I suspect that most medical practitioners involved with the treatment of athletes, are currently inundated with cases relating to muscle overuse ad abuse syndromes. It is only natural that all runners at some point in time, will suffer from soft tissue sprain and strain conditions due to a variety of mechanisms failing to support increased running distances for longer periods of time.

I was recently exposed to a patient suffering from repetitive Gastrocnemius muscle strains on the left lateral head of the muscle that occurred 8-10km into the race, proved to be debilitating at the time and kept recurring no matter what treatment protocol he followed. Not only was his pain localized close to the traumatic zone, but he also experienced pain extending from the instep of the foot, over the posteromedial aspect of the ankle and over the calf and back of the knee to the lower posterior thigh.

Myofascial pain and dysfunction syndromes leading to trigger points in the calf muscles are extremely common and yet very complex in nature and exceedingly difficult to treat. In order to treat lower limb syndromes effectively, it becomes imperative to identify the causative mechanism accurately and early in the treatment phase. The practitioner must determine whether the mechanism is mechanical, biomechanical, kinematical, neurological and / or traumatic.

To treat lower limb syndromes effectively, a multi disciplinary approach must be adopted to evaluate and test all variables in all the kinematic chains that could lead to imbalances, anomalies, abnormalities and overload mechanisms over and above the impact of long distance running.

If you as a runner suffer from the abovementioned syndrome, I would like to make the following suggestions:

• Do not procrastinate! Seek treatment immediately.
• Exclude structural abnormalities, eg. Leg length discrepancies, degenerative disc and joint disease in the lumbar spine, SI abnormalities etc. etc. X-Ray investigations will give an initial accurate indication and provide a baseline for comparison.
• Compile a team of specialists to target regional examinations to determine structure and functional relationships.

Eg: Podiatrist to evaluate lower limb biomechanics.
Physiotherapist to treat the muscle and other
related soft tissue pathology.
Biochinetesist to identify imbalances, weaknesses
and compensatory mechanisms.
Chiropractor to correct spinal and peripheral
joint aberrant movement patterns and restore
structure and function relationships.
Kinesiology and acupuncture could be beneficial.

It is imperative that once a diagnoses has been made and a treatment protocol has been agreed upon, that all role players be kept actively involved and updated as to progress or lack thereof. Regular goals must be set and progress measured against a previously measures baseline for comparison.

What would a treatment protocol to manage this syndrome entail?

A number of treatment modalities have proven themselves to be extremely effective. Before any direct treatment protocol can start, it is essential to correct all biomechanical imbalances, movement abnormalities and to identify, isolate and remove possible mechanisms responsible for the etiology behind the development of the myofascial disorder eg :

1 Re-evaluate the patients training program and methodology.
2 Ensure normal biomechanical movement of all joints but specifically the Sacro-iliac joints. Maintain healthy structure and function relationships, thereby limiting mechanical strain and overload on the muscle.
3 Follow a strict stretching protocol:
By adopting a regular stretching routine, muscle tension is reduced and an increased range of motion is established.
Effective stretches minimizes arterial compression due to abnormal muscle tone and normalizes blood flow.
Regular stretching reduces pain by normalizing muscle physiology and reducing chemical imbalances that may irritate sensory and motor nerve endings, thereby causing pain referral patterns.

4 Dry needling of the involved trigger points can be extremely effective especially so if combined with heat and stretch protocols.

5 Biopuncture techniques using Traumeel S have proven to be the most effective treatment protocol by far. If one understands the physiology behind the effect of Traumeel S at cellular level, one cannot but agree to its efficacy.

Traumeel S is a biotherapeutic antiphlogistic that contains many low potentised proteins and complies completely with the conditions for arousing an immunological bystander reaction. By stimulating the formation of Th3-cells, the inflammation will be restrained. It is important to note that this form of therapy is not suppressive, but stimulating. The self regulating control of the inflammatory process will not be touched. Nsaids, although effective in the short term, suppresses the inflammatory reaction by intervention at the cyclo-ogygenase level thereby limiting the formation of prostaglandins. Patients will however complain that pain will return as soon as the effect of nsaids diminishes within four to eight hours.
Where an antihomotoxic agent with low potentised proteins is introduced into the GRS (Ground Regulation System) patrolling macrophages will digest it almost completely. It does not matter whether the agents enter the body via the mucus (sublingual) or directly in the bloodstream or the GRS (injection). The residues are transported back to the macrophage surface in the form of short amino acid chains motifs. There they act like an antenna on thecell surface. The motifs are recognized by passing T-lymphocytes, taken away from the macrophages and bound to receptors of their own. This is the signal for transformation into Th3-cells (regulatory lymphocytes). Since the Th3-cells contain proteins, they will be transported to the lymph nodes (homing) where they will be multiplied (cloning). The activated Th3-cells search for inflammation promoting lymphocytes (Th1, Th2, T4, ....) from the inflammation area, which motifs are dependent on the foreign substances that caused the inflammation. The Th3-cell will look for lymphocytes with a similar motif (not equal, but following the simile principle). As soon as the similarity is confirmed, the Th3-cells immediately start with the synthesis of the highly active TGF-B (Transforming Growth Factor B), which will decrease the activity of the Th1 and Th2 lymphocytes and thereby modulating the inflammatory reaction allowing tissues to heal.

Traumeel S works by modulating the generation of reactive oxygen by activated neutrophils and by inhibiting the release of inflammatory mediators and neuropeptides.

The advantages of using a product like Traumeel S:

- No GI toxicity
- Does not inhibit platelet aggregation
- No sodium and fluid retention
- No adverse renal, hepatic, cardiovascular or CNS side effects
- Enhances cellular recovery and therefore healing

To conclude, train smarter, rest more, stretch more and modulate the adverse cellular and biochemical pathways in the muscle with products like Traumeel S.

Good luck