Wednesday, October 25, 2017

Older Men And Calf/ Hamstring Injuries

Both the calf and hamstrings
After last week's post, I was just talking to my colleague and she noticed that (just like me), she has also seen a few cases of patients tearing the calf muscles too. All happened to be male patients on the older side of 40 years old.

I thought of my own patients with calf muscle strains/ tears and realized that they too tended to be the older male patients too.

I was pleasantly surprised that our observations was spot on. A recently published article in the British Journal of Sports Medicine investigated over a thousand articles on the risk factors of calf muscle strains. Ten articles satisfied their inclusion criteria of which more than 5000 athletes in football, rugby union, Australian rules football, basketball and triathlon were involved.

As you get older, your aging athletic body has a few things going against you. You have a higher incidence of disc degeneration and the potential of L5 nerve root compression as mentioned in last week's post.

Older athletes lose some muscle power output and rate of force production. (Trust me on this, I have definitely experienced this).

Moreover, as the athlete gets older, your testosterone levels and production start to decline and this may limit your muscles' rate of recovery, which can lead to accumulative fatigue.

The most predictive risk factors were down to age and previous injury of calf strain. Having previous hamstring or groin strain was also a contributing factor. A possible proposed mechanism for this is a change in the change in the muscle architecture following a muscle strain.

When your muscle heals after a previous injury, the damaged muscle is usually replaced by a fibrotic scar tissue. It is often common to get future damage in the areas adjacent to this scarring.

Another factor that may play a role is due to a change in the length and shape of your damaged calf muscle. Shorter muscle fascicle length has been noted as a risk factor for repeat hamstring strains too.

We can't help you when it comes to your age and previous injuries to the calf and/ or hamstrings. But what we can do along with treating you is to ensure you have a sound rehabilitation process with some definite focus on eccentric exercises.

Here's a tip for those who you who haven't seen us in our clinics. Do your eccentric training at the end of the day when you have no training scheduled or only light training the next day. This minimizes the risk of DOMs or delayed onset of muscle soreness.


Green B and Pizzari T (2017). Calf Muscle Strain Injuries In Sport: A Systematic Review Of Risk Factors For Injury. BJSM. 51: 1189-1194.

Sunday, October 22, 2017

SS Turns 8!

Our clinic celebrated our 8th anniversary yesterday. A big thank you to all our families, staff, friends and patients for all your support all this while. We wouldn't have done it without all of you.

Our goal has remained the same all this while. To make our patients better quicker. "As long as we're happy and enjoy treating our patients, it's not really work."

Here's to many more years to come!

Monday, October 16, 2017

Hamstring/ Calf Pain? Treat Your Back

Now here's a nasty hamstring injury
I was looking through some of our past articles in our Physio Solutions blog and came across this article on how treating the lower back helps with hamstring injuries.

Here's a good reason why this is so. This article written way back in 2004 addressed the issue of hamstring and calf strains in older footballers in particular (but can also be in runners, triathletes etc).

I came across many of Dr John Orchard's articles back when I was doing my post graduate physiotherapy studies in 2003. This particular article suggested that a possible mechanism of higher occurrences of hamstring/ calf strains in older athletes may be due to your lumbar spine (or lower back) issues.
See where L5 nerve root is, (disc is next to it in white)
He suggested that the L5/ S1 neve root segment may be more prone to irritation and compression under the lumbosacral ligament due to disc degenerative changes. Dr Orchard notes that the L5 nerve root has the "most tortured path through the lumbosacral canal" before going over the sacrum to join the sacral plexus (or nerve roots).
The lumbosacral ligament further lessens the L5 space 

It may be likely that the location of a larger lumbosacral ligament is clinically more significant in older athletes due to degenerative disc changes (or slipped discs).

Due to possible L5 nerve root entrapment, some older athletes may have regular hamstring/ calf  and nerve muscle and tendon injuries. This happens when the L5/ S1 segment loses disc height (due to a slipped disc).

Space for the L5 nerve root is thus reduced (under the lumbosacral ligament) and may cause back pain and/ or hamstring and calf muscle/ tendon injuries.

So now you know why we treat your lower back when you have a hamstring or calf injury, especially when treating just the hamstring or calf doesn't improve your condition.

This is especially so when you saw from last week's post on how the hamstrings are closely related to the thoracolumbar fascia.


Orchard JW, Farhart P et al (2004). Lumbar Spine Region Pathology And Hamstring And Calf Injuries In Athletes: Is There A Connection? BJSM. 38(4): 502-504.

Sunday, October 8, 2017

How Your Hips Are Connected To Your Shoulders

Yes, our shoulders are connected to our hips! Definitely if you refer to work done by Tom Myers in his Anatomy Trains book.
If you look at the picture above, you can see that the right Vastus Lateralis (outer thigh muscles) through its fascial attachments are linked to the buttocks then through the thoracolumbar fascia across to the opposite (left) rib cage, shoulder and arm.

If I say it simply, it means your Vastus Lateralis actually attach to your arms! Or if I put it in a different way, your arms don't end at your arms. They end at your legs.
Another look at the connection
So supposing you have a rotated/ and or unstable pelvis (or hip), this can affect your shoulder and change the biomechanics in your shoulders and cause pain.

So in order to treat your shoulder pain, I'm not really crazy if I assess your hips before I look at your shoulder.

Just ask Bertrand, without really assessing his shoulder pain, I made his shoulder better just by taping his hip. 

Now when you come and see us in our clinics, you know why we look at your hips first if you have shoulder pain.