Digressing. The middle aged man calf syndrome

In the last couple of months I have tried to “up the ante” with training load to further increase my fitness and start to enjoy more the Aquathlon/Duathon/Triathlon local competitions I compete in with other people my age. Physical activity is important to maintain/improve fitness but also to help with our mental wellbeing (see the evidence here). For me it is also a way to keep up with my super active family and a social opportunity to meet other people. But of course, to do it safely I need to train. Training is done progressively, within reasons and adequate to my fitness levels, and most of all trying to get some routine times to have consistency. But despite all this I have fallen victim of the classic party pooper for anybody involved in running activities after a certain age. I am in this with many other colleagues/friends my age. All former athletes at some level, very active and all recently affected like me by the “old man calf syndrome” or as we jokingly describe it “being shot by the invisible sniper while running“.

Calf strains are in fact common. The most common calf injury is a tear of the medial gastrocnemius muscle (Tennis Leg) but other structures including the lateral gastrocnemius, and soleus also may be the cause of muscular pain experienced suddenly while running. In my case, I seem to favour the soleus, but in general, I see many like me struggling with this. If you want to know more about the anatomical structures, make sure you read this very recent amazing paper from Bosterlee et al. which used imaging to do a 3D reconstruction the soleus (see image below).

(from DOI: 10.7717/peerj.4610/fig-1)

And if you want to read more about the gastrocnemius structure, read this really good paper here.

In the literature to date, there is an absence of definitive data relating to risk factors for calf muscle strain injuries. Despite the fact that is really common, there seems to be very few studies on this. A recent systematic review does suggest that strong evidence exists for an association between increased age and future calf strain as well as previous injuries and recurrence. So, there it is, you get older you increase risk, you get your first “pop” and you are going to get more. However, the systematic review clearly indicated that there is a lack of well controlled studies on this and the causes still need to be worked out (albeit we can all agree that for sure it is multifactorial).

Many things should be looked at: 1) blood flow to the calf muscles might be compromised with age, 2) neuromuscular function in the whole lower limb is negatively affected by age, 3) tendons are affected by age and activity and are still mechanosensitive in older adults, 4) tendon elasticity is affected by age and activity. Despite the fact that activity helps reducing the negative effects of ageing on musculoskeletal structures, we are often bound to many hours of “desk work” which has major negative influences on blood flow and neuromuscular function of the lower leg.

Therefore, there is a plethora of things which can cause the injury to occur in the first place and then re-occurr. While research is needed to understand the cause and possibly the best way to reduce the chances of occurrence (albeit it is common advice to strengthen the muscles, increase tendon elasticity and neuromuscular control paired with an adequate pair of running shoes), some advice exists on recovery modalities.

The usual conservative treatment initially should consists of rest, ice, compression, elevation (RICE). Non Steroidal Anti Inflammatory Drugs can be utilized, though this is controversial. Patients can utilize cryotherapy, massage, passive range of motion, and progressive exercise to reduce the symptoms.

In general, Grade I injuries, which present with partial tearing with no loss of muscle integrity, heal in a few days to a few weeks. Grade II muscle strains (10–50% of muscle disruption with loss of strength) need one to 6 weeks before the patient can return to training. Grade III injuries could take up to six months for return to activity as they involve loss of more than 50% of muscle integrity and have noticeable defects. Re-injury is frustrating and common, and therefore a cautious approach to return to training and competition should be used.

For sure, there is no magic pill or magic bandage which can “fix” you, unless you are after some placebo effect.

So here it is for research groups interested in soft tissue injuries in ageing athletes: there is a lot which needs to be done to understand more about the aetiology of calf strains, its prevention and rehabilitation.

We need your help to keep our competitive souls going and avoid the disappointment of limping to the finish line.


Time goes fast, things happen and time to write just goes

Since December I have been staring at the blog without much time to write. It is amazing how fast time flies by. It’s been busy time at work at the Aspire Academy. We are completing a move to a brand new facility which will be unveiled soon (it is pretty impressive by the way!) while carrying on with day to day activities to support the development of our young athletes. Results have been pretty impressive as we already have 5 athletes qualified for the World Junior Athletics Championships this summer and few hopefully to come, some have also won Asian Championships medals last night and things are going really well there. Our new Fencing programme is showing signs of improvement with some great placings and podiums in international competitions. Table Tennis and Squash continue to produce credible international performances and we now have some interesting athletes in Motor Sports and Shooting/Triathlon. Finally, our graduates are doing incredibly well showing that Aspire legacy is strong.


It’s been busy also completing some research projects and trying to get them published. A productive few months, but I have to say the whole publishing process is now starting to get on my nerves and I am not sure I still have the energy to endure such process when the reviews received show lack of understanding…but that’s probably a topic for another post.

One of the articles I am mostly proud of is this one on the Video Analysis of Injuries at the Handball World Championships played in Qatar 2015. This work is a true example of international collaboration with a lot of people involved in the project and an outcome which challenges the need to review refereeing in a sport in order to reduce the injury outcomes. This project is also one of the many published and led from Qatar which were all part of the Aspire Zone efforts during the World Championships in 2015 to do more work to enhance handball knowledge. New information and knowledge was in fact generated with regards to injuries, performance demands, goalkeepers performances and soon on passing/shoulder load. It is a long process to get data published and available but still all this work is a legacy for the Handball community to enhance our understanding of how to prepare players. I have further contributed to sharing more information about my beloved sport writing a chapter for the last book edited by Dr Anthony Turner on Strength and Conditioning.

The collaboration with my bioengineering colleagues in Tubingen to understand more about the implications of using vibration combined to exercise continues with a recently published work on an experiment conducted a couple of years ago on upper body vibration and H-reflex lead by Dr. Federica Sammali suggesting that fatigue mechanisms with vibration exercise may be different than typical resistance exercise. And finally this work from our unit reporting the typical variations in hematological parameters in adolescent athletes.

There are more papers currently under review and some about to be submitted which will hopefully see the light in the next few months on: Table Tennis and Squash performance, training load in adolescent athletes, new methods to assess training load and performance modelling and some work on Vitamin D. If the review process is not incredibly painful, they should become available this year.

Sporting season is in full swing, so time is even less, but every day is a chance to learn something new and help our coaching community in supporting the athletes to achieve their dreams.

In the sporting World, many things have been debated in the last few months. Doping stories triggered by the wonderful documentary Icarus (if you have not seen it yet, do so on Netflix) are continuing and hopefully some actions will be taken soon and everyone will get more clarity about some recent episodes.

The last aspect I will briefly touch on is expertise. I am not sure where the sports industry is going at the moment. The internet has clearly facilitated our way to access and share knowledge, however it has also generated a lot of confusion. I share the same worry many of my colleagues have.

Few years ago (showing grey hair here), it was important to have credentials before applying for jobs and/or having the right/possibility to speak about topics. Credentials in the World of science refer to academic degrees and publications and in the World of Sport in a combination of the above + experience. I see now a lot of individuals discussing/presenting/debating/writing books on aspects they have no expertise/experience on. There is also a proliferation of self-proclaimed experts offering advice/consultancies and running “educational” activities. I will write more about “expertise” in another post, but my feeling is that our profession is in need of help.

What is your view?

New Year New Blog

It’s been a long and challenging year professionally and personally and I realised that I have not written much on my blog despite the good intentions last year. Time unfortunately is lacking and it becomes challenging to be able to produce meaningful articles for the blog, despite the many drafts that sit in the server 🙂

I have decided to move to the WordPress platform and will abandon the Blogger version as this allows me to have more and better options for the blog. Hopefully, this year there will be more articles here.

It’s been an interesting year in Sports Science. There are many debates in various areas which are likely to produce more interesting research work in 2018. In nutrition, there is a never-ending battle between the carbs-nocarbs camps to optimise body composition. Sadly the debate seems to be confined to the realm of quasi-science and opinion rather than based on experimental evidence. Some good work worth reading is this recent one from John Hawley’s group showing that energy restricted high-protein diet confer no advantage to weight loss in the presence of an appropriate exercise regime. Another interesting article was this one featuring Prof. Tim Noakes as an author suggesting that carbohydrate ingestion in a fat adapted athlete during training could enhance high intensity endurance exercise. The battle continues on social media, books are being published and sold, hopefully more experimental work will help us understanding more about diets. An interesting article in this field was this one about the big Vitamin D mistake and the need to avoid Vitamin D deficiency. I am working on a paper on this topic and the more I read, the more I think that there is a bit of a “drive” to have people on Vitamin D supplementation….will see what happens with that in few months.

Few debates also appearing in the training literature. This recent work from John Kiely continues to challenge the notion of periodisation and this review from Jeremy Loenneke’s lab challenges the notion of muscle size and strength. Finally, Stuart Phillips’ lab published this pretty cool review/meta-analysis/meta-regression indicating that with protein supplementation, protein intakes at amounts greater than ~1.6 g/kg/day do not further contribute RET-induced gains in FFM. So, if you are too keen on protein shakes, you may be connecting your bank account to the sea as the late Professor Mike Rennie used to say in his fascinating lectures. For sure the literature will grow in these areas and we will have access to better information soon.

Finally, the world of wearables is growing and so is the literature. Sleep devices need a lot more work in terms of validation and reliability. A new Cortisol biosensor able to detect cortisol concentration in sweat seems promising. More sweat lactate sensors seem to be promising too as well as Glucose biosensors. A new concept of Lab on a glass was also published suggesting the incorporation of biosensors in eyeglasses, definitively an interesting avenue for sports like Triathlon and Cycling. And finally, it is great to see the work funded form ESPRIT with former collaborators is finally becoming available. This is definitively an area which will grow exponentially and something I am passionate about.

So, this is it for now, the new blog is a new beginning. Let’s see what happens in 2018.