If you’ve been following my athlete journal at all you’ll know I’ve had some issues with tearing my calves. Quite a few issues in fact, and it was the fifth tear a month ago that saw me finally realize I needed something more aggressive for treatment than massage, rest, and rehabilitation exercises.
If you’ve been following my athlete journal at all you’ll know I’ve had some issues with tearing my calves. Quite a few issues in fact, and it was the fifth tear a month ago that saw me finally realize I needed something more aggressive for treatment than massage, rest, and rehabilitation exercises.
The first thing needed was an MRI to see exactly where the tear was. With the pain pretty much in the center of my leg at the point where my gastrocnemius and soleus meet it could have been a tear to the muscles, the tendons, or even the fascia surrounding the muscle(s). The MRI showed it was a soleus tear, but also that there was significant swelling between the two calf muscles.
The soleus tear meant that it would take longer to regain full use as they heal slightly slower. The swelling between the muscles was an issue, as muscles apparently like to stick together and this was causing the muscles to have a little bulge of fluid between, like a piece of grit in an oyster. Except in this case it wouldn’t become a pearl, but rather an ongoing source of inflammation.
The doctor’s suggestions involved everything from rest and ice – no thanks, had enough of that – to some other new fangled state of the art thing that was going to cost over nine hundred dollars per visit! (This is all WADA legal advice too, so the cost wasn’t for the Lance Armstrong program). But then he suggested this thing called Traumeel.
If you Google Traumeel what you’ll likely find are a bunch of homeopathic sites speaking of arnica creams because that is the main ingredient. Arnica has been hailed for some time as a great anti-inflammatory for topical creams and I know many kickboxers who swear by it. But arnica is a homeopathic remedy. I wasn’t sure I was ready to grow dreadlocks and wear tie-dye and spend my days contemplating my navel just yet. I was, however, completely and utterly sick of the problems with my calf and I was sitting in front of one of Australia’s absolute best sports doctors, who was telling me, very clearly, that Traumeel was the way to go for this injury.
While the first reaction for many doctors is to go straight to cortisone there are some big considerations in regards to it and how the body reacts. The following is an excerpt from Sports Injury Bulletin explaining the pros and cons of cortisone and Traumeel:
Corticosteroid Injection Therapy
Corticosteroids are anti-inflammatory drugs. By inhibiting the accumulation of neutrophils and inflammatory mediators (immune system cells that flood the site of damage), corticosteroids reduce the local inflammatory response and severity of pain. There is a delayed response to steroid injection but the analgesic effect may last for several weeks. Evidence shows mild to moderate pain relief lasting for six to eight weeks after muscle injury.
Steroids are usually administered in combination with a local anaesthetic around the damaged muscle or into the peritendinous region (soft tissue around the tendon). This is often done under ultrasound guidance, to pinpoint the area of damage. In acute (traumatic) injuries steroid/anaesthetic therapy provides early pain relief, enabling the individual to get back to normal activity (assuming no significant structural damage) and allowing for objective assessment of the extent of injury. This treatment can also bring early rehabilitation and thus a reduction in subsequent injury risk.
The downside of using anti-inflammatory agents is that they can delay healing and scar formation, thereby risking re-injury. This is because of the way the injections act to alter the inflammatory response, interfering with the recruitment of cells for tissue repair. Among patients on long-term steroid therapy it is common to see not just slow healing but also tissue atrophy and increased risk of infection.
These adverse effects of corticosteroid treatment have brought about the development of new injection therapies, to provide analgesia without adversely affecting local tissue repair.
Traumeel
Traumeel is a homeopathic combination drug that reduces inflammation, swelling, and oozing. The pharmacology involved is not yet understood. Studies suggest the drug modifies the action of neutrophils and the release of inflammatory mediators. Injected locally, its analgesic effect is comparable to steroids but without the risks of tendon rupture or skin depigmentation. A relatively old drug (available for eighty years), Traumeel is licensed for frequent use, with the only contraindication being adverse allergic reaction. Among elite athletes its use is common and anecdotally it attracts very favorable reports. There is data to suggest comparable efficacy of both topical and injected Traumeel when compared with NSAID therapy, with fewer side effects and greater patient satisfaction.
I’ve never had a cortisone injection into a muscle so I can’t comment too much about that. I have had it into my shoulders and hips to settle injuries, though, and from my experience, when it goes into joints it’s incredibly effective at reducing the pain caused from inflammation.
As far as Traumeel goes, my n=1 study showed it to be a very effective treatment for muscle tears. My doctor said that he typically uses it on day two, four, and six post-injury, so it is really only useful for muscle tears when used almost immediately. If you wait two weeks and have nagging pain from a tear it’s too late for this treatment. I ended up only having two injections because of timing (it was heading to the weekend) and also the size of the tear itself, which was quite small.
The injections were administered under ultrasound to make sure they went to the right place. I ended up having it directly into the tear as well as the space between the two calf muscles. This is precisely why I went to a doctor. While searching for information on Traumeel for this article I found many forum posts about people buying it online and doing their own injections. I’m not sure about you but I don’t believe I could freehand an injection into the back of my leg so well that I could hit a space the length of your thumbnail and about three times the width of the needle itself. For this particular treatment to work it needs to go right to the tear, so it will need to be done by an expert with the right equipment.
The night of the first injection my calf stiffened up so much I could barely walk. The funny thing was the next morning it was feeling almost one hundred percent and nearly entirely pain free. That’s not bad for the second day after a muscle tear. After the second injection on day four there was almost no stiffness although I believe much of this was because of a smaller amount being injected as much of the tear had already been closed from the previous injection.
The next few weeks were an interesting experience. At this stage I had been injuring myself on almost two-week intervals. Every time I went out the door to run I felt like I was running with a time bomb ticking away in my legs. The Traumeel is like using super glue on the muscle tear. It basically just sticks it together. That stickiness causes a feeling in the muscle like a big knot just like you’d feel if someone shin kicked you to the thigh. So for a couple of weeks I was unsure as to whether or not the feeling in my leg was an impending tear, or even one I’d just done, or just the Traumeel doing it’s job.
After a quick talk with the doctor confirming that is how it was supposed to feel, it’s been like a huge weight lifted off my shoulders. That same week, after twice weekly massages, all the stiffness in my calf disappeared. Last week I ran four days in a row, including a hard twenty minutes on tired legs after a three-hour ride, and was completely pain and stiffness free. I’m hoping this means that my problems are finally over.
As someone who has always been a non-believer in homeopathic remedies this has been an eye-opening experience. Traumeel has proven to be a valid treatment for this type of injury, although I’d suggest that you shouldn’t be doing it yourself.
Photos courtesy of Shutterstock and Traumeel.
