Of "Giant Strides" and "Tennis Leg" - a Cautionary Tale...

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DeepSeaDan

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I'm a Fish!
( I originally published this in the "Basic" section, but have re-printed it here to be sure that all of us "long-in-the-tooth" folks see it... ):

A few years back I had a class of Divemaster candidates participating in their final series of dives aboard a charter on the St. Lawrence River. It was late Spring & the river at this time of year is moving along at a decent clip. The 1st dive was on the wreck of the "Daryaw." This dive is challenging for several reasons, including the fact that the wreck is wedged at a point where the river narrows, thus the velocity of the water increases significantly. The DMC responsible for this dive had submitted his dive plan to me, & I had approved it. The plan called for a giant stride entry off the stern - one had to distance themselves from the stern as much as possible, then quickly move left & grab the shot line to the wreck before the current swept you back to the stern of the dive boat. Candidates were then to pull themselves down to the wreck. Once on the wreck ( actually "under" it as it rests upside down ), divers get a reprieve from the current as the wreck tends to shelter you from it. All candidates made the dive successfully & we all gathered for the debriefing. One candidate, 57 years young, complained that he had "bumped his lower leg" on the ladder when entering, that the leg was sore but manageable, and he was fine to continue on for the remainder of the days dives. The days training was completed without any further incident. In the following weeks he reported his "deep muscle tissue bruise" to be slow to heal. I do not recall if he consulted a physician or not, though I don't believe he did.

Fast forward to this past Fall, & my friend is now doing some relaxing diving in Jamaica. Another giant stride off a dive boat and "OUCH!" - another sore calf muscle! This time it was the other leg! This time my friend was certain his leg did not contact the ladder. The pain was considerably less this time, & he continued his dive vacation with minor pain in his calf area.

So my friend, being the inquisitive type, gets home & goes online to investigate the issue, and this is what he finds:

"Tennis Leg":

Tennis leg is a musculotendinous junction rupture: a stretch, tear, or complete rupture of the connection between the gastrocnemius (calf) muscle and the Achilles tendon. Tennis and soccer players over 40 are the most frequent sufferers. The injury often occurs when lunging or pushing off one leg to get to a wide ball or serve. It feels like being kicked in the leg from behind: the tennis leg sufferer feels an instantaneous severe sharp pain, turns around to see who kicked them, only to discover that no one is there. Note: “Tennis Leg” is an informal term that is sometimes applied to stretches, tears, or ruptures of the calf itself, rather than to the Achilles-gastrocnemius junction."

On both dives my friend aggressively "pushed off" with his following leg when making the entry, despite knowing full well that one is supposed to "step off" into the water when performing this entry. In his case, it appears his aging tissues could not stand the strain placed upon them during these entries, & he suffered tissue injury each time. He thinks the 1st injury was worse due to climbing back aboard the boat in heavy, cold-water gear & fighting the surface current. It now appears certain that he did not, in fact, contact the ladder on his first dive, and that he likely did suffer the cursed "Tennis Leg" syndrome.

My friend is off to see his doctor now in the hopes of getting some definitive answers to exactly what happened to him & to have testing done to determine the extent of damage, the progress of healing, & some advice on how to prevent recurrence.

There are lessons here for all of us:

> If you suffer an injury - see a Dr. a.s.a.p. - do not self-diagnose!

> Stay fit! Stretch! Keep your musculature & cardiovasculature primed for diving ( especially good advice for older divers! )

I'm hoping to hear from some of our medical mods. on this one - please chime in!

Yours in safe diving,
DSD
 
This may well have been a plantaris tendon rupture. It's a common injury in middle-aged people. However, gastroc tears and even Achilles tendon ruptures are also not rare injuries, and all of three conditions result from the same kind of situation -- sudden loading or pushoff from the forefoot. Definitive diagnosis is made by ultrasound or MRI, although an Achilles tendon rupture, if complete, is generally clinically obvious, because the person cannot point the toe.

Plantaris tendon ruptures and gastroc tears are treated simply by rest and analgesia, whereas Achilles ruptures require surgery. Severe tears at the musculotendinous junction of the gastroc and the Achilles tendon are bad injuries, because they are often not amenable to surgical repair, and they may not heal well. A good friend of mine has spent almost a year healing and rehabbing a bad case of that.
 
That sound like something that happened to me this last April. But I was not doing a giant stride I was waling down a real steep boat ramp in full gear. and felt a pop in my left calf muscle and it felt like it rolled up. could swim around no problem get out of the water and try and stand on it (put weight )pain!!!. It just didn't want to heal. I had a DOCTOR appointment for my PHYSICAL , AND asked him about it(he is a diver and was recommended by DAN) I explained to him what I did and that the pain was at mid calf and the it was painful to put any pressure in to the ball of my foot ,but I could walk with weight on my heel. And that when I was in the water doing the flutter kick and the frog kick I had no pain . Did not even know there was a problem.. He said that he new exactly what had happened . He explained the I had tore/ruptured a muscle/tendon that is like the Achilles tendon and large calf muscle ,But this one is smaller and reals has no real function and the 2 out of 10 people have them . Not all have them . He said that he had ruptured is left when he was younger (20's) playing tennis . and then a couple years ago he ruptured the right while he was at a dive medical convention /dive trip ,While he was doing a giant stride off a boat. He said that it would hell with no adverse affects and needed just a little time . he said the good new was that I only had one more to go and would not happen again (and then laughed . Sorry I can't remember the name of the tendon/muscle. When I go back for my next physical I will ask him .
 
That is the plantaris tendon I wrote about above. Typical history is a "pop" and a rolling up or slithering feeling in the calf.
 

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