Case Study – Calf Tear 1 Week before an Ironman

The athlete attending Pro Sports Medicine was a male age group (45+) triathlete. With a long history of training for and competing in triathlons. No recent history of calf problems and no other significant findings on subjective examination.

History of the Injury

The injury occurred 2 days previously, when out on an easy training run. The athletes day consisted of an open water swim, followed by a gentle 1 hour jog. Since he was well in his taper, this was a big reduction in both volume and intensity compared to previous levels of training and should have posed no issue.

He described feeling some tightness after coming out of the swim, but more of a cramp feeling than anything. He felt comfortable to continue with the plan to run and completed the run.

However, the feeling of tightness did not disappear and though it also didn’t get worse, was a bit of a concern. The pain didn’t go away in the hours after the run and was referred by his coach for assessment at Pro Sports Medicine.

Assessment

The pain was localised to the lower portion of the calf, just above the achilles tendon. It was a very localised pain, which did not refer anywhere else. There was no apparent swelling or bruising.

Functionally, the athlete was very good. No apparent limping when walking and had good strength and power on testing, though was aware of the pain in the same spot when using the muscles in the calf. From the functional and hands on testing it was likely to be a low-grade soleus tear.

However, to be sure…

One advantage of an assessment with us here at Pro Sports medicine is that we are able to carry out diagnostic ultrasound scans on the day, so for soft tissue injuries like this, we can really accurately diagnose and grade the injury immediately.

This is a massive advantage in most assessments, but particularly in this case. When the goal event is so close and there is no time for further assessment or see how the injury behaves over time…the athlete needs answers today, which happily we are in a position to provide.

Diagnosis

On completion of the session the clinical and ultrasound assessment confirmed a grade I tear of the soleus, though it was on the upper end of grade. Though not ideal going into an ironman, it was likely that the nature of ironman running (no sudden accelerations required), it could be done. There are obvious risks associated with any sport, and though there will be a slight increase in the risk in this case, the level of risk is known, and the athlete can make their own decisions based on a high quality and accurate assessment and diagnosis.

The athlete was given the appropriate management advice and exercises to use during the week and we wished him every success for his Ironman attempt.

Follow-Up

Having completed the week of rehab, a bit of rest and travel, the athlete took himself to the start of the triathlon.

We are happy to report that the Ironman was successfully completed, and he was even able to run the marathon more or less as planned. Though inevitably there was a fair bit of soreness towards the end and after the event, the injury did not get any worse.

There was some consequence to running with the injury, the compensation caused an overload on the opposite calf, so rehabbing both calves will be our next task for this patient, but with the time to do it, the athlete will be back up and running in no time.