Simplavida: Simplified Longevity

Paul: Hey Howard, we're back. We're gonna make fun of you. Not really though. So you texted me the other day and you were like, I don't know, what was it, like three miles from anywhere in the middle of the woods

Howard: I was

Paul: and, yeah.

On a trail, and it wasn't that you had been like chased by bears or attacked by porcupines or anything else, but something else had happened. What was it,

Howard: Ugh, this is awful. You know, as you can tell by the weather behind me, this is a typical weather in New York, wet, rainy all the

Paul: Seattle? Yeah. Yeah. Yeah.

Howard: I have a local trail a few miles away that I've run and I've run it so many times over the years. I know every rock, every creek everything that's safe to put my foot on or not.

So I came on this rock and I put my foot there and a good firm rock, except now it was all mossy and my, my foot slipped back. I went forward and my calf went pop. And so I was two and a half to three miles away from my car and I had to go over a few streams and I can barely walk.

Paul: I was, I last, I think one of your, one of your last text was, I'm wandering in the woods looking for a stick for a crutch.

Howard: was, I was looking for a big walking stick or something. It was funny,

Paul: So

Howard: made it out.

Paul: W Yeah. Well, you're here, so I'm gonna assume this is either you or a body devil. But so let's talk a little bit about the, the actual injury. So first off, what is, what, what is, what is the pop? What actually happens? What do you think happened? You don't know, obviously, but, or maybe you

Howard: is, so this is you know, a classic tennis leg. Classic story is, you know, a male, it can, it can happen to women, but it's usually male quick, you know, trying to run for a ball on pickleball court now, or a tennis court when the better sport was played previously. And they feel a pop.

And that the pop is above the, above their Achilles. It's in the midcalf usually on the inner side. So the gastroc anus muscles in the back of the calf, the two muscles. There's medial and lateral. It's always the medial one. It occurs where the muscle is starting to turn into the tendon, what we call muscle tendon junction.

Many of these, you know, are mild, some are more severe. There's a muscle. Deep to the gastroc anemia, which we call the sous really important muscle. And if these injuries involve the sous, it's a much more severe injury. It's gonna take a long time to recover. So I got to the office, I got there late, I pulled my ultrasound machine out and then, and I ultrasounded it so.

Paul: Good for you.

Howard: you know, there was a small hematoma there, a small strain at the muscle tendon junction of, you know, my medial gastro. So, and my sous was fine, you know, I think I was telling you. I see a lot of people with these injuries and some, you know, are crippled, they're miserable, they can't walk, they're on crutches, walker, they want pain medication.

So I really, I've never had this, so I really didn't know what to expect on the second day. Right. So I think I messaged you on the second day. Yeah. Not so bad. So you interpreted that as, you interpreted that as, are you running? I'm like, no, it's not that good.

Paul: I know, I know. I'm bad that way. Yeah. So you're out running, right? Yeah. No, not adult.

Howard: yeah, but it wasn't nearly as bad as I thought it was gonna be. And so

Paul: do, no, go ahead. Well, I was just gonna say, so how do you, how do That's all right. I'll, I'll sort this out in editing, but how did you know? How would you have known that? It was a, without MRI in it? Without an MRI. What might have told you that it was a more serious injury, either at the time or day later that's telling you, I need to go see someone about this.

What? What was,

Howard: I guess if it, if it was swollen, if it was black and blue, if I really couldn't get my heel down to the ground or my foot flat if there was weakness there, I couldn't push off. And if I was miserable and couldn't walk, I would, I would see someone. Because as we're going to get into, mine wasn't as bad as it could have been.

At least I didn't think it was. And how you manage these can affect the recovery too. And how you manage these can affect your d training while recovering from an injury because you don't wanna rest too long either.

Paul: Yeah. Is there a. I used to, there was an expression I used to hear, it was like old man's calf or something. I dunno what it was exactly. But the idea was that with aids, these calf injuries become more common. Is that it? Yeah,

Howard: Tennis

Paul: is that because of, is that because of a change in the, in the musculature of the calf, whether it's repeated strains or weakness, or is it something, something else going on?

Like what's the, the ideology

Howard: That's a good question. You know, in, in a recent podcast we talked about the importance of power training. And I actually do train for this. So I train my gastros and calf muscles for explosive. Forward movement so that I hopefully don't pop my Achilles or get a tennis leg. So this wasn't, you know, I played a lot of tennis and basketball and I don't, I didn't injure it there.

This, this was a bad, this was a bad injury. You, you know, slipping on the rock. So maybe it would've been worse, or who knows?

Paul: But it was also probably because it was it, it was out of plane though too, right? I mean, you went sideways off the rock, right? Yeah. So that's hard to train. That's really hard to train for.

Howard: Yeah, my foot got my foot bent, went forward, slipped and I fell forward. So it just cranked my ankle up against my tibia.

Paul: Yeah, I had a, I had an orp, I had an orthopedic guy once tell me that I, I twisted my ankle on a trail run, similar sort of story. And he is like, here's the good news. He said, you've twi, you've twisted your ankle so many times that the, the ligature there is basically a mess. So, , there's nothing left to, there's nothing left to, to, to hurt.

Right. Because it's like I, I've rolled my ankles so many times on so many runs and so on. It's just. Weirdly enough, they're actually very, very stable in terms of normal running. But if it go, if, if I'm doing something and it goes over, it'll go, I'll go right

Howard: It just goes all the way. Yeah.

Paul: Yeah, yeah, yeah, yeah,

Howard: So this was fascinating. So I, I called my, I work with a trainer sometimes on Wednesdays. And I called him and I'm like, look, you know, I popped my calf yesterday. I should, I should probably take today off. And he is like, nonsense. Come on in. We'll find something to do. Great. I'm not gonna say no, I, I mean, I have a right leg. So we immediately started on some loading. Very careful, very deliberate. Nothing quick movement. Just a lot of isometric work just to start to get that muscle and tendon moving. 'cause that helps in the healing process. And I was, again, I haven't, I've never had this injury before and we've talked about how fear.

Really starts to affect us, right? Fear of injury, fear of making things worse fear of recurrence. So I had that fear, you know, like, oh shit, you know, how much do, do, do I wanna push this? And he was like, don't worry, you know, you are gonna be fine. And sure as heck, you know, I was in the gym for an hour and it was no more sore than when I entered the gym.

And the next morning I woke up. And it's felt even better. You know, I, yeah, I mean, I will definitely be running by by Monday or Tuesday if it continues

Paul: you asked me that. You said, given my, I'm a veteran of these things, and so you asked me how long until I was typically back running and I was like, less than a week usually, I mean, yeah, it's not really very long and I don't know. I mean, I haven't had a particularly severe strain, so to be clear, but I mean, I will get these exactly what you described, like a small twisting injury from going off a rock sideways or, or even in my case, like a, , a long hill run will do it sometimes, like where you just get to the point where it's, you've strained the, the, that musculature for so long going uphill that just something just says, , screw it, I'm outta here.

And,

Howard: just, I also think that us being as fit as we are, helps improve the healing process because the machinery is in place to create, create new tissue. Right. It's used

Paul: Well, and the vascularization is more intense, right?

Howard: Absolutely. You know, the inflammation is low in that region. I just think it's a perfect he healing environment to just rev up the machinery a little more.

Paul: So do you think the advice, like I've often argued that we over caution people after an injury that, oh, you shouldn't try again until you're feeling absolutely no discomfort. And I just think that's a really, in general, is a really dangerous position to take with people because it leads to this apprehension and fear you're going to feel some discomfort 'cause you're about to do a movement you haven't done in a while.

Howard: Right. No, I was very thankful for my trainer. I. Who insisted that I come into work with him because that was really important. You know, I was only a day out from the injury and I tolerated this load. I there, I didn't think that I would. And I'm just now in a much better place. In terms continuing my workouts.

I mean, I just rode my bike for two hours and I'm gonna, I on the weekend, you know, in a few days.

Paul: Yeah,

Howard: That, that really took a lot of the fear out of the equation. Now, I'll tell you as a, you know, I'm gonna put my orthopedist hat on for a second because if I have, if I have you in front of me, right, and I've treated you 12 injuries over 10 years, I know that the minute I tell Paul that he can go, he's doing a 12,000 foot. 20 mile run. Right? So I,

Paul: Yeah,

Howard: so, so you gotta be careful, you know? So I'll give caveats. I'm like, look, you can start to push this. I want you to do some isometrics, some this, some calf raises, then light jog. And I'll say, light jog, light jog, light jog, stop. You know, don't push this. So I have to sort of keep in mind who I may have in front of me.

What their history is. And so, yeah, 'cause I, I wanna, min, I don't wanna scare people, but I don't want to give them the all clear to go hurt themselves again.

Paul: Yeah. Although as you often point out, I am, both of us, and maybe me in particular, I'm a, , a monkey for this stuff. So I'm an like, I recognize right away that, , my tendency to go right back out and run up 12,000 feet of something is not widespread in the population. So,

Howard: No,

Paul: extrapolating from.

Yeah. And so I, my concern is often on the other end where people have read too many times about recurrence and chronic injuries and all these kind and there, and so for, I'll, I'll hear about people who are still talking about an injury they had two years ago, and I'm like, well, have you been reinjured since?

No, but I can still feel that spot. Oh, bullshit. You know what I mean? And maybe they can, I don't know, but the, the brain's really powerful. The brain's really powerful that you convince yourself. You can feel something. You can often feel something. Right. So it

Howard: Yeah, I,

Paul: mean that much. Yeah.

Howard: I, I, I agree. We should probably do a, a pain podcast one day because at that point, you know, if you have chronic pain, it's, it's, yeah. The chance that it's still peripheral, I. Is, you know, is very low. It's probably centralized by then, and I don't tell people it's in their head, but pain is complex and it might be in your head it's real, right?

I'm not saying it's not real. I'm not saying you don't have pain, but it's very complicated. So it's very important. My case in point here, it. To, to, to push the envelope a little under guidance. Not too much. It gave me a tremendous amount of confidence. I immediately knew one day after the injury that, hey, this wasn't gonna be as bad as I thought.

And you know, I, I can be a knucklehead like you though too. So, you know, my brain is saying all.

Paul: have no, I, yeah, I have no monopoly on

Howard: brain is saying three or four miles on Sunday, but I, if my friend says, you know, let's do eight on this rocky trail, I might say, okay I need another walking

Paul: I'm good to go. That's right. You may have to bring one of those collapsible poles, , that fit in your backpack or what, whatever it is. So the last, last point before we stop on this, the other comment you'll get from people is, look, Howard got injured despite, , he's a doctor, he knows this stuff.

He's a sports medicine guy. He does all this resistance training and strengthening and power and look, he got injured. Anyways. All this injury, all this training stuff is pointless because he got injured. Anyway, I and I, you hear that a lot, which I find fascinating. It's like people saying. , they were wearing a seatbelt and they died in a car accident anyway.

Well, yeah, but that's not the point. The point is that that it's protective broadly. Not that no one will ever get injured again when they wear a seatbelt, or no one will ever get a calf injury from training.

Howard: Yeah. You know, I think I wrote a post for our site on, on this, but as I say, again exercise is the risk you take to avoid the consequences of being still. So are there injuries with, in, in running and, and weight training and cycling? Of course. But you know, I healed better because I'm a runner and because I weight train.

You know, and I'm gonna be back at it and I missed a week of running. Okay.

Paul: Yeah.

Howard: Point not taken. I'm not yeah, it's okay.

Paul: no, no. That's great. Good. Well, thanks Howard. This is, I think this is really helpful for people to hear that, not at least that I'm not the only knucklehead around here, so

Howard: Definitely not.

Paul: as you say,

Howard: Bye.

Paul: all right, thanks Howard.