Calf Strain: A Running & Jumping Athlete’s Nightmare

He sits on the bench with an ice bag on the back of his lower leg.  A calf strain is a common sight with athletes young and old.  Everyone wants to know why.

Looking at athletes at every level of athletics, calf strains have become the Great Equalizer. It’s an injury that is way too prevalent.  One of my favorite running buddies is wrestling with a strained calf and I know, as both a certified athletic trainer and a competitive athlete, calf injuries suck!

In the NFL, last year was a bad year for injuries to the calf.  Fans, coaches and players were frustrated to consistently see way too many calf injuries on the NFL injury reports each week.  These slow-healing injuries negatively impacted NFL fantasy football rockstars like Victor Cruz (NYG), Crockett Gillmore (Balt) and Sammy Watkins (Buff).

The hamstrings on the back of the thigh get all the hype when it comes to what we call “soft tissue injuries” in the NFL.  But when you ask skilled players like wide receivers, running back and defensive backs what muscle injury frustrates them the most, calves and groins typically head up that list.

What is a Calf?

A small cow?  Yes, but that’s not important right now.Calf cow 22

The “calf” or calves (plural) is made of two long muscles on the back of the shin bones.  The gastrocnemius or “gastroc” is the bigger of the two muscles and it’s the more superficial of the two.  When you look at a calf “belly,” you’re looking at the gastroc.  It starts from two tendons above the back of the knee and it extends over the backside of the knee and anchors into the top of the Achilles tendon.

The deeper of the two calf muscles is the soleus.  It starts below the knee and it extends downward joining the gastroc at the top of the Achilles tendon.

Simply stated, the two calf muscles merge together to form the Achilles tendon, which we know attaches to the heel bone below the ankle.

The next time you look at a fast player’s calves, you’ll notice that most of these skilled players will have smaller muscle bellies that tend to be closer to the knees.  The bigger, slower players will typically demonstrate a bigger and lower gastrocs.

What Does the Calf Do?

Here comes the fun part.  The calf is not a big or powerful muscle but it’s a very important muscle group.  When running or pushing, the calf transfers all of the power from the legs, hips and back to the ground in a timely manner.  If the timing of that transfer of power changes ever so slightly, which can easily happen due to injury, fatigue, change in the surface area and/or a change in body mechanics, the calf muscle(s) can tear.

Because the calf crosses both the knee joint and the ankle joint via the Achilles, it raises the heel when running and it assists in bending the knee.  Both of these actions are vital when running fast and changing directions.  THAT’s why a calf strain can quickly bring fast players to a screeching halt.

What to Do When a Calf Goes Pop

Tear = strain = pull

When a muscle is injured, the small muscle fibers that make up the muscle belly pop or tear similar to cutting small rubber bands.  The more fibers that tear, the worse the injury. These fibers have a blood and nerve supply so when muscle fibers tear, they bleed into the wound and create pain.

NFL fans saw first hand in the 2014-15 playoffs how Aaron Rodgers’ ability to move and throw quickly changed because of his calf strain.

Initially, an injured calf muscle needs more rest than it needs fancy physical therapy techniques.  Scar tissue is a calf’s best friend.  Scar tissue fills that new injury wound/hole in the muscle and, in a sense, pulls the healthy fibers together.  A common mistake in aggressive sports medicine settings is to over-treat a calf strain by doing too much too soon.  As with a fresh calf injury, being too aggressive early will cause more bleeding, more pain, weaker scar tissue and a longer recovery.  NFL players are in great hands because NFL athletic trainers are exceptional at properly treating these injuries.

I strained my calf three times within two months as I trained for an Ironman triathlon in Austria in 2009.  It was a frustrating and painful injury for me.  It proved to be very valuable for me as an athletic trainer and physical therapist.  It positively changed how I treat NFL players with calf strains.

Truth be told: Rehabbing athletes is much more enjoyable than rehabbing yourself!

The Bottom Line for a Calf Strain

Calf muscles heal slowly.

The key physical therapy pearl that I learned from rehabbing my own calf and dozens of NFL calf strains since then:  When you think the athlete’s calf is ready to return to full speed with no limitations, give the healing calf one more week.  Your calf will thank you.

Gameday For An NFL Athletic Trainer

Gameday in the NFL.  It’s easily the best day of the week for players, coaches, athletic trainers and, of course, the fans.

I’m often asked: “What do you do on gameday during the season?”  I’m currently in Minnesota with the Jaguars as we prepare for our season opener against the Vikings.  This is the start of my 25th full-time season in the NFL so I know how blessed I am to be able to work in my dream job for over 1/2 of my life.

Let me show you what a typical gameday looks like for an NFL athletic trainer for a road game.

5:00 AM– Wake-up, workout, do my own core & flexibility exercises and review notes for pre-game injury updates for the head coach.  This is the last quiet time I’ll have until later tonight so I enjoy the last of my  “me time” while I can.

8:00 AM – Refreshed and relaxed, its time to head to the team breakfast.  I check on injured players with my medical staff for any last-minute surprises. Note: we don’t like medical surprises on gameday.

8:45 AM – With medical staff and supplies, we head to the stadium to prepare for the game ahead of the players.  The prepping of supplies – about twenty-five miles worth of tape, twenty-five gallons of fluids and forty-five jock straps along with the trunks of emergency equipment is completed the night before by my awesome assistants Justin Bland and Rod Scott.  We’re fully dressed in game attire – minus the game shirt in favor of a T-shirt – it’s “work time” to prepare 45 players and staff for the game.

9:30 AM – The first of the buses arrive and it’s “go time” for us athletic trainers.  What does this mean? We put to use our sports medicine skills such as taping 80+ ankles, aggressively preparing the players with massage, manual therapy techniques to increase joint range of motions, soft tissue treatment to enhance muscle and fascia blood flow, flexibility drills to promote movement patterns and the many pre-game routines that these world-class athletes need to compete at an elite level for 3+ hours.  Most players have little rituals that they need to strictly follow in the athletic training room in order to have that “great game” – some may call it superstitions. Each player has a solid routine that they always follow such as a certain sequence of stretches or exact placements of athletic tape.

10:30 AM – The fast pace and high energy pre-game work continues along with updating the staff about important medical issues related to the players for the game that may impact coaching strategy and player availability.

12:10 PM – As the players head to the field for pre-game warmups, the medical staff follows.  The unwritten rule: “If the Athletic Training Room gets quiet, you’re probably last for something.”  Run to the field!

12:20 PM – Check every sideline trunk, supply and emergency gear one last time.  I like to watch my injuries players to see how they move during warmups as well.  I introduce myself to the sideline support staff, review emergency details with the paramedics, meet the airway management physician, review the communication format with the athletic trainer field observer and have fun catching up with the other NFL teams’ medical staff.  We traditionally wish them few injuries but the “good luck in the game” is always said with a smile on our faces because we know it’s a lie.  As one of my fellow PFATS athletic trainer said to me before a big game: Don’t give me that BS Ryan! We want to kick your ass just as much as you want to kick ours!”  He was 100% right!

12:45 PM – Update the team VIP’s of anything related to the health of our players.  I strongly stress to the player the need to hyper-hydrate and to get any needed sports medicine assistance now.  The locker room is buzzing with energy as we get ready to take the field and do our job. It an awesome and fun environment to be around.  This is the first time I usually put my “To Do List” aside and really get fired up for what’s about to happen on the field!

1:00 PM – The loud “They’re Heading Out!” cries out and the medical staff, with our pockets and medical belt packs properly stocked, excitedly head to the tunnel.

1:04 PM – The traditional high-fives, ammonia caps, words of encouragement and nervous claps on the shoulder pads are handed out as the deafening crowd noise makes it impossible to keep my composure.  I shake the Head Coach’s hand as I hand him a drink of water and follow through on a few player pre-game rituals, it’s time for the kickoff.  The energy, the noise and the look in our players eyes is addicting!  “THIS is why I love this job” echoes in my head and it’s such a rush to be right there as the stadium begins to rock!  As to what I scream at that point, I’ll keep that to myself….

1:05 to 4:15 PM – monitoring the field, racing out to evaluate and treat injured players, updating the Head Coach, position coach and special team coach on every injury on issues that affect performance, administering first aid to injured players, conversing with our doctors and assistant athletic trainers on medical injuries, taping/splinting/bracing injuries as needed and providing positive reinforcement to struggling players are just some of the duties that I juggle on the field during a game.  It’s multitasking at it’s best in a high energy and testosterone-filled setting with one eye on the field and one eye on the players on the sideline.

4:30 to 5:45 PM – The post-game buzz. No matter a win or a loss, I evaluate and treat post-game injuries and prepare them to fly back to Jacksonville.  The use of x-ray, specific sports medicine techniques and supplies helps this medical process run smoothly.

5:45 to 5:55 PM – Strip, run to the shower, put on suit and tie and race to the waiting 5 team buses.

6:30 PM – Security check and board the plane, hopefully with a victory in hand.  Update the VIP’s on medical issues, coordinate the icing and positioning of the players with my assistants for the long ride home.  Finalize any special tests and morning treatment lists.

30,000 feet – Eat something healthy & relax.

I love my job as an athletic trainer & physical therapist in the NFL.  It’s not easy. It’s a 7 day a week job for 6-7 straight months but I’m not complaining.  I love the challenge and the responsibility associated with my role.  I have an outstanding medical staff with a simple objective:  To keep the players in the very best of health to help them to do their job.

 

The Door: Inside the NFL Draft

Oz had the famed Curtain.

Babylon had the mighty Walls.

The NFL has The Door.

Only “Authorized Personnel” are allowed through the NFL Draft Room door. And, everyone knows it.  Often referred to as the “War Room”, the Draft Room is where franchise impact decisions are made and openly discussed.  Hence, the reason why only the chosen few are allowed to enter. I’m lucky to be one of the chosen few. Tomorrow, the NFL will hold it’s annual NFL Draft.

What’s in the Draft Room?

Although it varies from team to team, the secret Draft Board is the Holy Grail of this treasured plot of real estate.  Players are evaluated on every aspect of their game. Many factors such as the overall scouting grade, 40 yard times, workout stats, body size and weight and various intangible grades as well as what I’m responsible for evaluating: medical grades. Everything is clearly listed for each player on the Draft Board.

The higher up the Draft Board a player is positioned, the better the player’s grade. And, hence the more valuable they are.  The grading scale is represented on the side of the board next to a players name.  Therefore, higher graded players are moved “up the board” assuming that they will be picked earlier in the Draft. This is compared to those lower graded players dwelling down next to the plugs on the bottom of the wall.

The variable in any Draft Room is the amount of work and effort that each club puts into this process.   From the tireless hours of traveling and film work put in by the scouts to the painstaking medical grading of up to 900 players by the NFL athletic trainers and physicians to the hundreds of evaluations coordinated by the coaches, that NFL Draft Board is the result of a Herculean effort by many loyal worker bees.

The long Fall season of watching college players perform and the findings from the NFL Combine in February are far behind us now. We now stand on the cusp of knowing who made the grade.

The Secret Sauce of Knowing Who to Draft #1

You didn’t think I could actually disclose the trade secret, did you? Seriously, that answer is too detailed and I’m never going to be the person to disclose that sensitive information.  I’m the “medical guy” and I know my role.

Now comes the exciting part.  This weekend marks the collision of hard work by players who have spent a lifetime cultivating their skills and NFL staffs who have completed their homework to evaluate those players. Our staff will be dreaming of highly skilled and healthy players.  And, personally, I look down the road to see how well my staff’s medical evaluations panned out for players across the league. We evaluated nearly a thousand players and I’m always assessing how players perform medically compared to how we medically graded them.  It’s a great measuring tool to help improve the skills of me and my medical department.  It’s the only way that I’ll continue to be allowed to pass through The Door.