MLB Injuries

Dr. Morse breaks down the imminent return of Adrian Beltre

Photographer: Andrew Dieb/Icon Sportswire

Adrian Beltre

Beltre suffered an MRI-confirmed grade one-calf strain early in spring training and re-irritated again during his rehab, which has prohibited him from playing at all this season. Beltre finished the 2016 season playing in 153 games while managing 175 hits, 32 HRs, 104 RBIs, .300 average with a .358 OBP. The veteran, who started his career in 1998 with L.A. Dodgers, is expected to begin playing in extended spring training games today.

Calf strains are very common in athletes; especially athletes that require short bursts of speed, like football and baseball. Let’s break down exactly what a calf strain is, how it occurs, and how it is treated. A calf strain is an injury to either (or both) of the muscles in the back of the lower part of your leg. There are 2 muscles that make up the calf muscles: the gastrocnemius and the soleus muscle.

The gastrocnemius, which is innervated by the tibial nerve, is the larger muscle of the two and is typically split into two parts – the inner head and the outer head. The lateral head originates from the lateral condyle of the femur, and the medial head from the medial condyle of the femur. The opposite end of the gastrocnemius joins the soleus muscle to form a common tendon known as the calcaneal or Achilles tendon. The gastrocnemius, along with the soleus, is responsible for plantar flexing the foot at the ankle as well as flexing the leg at the knee. The primary function of the gastrocnemius is running, jumping, and other movements that are quick in nature.

The gastrocnemius is less involved in daily activities like walking and standing. It is compromised of fast-twitch fibers (type II), which are used in powerful bursts of movement, such as sprinting. The gastrocnemius muscle is actually prone to spasms that can be very painful and last for several minutes. A strained calf muscle typically occurs where one severely dorsiflexes the ankle, if extreme if this can actually lead to actually tearing the muscle. Both straining and tearing the calf are very painful and can be very challenging to walk with. Additionally, the gastrocnemius muscle is prone to overuse injuries.

The other calf muscle is called the soleus muscle, which is innervated by the tibial nerve, and runs beneath the gastrocnemius muscle from below the knee to the heel. The soleus serves to help plantarflex the foot, and along with the gastrocnemius muscle, is vital in walking, running as well as helping to maintain balance. The soleus has a fascinating and very important role, as it helps to maintain a standing posture and without it the body would actually fall forward. The soleus is comprised of slow-twitch fibers (type I), which help enable long-endurance feats such as distance running and are pretty resistant to fatigue.

Due to the thick fascia of the calf muscles, they are unfortunately prone to something called compartment syndrome. This is where excessive swelling of the muscle tissues leads to restricting blood flow and compressing nerves – often a medical emergency.

Calf strains typically occur in one of two way: with a sudden pushing off movement or from excessive over-stretching of the calf from either jumping or a quick directional changes. Most people feel a sudden sharp pain like someone hit you in the back of the leg. Some people even feel or hear a pop or snap, and find it difficult to rise from your toes. Swelling and bruising often follow pain experienced with calf strains or tears.

Calf strains are graded from 1 to 3, with 3 being the most severe. Grade 1 strains involve about 25% of the muscle fibers, and they are often mild. Some athletes even continue to play through the discomfort, often describing the pain as ‘tightness.’ Grade 2 strains are more severe, often involve up to 90% of the muscle fibers, and are more likely to have swelling and bruising. Finally, grade 3 calf strains essentially involve 90-100% of the fibers, and often the athlete will be able to tell you exactly when the injury occurred. With this severity of strain, the athlete often will not even be able to walk due to the pain and the accompanied weakness.

Grade one calf strains often improve with rest, icing, anti-inflammatories and applying pressure to the leg by wrapping the muscle with a compression bandage (thereby preventing the swelling from getting worse), taking about 7-10 days to heal. Grade two calf strains, which are the most common, are often diagnosed with the help of an MRI, and sometimes additionally involve the use of crutches, pushing the RTP to about 4-6 weeks. Grade three strains often take about 3 months to completely heal assuming that the muscle was not completely torn, in which case surgery would be required.

Gallo has been trying to fill in admirably for Beltre at 3B, though he is only hitting .193 but does have 14 HRs. I do expect Beltre to return to the Rangers lineup in the next week or two as long as he doesn’t have a setback. I anticipate that he will play in 3-4 rehab games and the meet with the Rangers medical staff to determine his return date.

This was written for the @TheFantasyDRS by Dr. Jesse Morse. I am a Family Medicine trained physician, and I will be beginning a Sports Medicine Fellowship in the next couple of months. If you have any questions or comments, you can contact me directly at @DrJesseMorse.

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