Good morning!
For two years I thought I was battling a muscle problem. Because of the area of the pain, not only myself, but various physical therapist believed either my soleus or gastrocnemius were the cause of my calf pain. Because of this thinking, I was given all the typical stretching and strengthening exercises, along with some instruction on self-myofascial release (foam rolling). None of the PT or my own self-treatment proved successful.
In midsummer I met with my new primary care doctor and shared my frustration with him. He determined that instead of physical therapy, he referred me to an orthopedic doctor. That did not make sense to me, but I was hoping this direction would ultimately get me to a physical therapist capable of solving my calf problem.
When I went to the orthopedic doctor back in late summer, much to my utter surprise, an x ray reveled a fractured tibia bone well above the area of pain, but also bone remodeling (bone growing process) nearer to my calf pain. While I understand fractures and bone remodeling, I could not totally understand why these issues caused pain in my calf?
The diagnosis of my problem did not make total sense to my thinking; however, it gave me some confidence that if healed my calf problem would finally go away. The doctor did not prescribe PT, but instead directed me to do nothing that would stress the tibia for 9 weeks and let the healing and remodeling process finish.
Still a bit confused, I even discussed the logic of why a healing tibia would cause pain to the calf muscle with a couple PT grad-students and a full-fledged PT, and even they could not fully understand. To be fair my details of what the doctor explained was lacking sufficient information.
Following doctor’s instruction, I did my best to minimize stress on my calf for ten weeks. For multiple reasons, my follow-up appointment was delayed, so I decided to start a run/walk program, without waiting. Thankfully I have been somewhat patient, and my calf has had minimal discomfort and my progression has been positive.
With my twice rescheduled follow-up coming up, I even questioned the need to go. However, the doctor had said back in the summer, he wanted to x ray again at my follow-up, so I was interested to see what my tibia looked like and get a better understanding of how the remodeling process and healing affected my calf?
Yesterday I went to my follow-up appointment and as promised they x rayed the front and inside of my leg. The nurse brought up my ex-ray on the laptop and told me the doctor would be in shortly. When she left me, I got up and took a closer look at the screen and from my non-professional view, my tibia looked perfect!
The doc eventually came in and asked me how I was doing? I explained that I waited the time he instructed and have since started run/walking and was doing fairly well. He looked at my x ray and told me everything looked healed, but to continue to proceed slowly. I insured him I would continue the process of run/walking until I was confident my calf was ready.
After we got beyond the progress and the way forward, I asked him if he could explain why the fracture was well above where the bone was remodeling and how did all of this impact my calf?
The much awaited explanation
The doctor first explained that when we fracture a bone, remodeling (regrowth) will extend the entire length of the bone. Makes sense! He then went on to explain, while I felt the pain in the calf muscles, the actual pain was from the muscles pulling on the tibia while in the remodeling process. The calf muscles were actually fine, however when they were called upon, they tugged at a weak lever (the tibia) and the pain just appeared to be in the calf. Perfect explanation!
Final thoughts
We often self-diagnose based on experience, the internet or others. I was guilty of all of these. Thankfully, I eventually got to the right professional and despite my limited understanding, I am nearly healed. Would I be happier if I had gotten this help 18 months ago? Of course, but I learned some great lessons for myself and those runners I coach. I also better understand the bone versus the muscle and while I will not diagnose anyone ever, I will encourage people to seek all views of medical help.
Lots of great lesson on this journey and I owe my calf muscles an apology for blaming them!
I hope you are enjoying the Christmas Season!
God Bless!
Mike
