that with even a mild muscle tear.

Regarding the RICE discussion, I dubiously used heat therapy immediately following my wrist surgery (removed ulnar head and reattached soft tissue) and throughout my rehab. Of course I wasn't part of a controlled study - let's do the other wrist and use ice instead :shock: - but I was pleasantly surprised by the lack of swelling and the speed at which I healed. It was certainly more relaxing.

 

[slewisoh]

Duplicate Post

 

[snvplayer]

Initially inflammation process is going to bring a lot of mediators and factors into the injury site. Vasodilation happens and dilated vessel can compress on nerves, inducing pain and nerve damage, maybe. Also, capiliaries become more permeable, which means all these mediators and factors are going to move into interstitial space, and hover right next to the tissue.

Inflammation is a part of healing process, but it does happen with its cost, and it's considered a rule of thumb to apply ice right after injury.

I think there was a lot of controversy with the study that contraindicated use of ice...

 

[slewisoh]

Initially inflammation process is going to bring a lot of mediators and factors into the injury site. Vasodilation happens and dilated vessel can compress on nerves, inducing pain and nerve damage, maybe. Also, capiliaries become more permeable, which means all these mediators and factors are going to move into interstitial space, and hover right next to the tissue.

Inflammation is a part of healing process, but it does happen with its cost, and it's considered a rule of thumb to apply ice right after injury.

I think there was a lot of controversy with the study that contraindicated use of ice...

Uhhhh...in plain English please? :???:

 

[heycal]

There's a very lucid discussion at CaringMedical.com entitled "RICE: Why we do not recommend it" that's worth reading. Ice and compression interfere with the inflammatory process which, after an acute injury, initiates the healing process. I'd like to see good controlled studies supporting the value of RICE in the ultimate outcome of injuries, particularly as some believe the tendency of Cipro and Levaquin to lead to tendon rupture may be a function of those drugs' documented antiinflammatory (in addition to antibacterial) effects.

If true, this would be a huge thing, no? Ice is virtually everyone's go-to choice for any kind of ache or pain, and we layman don't generally really know the difference between muscles, ligaments, and tendons. We just know something hurts and we grab an ice pack, sometimes on a regular and ongoing basis after certain activities, not just after an acute injury.

Do you believe this? Would you go so far as to stop using ice yourself, or advise others not to?

 

[charliefedererer]

The inflammatory response is mediated by so many pathways that there is little likelihood that RICE will prevent healing.

RICE as described above, would likely have stopped the bleeding within a few minutes, and prevented the large area of discoloration that the OP described (which was likely a localized avulsion, or tear, of the tibialis anterior muscle from its long origin along the tibia. Simple compression with an ace and elevation [even withouth the ice] would have likely stopped the slow oozing that unfortunately continued unabated in the noncompressed erect state. It is amazing how much slow oozing can occur from the disruption of so small an amout of muscle tissue.)

 

[heycal]

Uhhhh...in plain English please? :???:

He believes you should use ice after an injury.

Inflammation is a part of healing process, but it does happen with its cost, and it's considered a rule of thumb to apply ice right after injury.

I think there was a lot of controversy with the study that contraindicated use of ice...

Not only is ice usually recommended right after an injury, more and more I hear it prescribed as an ongoing treatment for various aches and pains. We're talking weeks or even months. What do you think of that practice?

 

[ollinger]

I've not seen any data demonstrating any therapeutic value of ice. Probably a result of the sport practice of spraying on a cooling solution or applying ice to an athlete injured in a game, but keep in mind that the intent there is to keep him in the game, not long term therapy. Reducing inflammation FOR THE MOMENT will help keep him in the game but there's no evidence of healing benefit, and we see there may even be harm.
There's a long history of pointless recommendations in medicine, perhaps nowhere more than orthopedics. Thirty years ago you commonly saw hospitalized patients in traction, something never seen now as it's been shown to be of no apparent value.

 

[charliefedererer]

I've not seen any data demonstrating any therapeutic value of ice. Probably a result of the sport practice of spraying on a cooling solution or applying ice to an athlete injured in a game, but keep in mind that the intent there is to keep him in the game, not long term therapy. Reducing inflammation FOR THE MOMENT will help keep him in the game but there's no evidence of healing benefit, and we see there may even be harm.

Ice is an effective pain reliever, as low temperatures interfere with pain sensors and nerve conduction.
Ice can slow the onset of swelling, which may allow a for a far better exam than a big swollen area offers.
The immune system is so complex and has so many pathways, that it would take an enormous amount of icing (? continuous) to interfere with healing.
There definitely is pressure on many team doctors and therapists to get the player back in the game if at all possible. Some of that comes from the doctors/therapists themselves who were drawn to be a team health care provider in the first place, and the quitting of those who feel their concern for an individual is being compromised.

There's a long history of pointless recommendations in medicine, perhaps nowhere more than orthopedics. Thirty years ago you commonly saw hospitalized patients in traction, something never seen now as it's been shown to be of no apparent value.

It was shown that traction led to higher rates of deep vein thrombosis and pneumonia in the immobilized patient. Early operation has become the standard to treat the hip and back fractures after studies showed that "conservative" traction led to the higher complication rates. But concurrently, improvements in aneshesia, super sterile rooms, better operative techniques, and better prostheses all combined to the continuous quality improvement involved with surgery.

 

[heycal]

I've not seen any data demonstrating any therapeutic value of ice.

So does this mean you never use ice yourself, or wish your family and friends to use it?

I'm having trouble believing that all the millions of health care providers and others who all make ice a central part of treatment for acute or recurring pain for ordinary folks are all making a mistake. Really?... I mean, if so, this is a HUGE thing, much more impactful on many more people than traction or what have you.

 

[ollinger]

As charlie alludes to, it's really not a treatment but a mild palliative, a distraction that has no particular known therapeutic benefit. Yes, I never use it myself. If someone is in pain, it's perfectly reasonable to suggest ice because the intense cold can mask the sensation of pain. My point is that it's never been shown to have THERAPEUTIC benefit, as opposed to a temporary soothing effect. All the people in this board who speak of icing their tennis elbow after they play are potentially reducing circulation (though I doubt by much) to an area of TENDONOSIS that is ALREADY deficient in circulation. Does this make any sense to you? Would one of the skeptics PLEASE find a piece of good ressearch that shows therapeutic benefit of ice?

 

[heycal]

My point is that it's never been shown to have THERAPEUTIC benefit, as opposed to a temporary soothing effect. All the people in this board who speak of icing their tennis elbow after they play are potentially reducing circulation (though I doubt by much) to an area of TENDONOSIS that is ALREADY deficient in circulation. Does this make any sense to you? Would one of the skeptics PLEASE find a piece of good ressearch that shows therapeutic benefit of ice?

I have no medical background, but I personally think tennis elbow is in it's own strange world of mysterious ailments, so let's leave that one aside for the moment. How about icing a shoulder after a match and the like? Or the ice treatments the PT folks regularly gave me for a couple of weeks after I tore my calf? All just to make one feel good temporarily?

Is there really no research to support the therapeutic benefits of ice in recovery or healing? Hopefully someone with more of a background than me in this stuff will step up and defend the good name of ice!

 

[ollinger]

I've never put ice on my shoulder, don't imagine I ever will. If I feel my shoulder took a beating during a match, the last thing I want to do is reduce circulation to the area as that could impede healing. Professional athletes do it because their primary agenda is to be ready to go again soon, so they put a premium on reducing swelling.

 

[heycal]

Professional athletes do it because their primary agenda is to be ready to go again soon, so they put a premium on reducing swelling.

Well, isn't being ready to play again the next day or in two or three days essentially "recovery" and "healing"?

 

[ollinger]

Not at all. Ice and compression may reduce the SWELLING that limits FLEXIBILITY, thus allowing me to play again in a day or two, but healing refers to the tissue damage that led to the swelling (swelling, or edema, results from tissue damage that allows fluid to ooze out of tissue and capillaries.) There's no evidence ice benefits that damage, and may actually further it by allowing you to play before the damage is healed. It's believed this is why a published study of high school tennis players showed an inordinate frequency of joint and spinal arthritis a few years ago -- playing every day, or nearly every day, may not allow successful "remodeling" of the joint surfaces. I noticed today that yet another young pro player, Fernando Gonzalez, is about to have hip surgery (the hip, being a ball and socket joint, particularly depends on a smoothly modeled surface.)

 

[El Diablo]

From Guga to Gonzo to Jimbo and many others, the numbers of relatively young adults who've needed major hip surgery should alarm anyone who plays this game every day. I limit myself to 3-4 times a week max, which comes out to about equal numbers of playing and non-playing days to allow my body to recover in hopefully some meaningful way.

 

[heycal]

Not at all. Ice and compression may reduce the SWELLING that limits FLEXIBILITY, thus allowing me to play again in a day or two, but healing refers to the tissue damage that led to the swelling (swelling, or edema, results from tissue damage that allows fluid to ooze out of tissue and capillaries.) There's no evidence ice benefits that damage, and may actually further it by allowing you to play before the damage is healed.

Well, this is certainly interesting, and I await some inforrmed defender of ice to offer a rebuttal.

 

[ollinger]

some say the world will end in fire,
some say in ice,
from what I've tasted of desire,
I hold with those who favor fire,
but if it had to perish twice,
I think I know enough of hate,
to say that for destruction ice,
is also great and would suffice
-----Robert Frost

(quoted from memory, so I might have gotten
a line wrong)

 

[heycal]

some say the world will end in fire,
some say in ice,
from what I've tasted of desire,
I hold with those who favor fire,
but if it had to perish twice,
I think I know enough of hate,
to say that for destruction ice,
is also great and would suffice
-----Robert Frost

(quoted from memory, so I might have gotten
a line wrong)

Close. I looked it up, and here is the exact wording:

some say the world will end in fire,
some say in ice,
from what I've tasted of desire,
I hold with those who favor fire,
but if it had to perish twice,
I think I know enough of hate,
to say that for destruction ice,
is also great and would suffice
be that is it may, and may it shall be
there's certainly value in following RICE
-----Robert Frost

http://en.wikipedia.org/wiki/Robert_Frost

 

[ollinger]

Ahhh, that's why he changed his name to Frost!!

 

[heycal]

Ahhh, that's why he changed his name to Frost!!

Exactly. You may have better luck with a poem by Robert Burns.

 

[charliefedererer]

The USTA recovery project 398 page report critically reviews many aspects with footnotes to back up the conclusions. Anyone can download the report (for free) at http://assets.usta.com/assets/1/dps/usta_master/sitecore_usta/RECOVERY PROJECT FINAL.pdf

Here is what it has to say about the use of ice starting on page 161:

"The use of ice following an acute injury is well supported in the literature and a
commonly used practice during rehabilitative exercise and physical therapy. The
analgesic effects and initial vasoconstrictive action following ice application are well
documented and protocols for the application of ice to an injured or recovering athlete
following exercise and return to competition are common 69. The use of
cryotherapy for recovery however, is not well supported in the literature. Cheung et
al, 55 in a review of treatment for DOMS concluded that current research does not
support the efficacy of cryotherapy, apart from its analgesic effect used in the
treatment of injury. One study 70 investigating recovery following a simulated game
in baseball pitching found a combination of cryotherapy application to the shoulder
and light recovery exercise to enhance 24 hour shoulder strength recovery. The
present use of ice following baseball pitching in elite level baseball players may be
indicated and might have application to tennis where repeated bouts of serving on
consecutive days may necessitate recovery strategies for the shoulder to allow
players to optimize recovery. Further research however is needed before a more
definitive recommendation in this area can be made."

 

[ollinger]

Pretty much what I've said -- some benefit to reduce soreness and swelling, allowing you to go the next day, but no evidence of therapeutic effect. The "initial vasoconstriction" might actually impede healing of damaged tissue.

 

[mike53]

I'm not an expert here, but I think this guy is saying that ice is helpful, at least under certain circumstances, for more than just pain relief:

http://ajs.sagepub.com/content/35/1/93.abstract