 Poster: A snowHead
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Don't Moooove for a while.
Last edited by Obviously A snowHead isn't a real person on Mon 30-10-23 23:52; edited 2 times in total
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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Very painful deep tissue massage from the right sort of physio.
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| pam w wrote: |
| Very painful deep tissue massage from the right sort of physio. |
Something to look forward to 
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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Before you tackle the problem yourself - IME getting the advice from a good Physio is essential in order to know just how - and how aggressively (or not) - to treat it....Get it wrong and you could make it worse.
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You'll need to Register first of course.
You'll need to Register first of course.
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Physio. End of.
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Some "interesting" advice 
Avoid icing or antiinflammatories, which slow down the healing process.
There is no real strong evidence that massage speeds up muscle strain recovery. There is no logical pathway to explain why it would except for and perhaps increased blood flow - but less painful and cheaper ways to do that! Does offer a pretty good placebo effect!
(Better to visit a physiotherapist when you are a bit more recovered. They may be able to identify a cause for the strain and give you some specific exercises to reduce the likelihood of it happening again.)
Ultrasound may help, but again not super strong evidence and a suggestion it may produce a larger deposition of collagenous fibers, which may not be beneficial.
Assuming you don't have the option of
Platelet-rich plasma anyway, but again the evidence isn't that strong.
Active movement is actually better than complete rest. Do what you can without causing any pain.
Worth remembering that muscle strains generally heal just fine on their own without any intervention. Sleep and a good diet (plenty of vitamins and minerals + adequate protein) are probably as good as anything.
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| boarder2020 wrote: |
Avoid icing or antiinflammatories, which slow down the healing process. |
Nope.
For deep muscle pain ice won't really be helpful anyway, but anti-inflammatories can be useful if an inflammation is reducing mobility (and the physio is telling you that you need to move it). There have been some studies in recent years suggesting that some NSAIDs may slow down bone healing, but even those are far from conclusive.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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I have had calf muscle problems through running and I definitely recommend a physio.
An accurate diagnosis of the problem and the severity is important. The physio I see then came up with a number of exercises that I could do at home. They were not the obvious calf stretches that we all probably know, but specific rehab exercises.
I only had three appointments with him with a month between them. At the second and third appointments he assessed my progress, then changed the exercises accordingly.
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"The various phases of inflammation help repair damaged soft tissues. Thus, inhibiting inflammation using medications may negatively affect long-term tissue healing, especially when higher dosages are used. Standard of care for soft-tissue injuries should not include anti-inflammatory medications." BMJ
You can find exceptions to the rule, but a standard calf strain is probably not it.
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There have been some studies in recent years suggesting that some NSAIDs may slow down bone healing, but even those are far from conclusive.
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Good luck finding any conclusive evidence that anything improves muscle strain healing time! There is an explainable pathway of why nsaids may slow healing process.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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Quick update - thankfully a good sleep has worked wonders and now only some tightness in lower calf  , so probably just a bit of overstretching of muscle fibres .
I am pretty much in line with the minimal interventionists above and rarely take meds - the body has gotten pretty good at healing after several millennia of evolution and our feeble efforts have a very small effect and can be negative as discussed. Physio definitely worth it though.
Will be avoiding impact work and sticking to isometrics for a couple of weeks and hope to be good to go by PSB.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Buy a massage gun.
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You know it makes sense.
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There's a few stretching / strengthening exercises that can help with a speedy recovery - as per richjp I was given some specific stuff from a sports physio (eg right foot placed T shape in front of left / right arm up in air and slowly bring down and across body to touch side of left knee cap - repeat opposite side etc)
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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NSAIDS offer no better pain relief than paracetamol and may inhibit healing in the long term but the evidence isn't clear. In animal models early NSAID (or taking before exercise which is common) blocks the activity of satellite cells (important in the healing process of muscle) but how this translates into clinical practice still isnt clear. Anti-inflammatories (NSAIDS) certainly have a higher side effect profile than say paracetamol, so I would argue against their use, but this advice is often ignored due to long established, difficult to shift health beliefs. A good physio is worth their weight in gold, and they hardly ever prescribe analgesia (much less than Dr's)
There is no good evidence for any particular intervention in management of soft tissue injuries because designing a study that can measure these effects is very difficult.
Good eccentric stretching exercises have the least weak evidence base
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Poster: A snowHead
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@boarder2020, I thought icing the area was used to reduce swelling for the first 24 hours? Is that no longer the advice?
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@snowheid, I tore my calf on a BASI course, (damn silly one legged skiing). Got a physio who strapped it up and said I could continue. He did say if I wasn't on the course he would have advised a few days rest.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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| kitenski wrote: |
| @boarder2020, I thought icing the area was used to reduce swelling for the first 24 hours? Is that no longer the advice? |
Inflammation is part of the healing process.
There was never any good research around icing. The original ICE guidelines (later became RICE), were if I remember correctly published before a single study looking at icing. Then the myth just continued.
There still are situations where ice might be beneficial. But there's enough doubt about using it in general for soft tissues injuries.
In fact the BMJ have removed it and added "avoid anti-inflmatories from there advice - https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/
But as said above the evidence for everything is pretty low. It's simply too hard to really test. Most soft tissue injuries heal with no intervention perfectly fine on their own. People are quick to wrongly link whatever "treatment" they did to recovery.
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You need to Login to know who's really who.
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get a snooker ball, press & roll it as hard as you can around the area
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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If it's strained - rather than tight and stiff - I'd be wary of digging in with something as hard as a snooker ball. It could make it worse. I would see a Physio and get advice.
If doing it yourself, I would use a softer foam roller...and go easy to start with.
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You'll need to Register first of course.
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| boarder2020 wrote: |
... In fact the BMJ have removed it and added "avoid anti-inflmatories from there advice - https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/
But as said above the evidence for everything is pretty low. It's simply too hard to really test. Most soft tissue injuries heal with no intervention perfectly fine on their own. People are quick to wrongly link whatever "treatment" they did to recovery. |
... A useful link. But to be clear, that's not "the BMJ saying that..", it's a paper published on their site, right?
There is quite a lot of difference between the two things, and your text could be interpreted incorrectly.
"The BMJ" did not write that paper, and do not have a policy on this one way or the other.
The referenced paper doesn't really include any research or new data, it just seems to cherry pick some specific references. There's no attempt to assess the overall data, all the work seems to be about making up an acronym. If you follow the apparently cherry picked reference #2, that's also freely available. But it's specific to ankle sprains. So maybe you meant:
| someone who published a paper about an acronym in the BMJ wrote: |
| ..you maybe don't want to use anti-inflammatory stuff long term healing of ankle sprains.. |
Not quite so good as an appeal to authority argument. Especially as the OP wasn't asking about ankles at all.
The conclusion, from the referenced paper, is:
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| Recommendation (new): NSAIDs may be used by patients who have incurred an acute LAS for the primary purpose of reducing pain and swelling. However, care should be taken in NSAID usage as it is associated with complications (level 2) and may suppress or delay the natural healing process. |
I don't find that new or enlightening.
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@phil_w, even the NHS are recommending not to take nsaids for soft tissue injuries
https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/self-management-advice/soft-tissue-injury-advice/
It's not particularly controversial any more to say inflammation following soft tissue injury is generally a good thing.
You can argue the evidence that reducing inflammation following soft tissue leads to slower/poorer rehabilitation outcomes is pretty weak. I wouldn't disagree. It is however a lot stronger than the evidence supporting reducing inflammation for positive outcomes.
We do know that inflammation triggers a number of positive pathways in the healing process. I don't see a reason why you would try to slow this (again there will always be some exceptions).
Ice causes vasodilation, so less blood going to the injured area. I struggle to find any compelling reason why you would want to do that. In fact you'd probably want as much blood going in and out of the area as possible for optimum recovery.
Of course as I've already said most soft tissue injuries heal on their own regardless of intervention or lack of it. It's basically impossible to create a proper controlled rct to really calculate efficiency of different interventions.
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@boarder2020, that same link recommends icing if appropriate.
Applying ice
The use of ice is still recommended if swelling is a major problem
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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@kitenski, yes, as I said before there are exceptions. For example I know someone who had to wait a multiple days for his shoulder to be put back into its socket because there was too much swelling. In that case absolutely makes sense to minimise swelling as in the bigger picture getting the shoulder back in is more important for overall recovery.
For a professional athlete reducing swelling to the point they can play on the injury a few days later might make sense.
But for the average person with a relatively minor soft tissue injury I would suspect ice is usually not "appropriate". It's not like there are not other intervention options with more evidence behind them. Why risk something's that may negatively effect the outcome?
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Topfen/quark compress for approx an hour a day on the injured/strained/swollen area.
Apparently topfen has a high concentration of live lactic acid-producing bacteria which (may) aid recovery.
Routinely (or at least quite often) suggested for calf muscle injuries by many medical professionals and physios in Austria (and possibly other countries?).
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Very recent experience on grade2 calf strain.
Cause - stupidity…elementary mistake resulting in massive forward wrench to right calf…so violent that I was not able to tell if there had been a ‘pop’ or not. Immediate inflammation, pain 6/10 ouch. Got back to cafe and looked at calf, horrified to see big channel down the calf. Looked for the world as if part of my calf muscle was missing. This immediately made me worry about a tendon detachment, and I indeed had pain behind my knee. Difficult to walk with normal gait, but could walk. Pain increasing, and inflammation increasing, mobility decreasing. After a couple of hours, diagnosis possible a grade 1 but most probably a grade 2 tear - ie large internal tear to muscle, some tendon damage but probably not a detachment. Although that channel in the calf continued to worry me and it continued to be there.
I followed the new protocols - which we have been following for a while - no NSAIDs at all, no ice, elevation above heart to reduce effusion and carry away metabolic products, movement to the point of pain and no more.
After 8 hours, escalating inflammation and pain on movement but no pain on resting. Decreasing mobility. Prognosis from NHS and others websites: at least 14 days rehabilitation before resumption of sport activities and full recovery 4-6 weeks. Crikey.
Elevated all evening (after a gratis snowcat trip up to a wonderful local hotel and a wonderful dinner - thanks Yves) and on a pillow at night to get it above my heart.
Morning…stiff as hell, pain on movement, but able to walk in a limpy kind of way.
No skiing day two, but by 10am walked down from the hotel - 2000m to 1500m. Ouch limp limp ouch.
No massaging, more elevation in the evening. By morning of day 3, painful to walk upstairs, painful to walk in ski boots ouch ouch, but pain free actually passive in ski boot and in skiing position. So….pm day 3 get back on snow. Morning day 4 visible bruising around ankle from draining and pooling I think.
Sharp pain if I try to walk too fast in ski boots, no pain during skiing, big channel between muscles now gone, but diameter of calf way more than the other.
By day 5, skiing completely normally but sharp pain occasionally on walking up stairs or changing direction whilst walking.
Now…I strongly feel that the new protocol is good - only use NSAIDS when inflammation itself is an issue, eg stopping blood circulation. So No NSAIDS, no ice, elevation above heart, and movement to just below point of pain. I may have taken personal risks in resuming activity so quickly, but it has actually gone well. Now, two weeks later (and after some pretty intense skiing and mountain-biking) small residual pain if I massage calf hard, but that’s subsiding fast, no apparent muscle compromise, and muscle now of comparable size to the other.
Phew.
Last edited by So if you're just off somewhere snowy come back and post a snow report of your own and we'll all love you very much  on Wed 10-01-24 18:52; edited 1 time in total
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You know it makes sense.
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@valais2, do you have a link to this new protocol of which you speak? thanks in advance!
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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@valais 2, not dissimilar to the last time I wrecked my calf (skiing again 48 hours after injury, deep suspicion of NSAIDs). But when it was still painful a a few weeks later (having been skiing again for a long weekend and cycling daily) with a further ski trip planned, my MSK consultant did a several sessions of guided ultrasound hematoma reductions (which was about as gross as it sounds, think he took out about 30cL of fluid over 3 weeks) and put me on crutches for 2 weeks to give it some time to heal properly.
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Poster: A snowHead
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@Dyrlac, interesting … always good to hear of specific cases.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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You need to Login to know who's really who.
You need to Login to know who's really who.
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Thanks, Valais - interested to read these.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@valais2, the no ice link does say
Traditional cold therapy still has beneficial effect especially when injuries are severe and swelling is the limiting factor for recovery after soft-tissue injuries, and therefore no need to be entirely put out to pasture in the rehabilitation practice.
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@kitenski, ...yes that's right...I have had IMMENSE inflammation/swelling/effusion from some injuries (eg shoulder separation) and then it's vital to get the swelling down if it in interfering with blood supply, severely displacing something etc. ICE def on when that happens, and poss NSAIDs too. In two cases recently - hip down onto stone after a cycling misjudgement and then the skiing calf strain above, it was clear that the effusion was prominent but essentially non-threatening, so no ice and no NSAIDs.
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@valais2, glad that you recovered so fast. But I can guarantee you that wasn't a grade 2 calf strain.. Probably just a severe cramp, which can sometimes take days to settle
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