Muscle Strain (minor tear)
Just a quick post as a result of leg strength training this morning (8/5/19). I went in to the gym to do my usual Monday leg day and with cycling combined with strength training my legs are usually fatigued. I have been doing this combined training since 2004 and have always been a little skittish of getting a leg strain from attempting heavy lifts while fatigued.
Well it finally happened. Warming up my legs on leg press before moving to squats I had already finished a set with 450 and was going to go up. On the next set and the first rep there was an intense sensation like an electrical shock in the front of both quads. Most other strains felt like a pop or literal tear. The sled went all the way down to the safety catch where I was fortunately able to get out of the leg press. I sat there for a few minutes with some discomfort.
At this point I am not sure how bad it is, but I am hopeful because I was able to walk out with just a slight limp. In the past when I have had strains (tears) I was barely able to walk at all so this is at least promising that it is not too severe. But what does it mean for training ahead? Well it is too early to tell. I plan on doing my usual Monday afternoon active recovery session and see how my legs respond. Sitting here there is significantly more discomfort in my right quadriceps than the left.
I have been through this six times in the past when I was training heavier. I know it will heal so now it is just a matter of being careful and giving time to heal. I also have the Compex Sports Elite that I will use in massage mode to help in the early stage. My preference and approach after the first strain years ago was moving from R.I.C.E. to M.I.C.E. However, now I pretty much just use M and C (movement and compression) with some elevation in the evening. I would do I (ice), but with my schedule at work and home it is too difficult to work into the treatment consistently. Movement starting with extremely low intensity and load is what I find to be a key element. Each week I increase the intensity, load and duration just a little. By the end of week three I start getting a little more aggressive based on feel. If there is pain I back off.
Update (8/10/19):
This week I was able to observe this was a minor strain based on how quick it seems to be healing and the amount of bruising is not as bad as other past strains. I am still unable to squat down without holding on something and cannot stand up without help. I am still have to go down stairs using handrails and one step at a time, but still a fairly quick sense of improvement each day. Each light spinning session seems to be helping the healing process.
Update (8/12/19):
More blood has pooled in the same area as the picture so it is darker and there is a swath of yellowish color drifting down from about where the strain seems to be. Each rehab session seems to show some perceived improvement following. In this second week I will wear the compression sleeves only during physical therapy sessions. I will also start extremely light and very careful stretching.
Update (8/18/19):
I am happy with the plan and progress so far with this low grade strain. I still need to assist myself to stand from a deep squat with no weight. Going up or down stairs was without pain later this past week and without need to hold the handrails. The bruising is almost gone, which is pretty quick compared to past strains. I move into the 3rd week for easy spinning and then hopefully back to full fledged cycling training. Strength training will take a number of weeks to slowly build back to a full load that qualifies as strength training.
Update (8/26/19):
On one medical website it was noted that a minor or low grade strain would heal in about three weeks and my strain seems to be on track with this. Last week cycling rehab moved toward training at Tempo intensity and then this weekend I had a couple good outdoor rides showing promise. This morning I began to ramp up the strength rehab training (see below Phase 4 Rehab Sessions).
Update (9/4/19):
Back to structured training. While my fitness on the bike fell I am using mFTP from WKO5 to govern the intensity level as I start back this week with structured training on the bike. The first session was last night using a 3x20 session at near 100% of that mFTP, but in the last 20 I had to dial it back some due to the build up of body heat and fatigue. Fairly happy with that session though and will go forward from here. In strength training that will be a slower process before I can load it as heavy as I am capable. Also I have been struggling with extremely tight muscles in the legs and hips and a sharp lower back issue that may have come out of this so I have been stretching several times a day and using an inversion table in the evenings. All of these issues seem to be reducing day by day.
Muscle Strain Treatment: The following can help expedite healing.
R.I.C.E.
Rest
Ice
Compression
Elevation
or
M.I.C.E.
Movement
Ice
Compression
Elevation
Muscle Strain Risk Factors: The following factors can set up potential for a strain.
Compression: I purchased Sparthos Thigh Compression Sleeves from Amazon (link) and have them on now. These are just about right for this application and feel great. In fact I can walk without a limp while wearing them. Without the sleeves the pain intensity is higher and my confidence lower because the injured areas feel like they are going to rip wide open. They probably wouldn't but that is just how it feels.
Anti-Inflammatory: I am taking Naproxen Sodium a couple times a day only in the first week. None in the following weeks.
Phase 1 Rehab Sessions:
(8/5/19) 60 minutes with ERG set at 50 watts. I was rather uncomfortable during the session. Just glad to get this recovery and healing process started. As the day progressed the pain increased in the right leg. The left is not near as bad.
(8/7-9/19) 60 minutes with ERG set at 50 watts. A few random intense spasms in left vastus medialis and light spasms in right leg near the strain.
(8/11/19) Outside light spin on a flat multi-use path where I could keep wattage low. I finished 22 miles and that was enough to keep some activity in my legs. There were a couple moments of sharp spasms again in my left vastus medialis, but was able to spin through those.
Phase 2 Rehab Sessions:
(8/12/19) 1 week has past since the injuries. Leg extension machine extremely light weight almost like going through the motions, seated leg curls added weight since it had no impact to the injuries, leg press machine almost no weight up to 60 pounds only to stretch the quadriceps a little, unweighted squats and had to hold on to the rack to get up, Stairmaster Gauntlet revolving stairs 5 minutes, spin bike a few minutes of seated/standing effort.
(8/13-15/19) 60 minutes with ERG set at 150 watts with short intervals at 180 watts just to test the strained areas.
(8/17-18/19) 40 mile steady effort with light wattage and a few moments of higher watts just to see if the legs are healing.
Phase 3 Rehab Sessions:
(8/19/19) Leg extension and seated leg curl machine up to 75% of former training weight, leg press unweighted to 50 pounds, unweighted squats just to stretch in the lower range, stretching. I can now squat and come back up without needing to hold and assist.
(8/19-22/19) 60 minutes with ERG set at 40 minutes of L3/Tempo.
(8/24-25/19) Back to more of the normal outdoor rides, but kept Saturday limited to 60 miles.
Phase 4 Rehab Sessions:
(8/26/19) Leg extensions, seated leg curls, very light leg press, walking lunges limited to 15lb dumbbells, body weight sissy squats mainly to stretch the quadriceps, stretching.
(8/27-29/19) 60 minutes with ERG set at 40 minutes of L3/Tempo.
Well it finally happened. Warming up my legs on leg press before moving to squats I had already finished a set with 450 and was going to go up. On the next set and the first rep there was an intense sensation like an electrical shock in the front of both quads. Most other strains felt like a pop or literal tear. The sled went all the way down to the safety catch where I was fortunately able to get out of the leg press. I sat there for a few minutes with some discomfort.
At this point I am not sure how bad it is, but I am hopeful because I was able to walk out with just a slight limp. In the past when I have had strains (tears) I was barely able to walk at all so this is at least promising that it is not too severe. But what does it mean for training ahead? Well it is too early to tell. I plan on doing my usual Monday afternoon active recovery session and see how my legs respond. Sitting here there is significantly more discomfort in my right quadriceps than the left.
I have been through this six times in the past when I was training heavier. I know it will heal so now it is just a matter of being careful and giving time to heal. I also have the Compex Sports Elite that I will use in massage mode to help in the early stage. My preference and approach after the first strain years ago was moving from R.I.C.E. to M.I.C.E. However, now I pretty much just use M and C (movement and compression) with some elevation in the evening. I would do I (ice), but with my schedule at work and home it is too difficult to work into the treatment consistently. Movement starting with extremely low intensity and load is what I find to be a key element. Each week I increase the intensity, load and duration just a little. By the end of week three I start getting a little more aggressive based on feel. If there is pain I back off.
Update (8/10/19):
This week I was able to observe this was a minor strain based on how quick it seems to be healing and the amount of bruising is not as bad as other past strains. I am still unable to squat down without holding on something and cannot stand up without help. I am still have to go down stairs using handrails and one step at a time, but still a fairly quick sense of improvement each day. Each light spinning session seems to be helping the healing process.
Update (8/12/19):
More blood has pooled in the same area as the picture so it is darker and there is a swath of yellowish color drifting down from about where the strain seems to be. Each rehab session seems to show some perceived improvement following. In this second week I will wear the compression sleeves only during physical therapy sessions. I will also start extremely light and very careful stretching.
Update (8/18/19):
I am happy with the plan and progress so far with this low grade strain. I still need to assist myself to stand from a deep squat with no weight. Going up or down stairs was without pain later this past week and without need to hold the handrails. The bruising is almost gone, which is pretty quick compared to past strains. I move into the 3rd week for easy spinning and then hopefully back to full fledged cycling training. Strength training will take a number of weeks to slowly build back to a full load that qualifies as strength training.
Update (8/26/19):
On one medical website it was noted that a minor or low grade strain would heal in about three weeks and my strain seems to be on track with this. Last week cycling rehab moved toward training at Tempo intensity and then this weekend I had a couple good outdoor rides showing promise. This morning I began to ramp up the strength rehab training (see below Phase 4 Rehab Sessions).
Update (9/4/19):
Back to structured training. While my fitness on the bike fell I am using mFTP from WKO5 to govern the intensity level as I start back this week with structured training on the bike. The first session was last night using a 3x20 session at near 100% of that mFTP, but in the last 20 I had to dial it back some due to the build up of body heat and fatigue. Fairly happy with that session though and will go forward from here. In strength training that will be a slower process before I can load it as heavy as I am capable. Also I have been struggling with extremely tight muscles in the legs and hips and a sharp lower back issue that may have come out of this so I have been stretching several times a day and using an inversion table in the evenings. All of these issues seem to be reducing day by day.
 |
| Blood starting to collect inside right knee on day 4 |
Muscle Strain Treatment: The following can help expedite healing.
R.I.C.E.
Rest
Ice
Compression
Elevation
or
M.I.C.E.
Movement
Ice
Compression
Elevation
Muscle Strain Risk Factors: The following factors can set up potential for a strain.
- Muscle tightness
- Muscle imbalance
- Poor conditioning
- Muscle fatigue
Compression: I purchased Sparthos Thigh Compression Sleeves from Amazon (link) and have them on now. These are just about right for this application and feel great. In fact I can walk without a limp while wearing them. Without the sleeves the pain intensity is higher and my confidence lower because the injured areas feel like they are going to rip wide open. They probably wouldn't but that is just how it feels.
Anti-Inflammatory: I am taking Naproxen Sodium a couple times a day only in the first week. None in the following weeks.
Phase 1 Rehab Sessions:
(8/5/19) 60 minutes with ERG set at 50 watts. I was rather uncomfortable during the session. Just glad to get this recovery and healing process started. As the day progressed the pain increased in the right leg. The left is not near as bad.
(8/7-9/19) 60 minutes with ERG set at 50 watts. A few random intense spasms in left vastus medialis and light spasms in right leg near the strain.
(8/11/19) Outside light spin on a flat multi-use path where I could keep wattage low. I finished 22 miles and that was enough to keep some activity in my legs. There were a couple moments of sharp spasms again in my left vastus medialis, but was able to spin through those.
Phase 2 Rehab Sessions:
(8/12/19) 1 week has past since the injuries. Leg extension machine extremely light weight almost like going through the motions, seated leg curls added weight since it had no impact to the injuries, leg press machine almost no weight up to 60 pounds only to stretch the quadriceps a little, unweighted squats and had to hold on to the rack to get up, Stairmaster Gauntlet revolving stairs 5 minutes, spin bike a few minutes of seated/standing effort.
(8/13-15/19) 60 minutes with ERG set at 150 watts with short intervals at 180 watts just to test the strained areas.
(8/17-18/19) 40 mile steady effort with light wattage and a few moments of higher watts just to see if the legs are healing.
Phase 3 Rehab Sessions:
(8/19/19) Leg extension and seated leg curl machine up to 75% of former training weight, leg press unweighted to 50 pounds, unweighted squats just to stretch in the lower range, stretching. I can now squat and come back up without needing to hold and assist.
(8/19-22/19) 60 minutes with ERG set at 40 minutes of L3/Tempo.
(8/24-25/19) Back to more of the normal outdoor rides, but kept Saturday limited to 60 miles.
Phase 4 Rehab Sessions:
(8/26/19) Leg extensions, seated leg curls, very light leg press, walking lunges limited to 15lb dumbbells, body weight sissy squats mainly to stretch the quadriceps, stretching.
(8/27-29/19) 60 minutes with ERG set at 40 minutes of L3/Tempo.
Ref: RICE vs MICE
What we do know so far is that early functional movement is better than complete rest (Bleakley, Glasgow, Phillips, Hanna, Callaghan, Davison, Hopkins, Delahunt, 2011; Kannus, 2000). Moving utilises the principals of mechanotherapy whereby the mechanical loading prompts cellular responses that promotes tissue structural change – strengthening the healing tissue and minimise loss of condition (Khan & Scott, 2009).Past Experience With Movement:
- 5 other times with more significant strains - started first week with extremely low resistance spinning.
- Shoulder separation - started with unweighted front and side lateral motion.
- PCL tear - started first week with extremely low resistance spinning.
- Hip crash impact with hematoma - started first week with extremely low resistance spinning.
No comments:
Post a Comment