My Calf Muscle Tear Was Caused by My Low Back

By Chris Centeno, MD /

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calf muscle tear

This week I had what I call my first “old man” injury, a calf muscle tear while climbing the stairs. Really? Climbing the stairs? What am I, 80? In addition, I should have known that I was high risk for something like this as I had warning signs screaming for the last several weeks. In fact you may have warning signals blaring right now, but you’re likely ignoring them, just like I did. Let me explain.

Our Understanding of the Orthopedic System Is Stupidly Simplistic

The body is one connected machine, yet we have broken it into systems. I think we’ve done this so that we can comprehend how it works? Or maybe we do it so it’s easier to give tests in medical school? Not sure. However, what I am certain about is that our oversimplification and compartmentalization of the orthopedic system has harmed patients.

calf muscle tear 2Let me give you a concrete example that ties back to my calf muscle tear. The nerves in the low back connect to the muscles in my leg. We know that it’s usually the S1 and S2 nerves in the spine that supply the calf muscle. We also know that if for some reason those spinal nerves in the back get damaged, the calf muscle will shrink and die. Let that last statement sink in a bit—when a muscle’s assigned nerve is damaged, the muscle dies as well. Every first-year medical student knows this, and everyone who has ever met a paralyzed patient in a wheelchair knows that the muscles below the level of the injury shrink to almost nothing. Despite this very clear and well-known connection, most physicians have never contemplated what would happen to the muscle innervated by an irritated spinal nerve. It doesn’t take a rocket scientist to imagine that an irritated spinal nerve might impact the muscle to which it connects. Hence, my calf muscle tear could have something to do with my spinal nerves.

Why Did My Calf Muscle Tear?

I have a degenerated disc in my low back that sometimes irritates my S1 nerve. I can tell when it’s active because parts of my calf muscle will begin to very subtly rapid fire—a phenomenon known as “fasciculations.” I’ll also get pain in my outside ankle where the S1 nerve travels, and my calves will get tight. Notice I didn’t say my back hurts very much when this nerve is irritated. In fact, that’s much more rare.

So why did my calf muscle tear when I was just bounding up the stairs in my office as I had done many, many times before? Remember above when I said the nerve and the muscle are one and the same? For example, what happens to the nerve impacts the muscle. So pressure on the nerve in my low back led to my calf muscle getting tight and firing abnormally, and years of intermittent nerve irritation also likely led to the muscle being structurally weaker. Hence, I hit the step in just the right way and while the S1 spinal nerve signals telling the muscle what to do were delayed just enough so that the muscle tore.

What Were the Warning Signs I Missed, and What Should I Have Done to Prevent My Calf Tear?

Man did I have warning signs for my calf tear. Given that I knew how to interpret them, it was as if my body had painted a big red sign on the back of my eyeballs that read, “Dude, your back nerves are messed up and you’re going to injure something!” So what were the warning signs?

  • The jumping of my calf muscles
  • Tightness in my calves
  • On and off low back pain—remember I noticed my leg issues more than my back.
  • A sense that the small muscles that stabilized my back were “off-line.” I knew this because small innocuous movements, especially in the morning, would cause me to get small pains in my back that I would immediately prevent by reminding my body, “Don’t do that.” In essence, I could tell that at any minute, if I moved the wrong way, my back could “go out.”
  • Pain on the outside of my ankles
  • Pain in the outside of my hips

Notice that with many of the symptoms above, the average person would assume there was an issue where it hurt or was tight (e.g., in my hips, ankles, or calves). However, because I know what the S1 nerve can cause and I know my body, I knew how to interpret this constellation of symptoms and connect it to my back.

Now if I had actually been smart enough and less busy, I should have had one of my partners inject some of the growth factors from my blood platelets around my irritated S1 nerve. It would have taken all of 20 minutes and likely prevented my calf muscle tear by calming down the nerve and reducing the tension in the muscle. I could have also had a physical therapist dry needle my low back muscles and calf, which would have likely prevented the tear.

Understanding How to Be ProActive…

proactiveIf you want to head these injuries off at the pass and are good at listening to your body or you want to get better at paying attention to what it’s telling you, I actually wrote a whole book on the topic. It’s a quick read that teaches the warning signs and educates you on how to head these injuries off at the pass before they occur. Why? If you want to be that 80-year-old athlete that everyone marvels can still do things that some 50-year-olds give up on, you need to be ProActive about these warning signs!

The upshot? The body is one big connected machine. We have compartmentalized it to make it easier to understand, but we’ve done a great disservice to patients by doing so. It also comes as a shocker to patients that their low back may be causing a problem in the hip, knee, or ankle when their back doesn’t hurt much, but take my word for it, it’s much more common than you think. So take an hour and read my book ProActive and be a bit smarter than I was this week—get your little issues fixed by noticing the status updates your body is giving you before a train hits you from left field and sidelines your active lifestyle!

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11 thoughts on “My Calf Muscle Tear Was Caused by My Low Back

  1. Sam

    Wish you a fast and full recovery!

    1. Regenexx Team Post author

      Thanks Sam!

  2. ken

    is there a follow up to this story? did the platelets help?

    1. Regenexx Team Post author

      Ken,

      Yes, the platelets did the trick!

      1. kenneth katz

        awesome!!
        I’m heading for some of these treatments too. I know it’s the right path. no drugs no surgery. hard work, perseverance, thoughtfulness and biologics. it’s the only way.

  3. Chad Freeman

    I thought I could be the healthy heavy guy. Never smoked, never drank, but I enjoyed eating out with friends. I ate salads and ate bad in moderation, but my weight kept going up. Then I hurt an ankle, but because of the weight shift it started messing up my other ankle, and then because of orthotic insoles to help ankles it has started taking my knees. I am down 109 lbs this year to try and salvage what is left. Going to Pittsburgh RAPS clinic Wednesday to see what I should do with whats left.
    I was rear ended a year ago, and didn’t put the connection together until recently. Not long after I was rear ended, I got on an exercise bike and had a hard time putting my heel down on the ground. Then I walked and ended up blowing an ankle and getting peroneal tendonitis. Not sure I will ever be the same but I am getting checked out soon.

    My calf jumps a lot, and dry needling the low back helped so I am hoping they can do something with it.

    Narrowing it down is half the battle.

    In fact on PT dry needled the low back around that area and it went away for a day or two. But then came back.

    I have very little if any back pain. But those calf muscles twitch all the time.

    This is exactly what blew my ankle out. My calf muscles hit all the time. I was rear ended in an accident last year and noticed my calf was getting crazy tight. I finally blew my ankle out and have been through 3 physical therpists trying to solve this exact issue. It is better, but is still jumping as I type. So I stand on a slant board 15-20 mins a day but it will still tighten back up. It took me a while to figure out and has been a year of blown ankles and tight calves, now the knees are hurting.

    Hoping to address this Wednesday at RAPS in Pittsburgh.
    What took me a year to figure out is how to exercise my arch (everyone keeps pushing insoles instead of actually rehabbing the problem), I am walking in bare feet more now and took the insoles out. Trying to get smart feet again with daily exercises to strengthen and work on proprioception.
    By the way, cayenne pepper (natural muscle relaxer) finally let my calf heal, then I get on a slant board in order to constantly stretch the calf. But it re-tightens and I do it again the next day.

    1. Regenexx Team Post author

      Chad,

      The good news is, the RAPs team is amazing, and will figure this all out and be with you every step of the way!

  4. Laura Minor

    This is exactly me. Please advise

    1. Regenexx Team Post author

      Laura,
      If the issue continues it’s likely a good idea to look into.. We’d need to examine you to see what’s gonig on in your particular case. Here are the locations of Regenexx providers: https://regenexx.com/find-a-physician/

  5. Brian

    Could you explain how the injections in your back would help in this instance? I am in a similar situation. I have disk degeneration, nerve issues due to the degeneration, and have been having lots of issues with my calf muscle. It had been doing a lot of the same things like rapid fire spasms, cramping, and feeling like it was getting weaker before I strained it. I am highly active, and it is very discouraging constantly dealing with my calf (and back) issues, but my local doctor who does regenerative medicine/injections says that this type of injection doesn’t help with degenerative disks.

    1. Regenexx Team

      Hi Brian,
      By being able to successfully treat the nerve innervating the calf muscle and the other structures like supporting ligaments, etc. contributing to the problem with our Regenexx-DDD procedure. Your local doctor is right if he is suggesting that injecting a degenerated disc itself is not helpful.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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