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Gastrocnemius Tendopathy? Calf attack?
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A little help from my friends...

I'm a long distance ciclist that also likes to swim and run. I hurt myself mid July cycling to my family reunion in rural Georgia. The problem started around mile 40 mile and because it's impossible for me to stop until the pain forces me to fail, I pedaled another 160 miles for a total of 200 miles in 10+ hrs. (God why did you make me this way?) The pain felt like a sharp sprain on the outer side of my calf behind my right knee where my calf tendons connect to the tibia but the pain is deep and sometimes hard to pin point exactly. The shooting pain was like an electric shock every pedal stroke. It got so bad the last few hours I could really only pedal with one leg. So initial diagnosis is Gastrocnemius Tendopathy. I have very arched feet and really bad right ankle dorsifelxion which means my right calf is always a little tight but that didn't stop me from going coast to coast the year before.
Ive been in Peru since July for work and been able to see a few doctors ($45 a visit isn't too bad). MRI, X-Ray for my knee, hip, ankle etc and nothing to worry about (I can email digital image files) Except I can't walk 5 blocks without the exact same pain sneaking up on me. Sometimes the area feels a bit numb or tingles a little. I think it's actually getting worse because I can't even swim anymore.

Let me add that when I say anymore: My treatment could be broken up into 2 stages. The first 5-7 weeks after the injury I was encouraged by PT to continue training cycling and swimming at 70% but no running. Since I didn't get any better the last 8-10 weeks have been let's sit and wait to see if anything happens. So no swimming anymore which was the last sport I quit. I hope this doesn't sound confusing but I can extend my leg no problem no pain, even some weight bearing excersices are o.k. but walking makes me limp.

Leo "Good times" Garcia
Last edited by: LeonardoGarcía: Dec 3, 18 18:33
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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So, the pain is behind the knee but on the outer edge of the right leg, and it started after a VERY long cycling journey. It very well could be tendon irritation/inflammation of the hamstring (at the insertion area of the knee). People always think of hamstring tendonopathy as being up toward the top of the leg/butt area but it can also get irritated near the knee as well.
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Re: Gastrocnemius Tendopathy? Calf attack? [eye3md] [ In reply to ]
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Thanks for your insight. For clarification the injured area is below the knee. If the hamstring inserts to the top of the knee that wouldn't explain why the pain is coming from below the knee?

The pain seems to be coming from below my right knee where the top of my calf inserts on the outer right side. The pain feels very deep. Please let me know your thoughts.

Leo "Good times" Garcia
Last edited by: LeonardoGarcía: Dec 4, 18 5:10
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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A calf attack is typically in the belly of the muscle, not associated with a tendon.

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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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The hamstrings are a 2 joint muscle group, they cross both the hip and the knee. So the lower insertion point is on the tibia, (i.e. below the knee.)

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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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Go see a physical therapist if your MRI and x-rays are negative. Also, when you feel pain that is not minor, don't ride another 160 miles. ;)
Last edited by: Nerd: Dec 4, 18 6:09
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Re: Gastrocnemius Tendopathy? Calf attack? [Nerd] [ In reply to ]
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I have done 40+ thearpy sessions. These guys get depressed when they see me walk in. To be really frank I think the PT's are starting to believe that I'm making up stories. They keep asking me over and over again "you're resting right, and there's absolutely no improvement?"

Will never ride 160 miles with intense pain again.

Leo "Good times" Garcia
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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LeonardoGarcía wrote:
Thanks for your insight. For clarification the injured area is below the knee. If the hamstring inserts to the top of the knee that wouldn't explain why the pain is coming from below the knee?

The pain seems to be coming from below my right knee where the top of my calf inserts on the outer right side. The pain feels very deep. Please let me know your thoughts.


As JasonHalifax pointed out, the hamstring muscles insert below the knee. The pain can be referred. With what you describe of your pain, and how it happened, I am still betting you have a stubborn case of lower hamstring tendinopathy...............how to fix it??? Well, I hope you've not been trying to run or bike while it was hurting.
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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By bad right ankle dorsiflexion do you mean your right foot is more in plantar flexion? No issues with the left?

If we are hazard guesses on the internet, I'd either lower your saddle 0.5cm - 1.0cm or put a few shims under your right cycling cleat. Generally pain behind the knee, especially when cycling is 'typically' a saddle that is too high. See if that makes a difference.

Working mobility on your high hamstrings and hip flexors on that right side might help if the problem is starting upstream from your calf/knee.

Weird pains like that can also be nerve entrapments, but those are difficult to diagnose. I feel like I've had one on the medial side of my knee for going on 4 years now, and it bugs me when I run.

Disclaimer...not a dr or doc or phd or pt, just been around for awhile so take the above with a grain of salt.


Brandon Marsh - Website | @BrandonMarshTX | RokaSports | 1stEndurance | ATC Bikeshop |
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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Could be a plantaris tendon rupture?
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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I hope you are able to determine the cause soon. Stay positive!
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Re: Gastrocnemius Tendopathy? Calf attack? [eye3md] [ In reply to ]
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I'm going to pursue your insight and consult with a doctor. I have a hunch you're right because even though I limp after walking a few blocks, I have no problem doing heavy calf raises with no pain. It couldnt be a gastrocnemius tendonapathy if I can do weighted calf raises painlessly. I bet it has been my lower hamstring all along which may explain why the pain feels so deep behind my knee. I'll keep everyone posted. Many thanks for everyone's time and interest.

Leo "Good times" Garcia
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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LeonardoGarcía wrote:
I'm going to pursue your insight and consult with a doctor. I have a hunch you're right because even though I limp after walking a few blocks, I have no problem doing heavy calf raises with no pain. It couldnt be a gastrocnemius tendonapathy if I can do weighted calf raises painlessly. I bet it has been my lower hamstring all along which may explain why the pain feels so deep behind my knee. I'll keep everyone posted. Many thanks for everyone's time and interest.

Yeah, I agree with ya that I do not believe the gastrocnemius muscle (or associated tendons) are the problem. If this was a "calf attack", doing calf raises may/wouldhurt, and you should've healed from it by now. With your pain being up higher, it's certainly not related to the Achilles' tendon. Definitely get an evaluation by a sports med doc, and yes, please keep us updated
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Re: Gastrocnemius Tendopathy? Calf attack? [eye3md] [ In reply to ]
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Hi eye3md,

Finished 4th therapy session and so far no improvement. Sports doctor is scratching his head, go so far as to say baffled. I'm working the lower hamstring tendonapathy diagnosis but he isn't biting. It seems there are all sorts of things going on behind your knees as far as muscles and tendons and whatever. My MRI's are all "go run a marathon clean" but I'm limping after a mile or two. It's this deep pain I can't always pinpoint or describe precisely. A numbness that goes from a "starting to get my attention" to "wow this really popping and hurting...now Im limping" within a mile or two. Who would you go to see if you could pick a specialist is there a really good one that's the authority with this type of sports injury?

As always thanks for your time and effort.

Leo "Good times" Garcia
Last edited by: LeonardoGarcía: Dec 12, 18 13:39
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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LeonardoGarcía wrote:
Hi eye3md,

Finished 4th therapy session and so far no improvement. Sports doctor is scratching his head, go so far as to say baffled. I'm working the lower hamstring tendonapathy diagnosis but he isn't biting. It seems there are all sorts of things going on behind your knees as far as muscles and tendons and whatever. My MRI's are all "go run a marathon clean" but I'm limping after a mile or two. It's this deep pain I can't always pinpoint or describe precisely. A numbness that goes from a "starting to get my attention" to "wow this really popping and hurting...now Im limping" within a mile or two. Who would you go to see if you could pick a specialist is there a really good one that's the authority with this type of sports injury?

As always thanks for your time and effort.



Sorry to hear no relief. That is a bummer.

With the numbness and tingling, you also have to consider issues further up the chain, such as in the spine. I cannot recall if you mentioned it or not but have you had an MRI of your lower spine???
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Re: Gastrocnemius Tendopathy? Calf attack? [eye3md] [ In reply to ]
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The numbness and tingling is quite rare and minor. It happens very infrequently and is very transitory.

Leo "Good times" Garcia
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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LeonardoGarcía wrote:
The numbness and tingling is quite rare and minor. It happens very infrequently and is very transitory.

Yeah but any numbness is not a good sign, no matter how long it lasts. I'd see a sports med specialist.....and if you are already seeing one, I'd get a second opinion. Also, the thought of checking for nerve issues (spinal, impingement, etc...) should still be considered.
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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Was any of the professionals you've consulted able to replicate the pain with passive movement?
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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Have you thought about the possibility of taking maybe 2-3 weeks completely off, letting your injury calm down a bit, and then slowly getting back into some swimming, PT, cycling, etc?
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Re: Gastrocnemius Tendopathy? Calf attack? [Zissou] [ In reply to ]
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I haven't been able to run since injury mid-June. No cycling for 2-3 months. Quit swimming a month or more ago. Decided to quit gym two weeks ago. I'm driving my family completely nuts. So far, and maybe this will help somehow find the right path to recovery, 0 improvement. I had to make a presentation today and after standing for and hour or so I had to ask for a seat because behind my knees was aching.
I'm starting to think that the inactivity could be making the condition worse. I wonder if the actual "trigger" is just load related i.e. walking or standing. No amount of rest seems to help so far. I've read that some injuries don't respond to any type of physical therapy. My favorite part is when the doctor looks over all the MRI's and suggests "have you considered Yoga?"

Leo "Good times" Garcia
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Re: Gastrocnemius Tendopathy? Calf attack? [Thorax] [ In reply to ]
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The doctors ask me to do any number of excersices. No one single excersices hurts more than 3 on a 1-10 scale unless I do it 50 times. Once the cummulative effect of all the excercises gets to a 4 I quit. I walk out and maybe am only limping a little, hurts at night while I'm trying to sleep, next day a little better but more than 5 or 6 blocks and can sneak back up on me. Going on 6 months maybe 50 therapy sessions, last one was tecar therapy.

Leo "Good times" Garcia
Last edited by: LeonardoGarcía: Dec 15, 18 15:58
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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The pain felt like a sharp sprain on the outer side of my calf behind my right knee where my calf tendons connect to the tibia --

Below your knee is the tibia and fibula bones. The fibula is the "outside" bone and is the non-weight bearing one. Could this be the famous Iliotibial Band Syndrome?


Last edited by: Billyk24: Dec 15, 18 17:30
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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LeonardoGarcía wrote:
The doctors ask me to do any number of excersices. No one single excersices hurts more than 3 on a 1-10 scale unless I do it 50 times. Once the cummulative effect of all the excercises gets to a 4 I quit. I walk out and maybe am only limping a little, hurts at night while I'm trying to sleep, next day a little better but more than 5 or 6 blocks and can sneak back up on me. Going on 6 months maybe 50 therapy sessions, last one was tecar therapy.

This may be part of the problem as well. When I was getting rehab for my hamstring, some of the exercises I was given would make it hurt (similar to you, a 3-4 on the pain scale). I started thinking "this can't be good", told my PT (physio) about it, and he said "you should stop those and let's focus on other areas". I've never gone back to those exercises and have been improving ever since. So, I would stop those activities that bring your pain level to a 3-4. You've stopped running/cycling but these activities may be contributing as much harm. And just like doctors can be hit or miss, PT (physio) can as well. The first one I had, did not listen to my complaints of increased pain. Also, he did not seem to have an organized plan on how to "attack" my hamstring problem. I changed PT and he had a stepwise plan to improve me. Never be afraid to seek another opinion
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Re: Gastrocnemius Tendopathy? Calf attack? [eye3md] [ In reply to ]
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Eye3md, thanks for sharing your experience with me. When I described the excersices that the doctor asked me to perform, in a text a few days ago, that give me the 3-4 pain I described, it was for a monthly evaluation of progress. I quit doing any rehab excersices quite a while ago just to see if completely resting might take me a step in the right direction. I appreciate your continued insight and comments.
Thanks

Leo "Good times" Garcia
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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 I'm excited folks I got a new diagnosis from a new sports medicine doctor. Popliteus Tendinopathy. Maybe this will be the game changer. Has anybody been diagnosed with this condition? How did you get better? Apparently it is more common among professional triathletes and runners, demanding training plans. I'm ready for a comeback!

Leo "Good times" Garcia
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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Compartment Pressure Syndrom. Your symptoms sound very similar to what I dealt with 6 years ago as I got myself back into shape. Top outer calf muscle is where the pain was focused. The resting pressure in my calf ended up being elevated and after 5 mins of exercise the pressure was off the charts which would just shut me down. I opted for PT instead of surgery. It took a long time to resolve. It wasn't diagnosed until after MRI and multiple physical therapy visits and they finally sent me to sports medicine specialist that did the compartment pressure test. He suggested immediate surgery...it had risks and still leaves a high rate of reoccurance.
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Re: Gastrocnemius Tendopathy? Calf attack? [MadGhost] [ In reply to ]
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This doesn't sound like me. I haven't been tested for CPS but I don't feel that I have a high pressure reading. I have had 7 MRI's (3 knee, 1 arto knee, 1 calf, 1 ankle, 1 thigh). All of them came back negative. This last MRI I was vocal about the radiologist finding something noteworthy. Made it clear that this was my last MRI.

I have read that in rare instances the origin of the pain can not be determined by MRI and does not respond to PT. I have also been told to rest for a few weeks which hasn't helped either.

A buddy told me to try dry needling but my doctor doesn't agree. My pain is right behind the knee and feels quite deep. It seems to excaerbate when I bend my knee inwards. I'm going to try a corticode shot, at this point if the doctor told me that cocaine would help I'd be snorting right now.

Leo "Good times" Garcia
Last edited by: LeonardoGarcía: Dec 22, 18 20:11
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Re: Gastrocnemius Tendopathy? Calf attack? [Thorax] [ In reply to ]
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Can you clarify what you mean by passive excersices please.

Leo "Good times" Garcia
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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Leonardo,
Reading through this thread, I am concerned about a couple of things:
1. that you have significant pain at rest/night, and that the pain is not necessarily reproducible with activity, and
2. that you said you have problems with dorsiflexion of your right foot.

These, and the fact that a sports medicine/ortho/physical therapy approach has not been able to help you indicate this may be a nerve problem, and not a musculoskeletal problem.

It wouldn't hurt to see a doctor (neurologist or PM&R) specializing in nerves/muscles/electromyography/ultrasound.

Two wheels good. Four wheels bad.
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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LeonardoGarcía wrote:
Can you clarify what you mean by passive excersices please.
I mean moving the affected member without input from yourself and replicate the pain you feel. Passive = them, active = you.
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Re: Gastrocnemius Tendopathy? Calf attack? [DrTriKat] [ In reply to ]
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Dr. on a whim I tried a Traummel injection a few days ago and I'm amazed. My dad is from Barcelona and told me that in Europe it's been widly used since his childhood but in the USA less so. The results, after going nowhere with 5 months of PT, are patently amazing. I would go so far as to say that the USA pharmacological industrial complex is conspiring against the medication because it's a cheap over the counter homeopathic medication. I'm not qualified to give any indepth technical analisys but my personal testimony albeit anectodal is that this is a miracle drug.

Leo "Good times" Garcia
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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LeonardoGarcía wrote:
Dr. on a whim I tried a Traummel injection a few days ago and I'm amazed. My dad is from Barcelona and told me that in Europe it's been widly used since his childhood but in the USA less so. The results, after going nowhere with 5 months of PT, are patently amazing. I would go so far as to say that the USA pharmacological industrial complex is conspiring against the medication because it's a cheap over the counter homeopathic medication. I'm not qualified to give any indepth technical analisys but my personal testimony albeit anectodal is that this is a miracle drug.

The only miracle associated with a homeopathic "medication" is that anyone actually purchases it.

----------------------------------
"Go yell at an M&M"
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Re: Gastrocnemius Tendopathy? Calf attack? [klehner] [ In reply to ]
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Clearly there are and always will be very polarized views regarding the effectiveness of homeopathic drugs. People have strong views one way or another. I could care less, I know I limped into the clinic and jogged out and nothing is stronger than one's own personal experience. After 5 months of physical therapy and no progress I could hardly believe that in 5 minutes I felt less pain. Jogged 10 minutes today, not saying Im cured but this is a step in the right direction.

Leo "Good times" Garcia
Last edited by: LeonardoGarcía: Jan 29, 19 6:41
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Re: Gastrocnemius Tendopathy? Calf attack? [LeonardoGarcía] [ In reply to ]
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Well maybe you guys were right. I hate to swallow my words but the pain came back just as before. Traumeel seemed to work for a day or two... maybe it was just my hope and some placebo effect. Hope can be dangerous.

Leo "Good times" Garcia
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