The most common injury which I see in middle
and long distance runners is the chronic muscle tear. These injuries
are almost always localized to a large muscle group, either the
buttock, groin, hamstring, or calf. I term chronic muscle tears
insidious or menacing because they present in such a way that
the athlete can continue to run daily, but when fast running is
attempted, especially track workouts or racing, the chronic muscle
tear interferes to the extent that either the speed work is painful
In contrast to acute (sudden) muscle tears
and bone and tendon injuries which improve with sufficient rest,
chronic muscle tears never improve unless the correct treatment
The athlete can rest for months or even years
without any improvement. This type of injury is usually reasonably
easy to recognize. The characteristic feature is a gradual onset
of pain, in contrast to the acute muscle tear's sudden onset of
pain. At first the pain of the chronic muscle tear comes on after
exercise. It develops to where the pain starts during exercise,
with the athlete being able to run through the pain. Pain finally
becomes a limiting factor, getting progressively worse, interfering
with training to the point that speed work in particular becomes
The athletes describing their injury confirm
a chronic muscle tear in their own simple way.
Eamonn Coghlan was aware of injuring his
hamstring two years ago but it never became a serious injury until
he upped his training last September in his quest toward masters
greatness. He describes his injury as 'a drag in the leg and a
pain in the butt'; "I cannot get full extension when running
fast. There's a constant ache deep in there." Running slow
didn't bother him but faster work became painful. Marty Liquori,
the legendary US miler, had retired years ago from running due
to a calf injury and on every attempt to resume running the calf
acted up; his description of it "I get to about 3 or 4 days
back running and the pain starts and I have to walk home; I can't
get up on my toes". After working with Marty this winter
he resumed running and recently ran a 4:46 mile.
Chronic muscle tears occur in muscle at sites
that are exposed to high loading. This loading is especially high
during faster running. Because the loading is so concentrated
over a small section of the muscle, an initial small tear develops
at that site. The tear is initially too small to cause discomfort.
The athlete may be aware of a tightness or low grade soreness
similar to delayed muscle fatigue in the muscle involved. However,
once the initial tear has occurred, a cycle of repair and retear
develops that leads ultimately to a large tender knot developing
in the muscle, which comprises muscle fibres surrounded by scar
tissue. I like to use the analogy of scar tissue as being like
chewing gum stuck and hardened to a wool carpet.
Minor muscle tears. The formation of intramuscular scarring (top
and centre) can painfully limit broadening on contraction (bottom).
In the muscle the scar tissue is inflexible
so when the muscle either contracts forcibly (shortens and broadens)
or stretches (lengthens and narrows) the scar tissue re-tears
and the cycle of repair and re-tear develops with increased irritation
and a matrix of more scar tissue is laid down. Excessive Scar
Tissue Formation at the site of tear inhibits normal contractibility
and extensibility of muscle.
To confirm that the injury is indeed a chronic
muscle tear, a physiotherapist needs only to press firmly with
a thumb or two fingers into the affected muscle. If it is possible
to find a very tender hard "knot" in the muscle then
the injury is definitely a chronic muscle tear. When palpated
with digital pressure, the knot in question can be excruciatingly
painful. Tim Noakes MD in the Lore of Running states, regarding
chronic muscle tears: "Conventional treatment, including
drugs and cortisone injections, is a waste of time in this injury;
the only treatment that works is a physiotherapeutic maneuver
known as cross fibre frictions. A better term would be 'crucifixions'
because nothing, not even the runner's toughest ever race is as
painful as cross fibre frictions applied to a chronic muscle tear.
Therein lies the key to the treatment of these injuries.
A chronic muscle tear will only get better
if (a) the cross fibre frictions are applied to the injury site,
in this case the tender knot in the muscle, and (b) they are applied
sufficiently vigorously. If the cross fibre friction treatment
does not reduce the athlete to tears, either the diagnosis is
wrong or the physiotherapist is being too kind. "This is
the one treatment for which you must have a physiotherapist who
has big hands, the forearms or a gorilla, and unbridled sadism."
Deep Transverse Cyriax Friction Therapy. The muscle fibres are
I have been named everything from Hitler,
to 'thunder thumbs, magic fingers, Saddam Hussein and worse,'
but the painful treatment is well appreciated by the athlete as
chronic muscle tears respond rapidly to six or eight sessions
of therapy. Physiotherapists who specialize in sports injuries
usually have expertise in administering cross-fibre friction and
because of the invasiveness of the therapy, which I term "bloodless
surgery," it is important to go to a therapist with experience
in the physiotherapeutic maneuver.
To avoid chronic muscle tears the athlete
should be fastidious about stretching, especially the main locomotive
muscles which cross two joints, ie, the hamstrings, gastronemius,
quadriceps and adductors. Muscle strength imbalances between opposing
muscle groups should be corrected. The strength balance between
hamstring and quadriceps is very important and serious athletes
should have their strength ratios tested on a Cybex or similar
strength testing machine. At all times, but especially when doing
speed work, it is imperative to be adequately warmed up. Prevention
is better than cure, but for the runner who has the symptoms of
a developing chronic muscle tear a little treatment early on saves
time out and a great deal of agony later on.