Quad Injury from Biking

by Ed
(Columbus, Ohio)

I am a 51 year old male and fairly

active cyclist in otherwise pretty good health who injured my quad tendons through over exerting on a training bike in February 2009 - spiraling downward at the moment!

Working with a PT, have but not currently taking nsaids considering acupucture and witch doctor :) - still have some sense of humour but fading fast!

Tried icing, heat wraps, ultasound, iontophorisis, and general PT therapy. Icing done intermittantly.

Have one "hot spot" three inches above the knee cap on each leg, but experience overall pain, tightness and stinging from upper thigh to just above the knee cap.

Getting to a point of pain at rest; activity seems to lead to more pain and irritation.

My questions are:
1)Why does the pain radiate to the upper thigh?
2)Do you recommend excercise or rest while doing the heavy icing?
3)From what I have read, tendon repair takes up to 9 month - how does relief under your program occur so quickly?

Thanks for your thoughts and advice.



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Joshua Answers:

Hi Ed.

1)Why does the pain radiate to the upper thigh?

Could be for any number of reasons. Let's come back to that question after we chat back and forth a few times.


2) Exercise or Rest while icing?

I recommend -movement-. And there's something of a balance to achieve. You want to keep the structures moving, even if it's just a tiny bit of shortness and length.

Rest is fine, immobilization is bad. I wouldn't exercise per se, but I would keep moving.

This can look like just contracting your quads and then hamstrings a few times, several sets a day. Or reaching down and punching/pounding on/shaking the quad muscles.

Keep it moving. Lots of good reasons. (I'm making a note to make a long page to answer this important question.)

Walking, light stretching, a slow bike. You want to pay attention, and make sure you are using your structures without straining or putting too much load on your presently acutely unhappy structures.

Make sense?


3) Tendon repair can take up to 9 months. Why does icing reduce healing time?

Now that is an interesting topic. 9 months to repair tenodonitis? Or a rip or tear? Or just for pain to go away?

It really all depends on how much actual damage there is, if any.

My suspicion with you is that you didn't actually -injure- yourself.

I think you had an increasing Pain Causing Dynamic that had been building up and making changes under the surface of the skin, your body compensating for it as best it could, and then you went past a threshold with that last workout, and BAM! you entered a whole new dynamic.

The Tendonitis dynamic consists of increasing tightness, irritation, pain, and can include actual tendon fiber damage.

Maybe you have actual wear and tear damage to the tendon, but that's not going to take 9 months to heal. If your nutrition is good enough, that heals fast.

But you are still left with chronically too tight muscles, shortened constrictive connective tissue, pain enhancing chemical flooding the tissue from the Inflammation Process, and a freaked out nervous system that thinks you are injured (You've been in pain since February, you must be injured!) and is trying to protect you....by tightening your muscles, keeping an inflammation process in place, both of which make you hurt more....which makes your nervous sustem think that you are injured, which makes it....

So, icing helps because it gets waste product and pain enhancing chemical out, new blood and nutrition in, which helps muscles relax and literally reduces the pain in the structure, then the nervous system isn't getting so much 'I'm injured' signals from the body, so it can start turning down the protective dial.

Icing as I describe is, in my experience, much more effective than the common ice pack routine.

Old stuff out, new stuff in, helps tendons heal fast by delivering the necessary nutrition and building blocks, and maybe even more importantly, it reverses the dynamic that caused the pain in the first place.


So. That felt long winded.

Before I tell you how to ice your quads and give you a couple other to do's, I have some questions to make sure I'm on the right track.


1. Any pain or problem in these areas before February?

2. Quick history of previous injury.

3. How active are/were you exercise wise?

4. Give me a brief picture of a normal monthly/daily routine up to getting hurt.


Answer those, and then lets set you up to get yourself out of pain.






Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert
www.TendonitisExpert.com














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Aug 03, 2009
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PART 2 - Quad Injury from Biking
by: Ed (Columbus Ohio)

Thank you so much for your time and advice.

1. No quad problems whatsoever prior to February.

2. History: Had a meniscus tear on the left knee fixed in March 2008 (more of a wear and tear issue than acute injury).

3. How active: Cycled about 100 miles a week from April through Dec. 2008 and did a couple of century rides during that time. Then cut back due to weather and used an indoor trainer. Problem ccurred by using too low a gear for about an hour on consecutive days - trying to gain leg strength; not a good idea in retrospect! Then failed to rest as it was starting to get warm enough for outdoor riding!

4. Routine before getting hurt: 45 hours behind a desk each week, did yard work / snow shoveling, rode the trainer twice a week for an hour, outdoor rides of 25 miles once a week weather permitting, 30 minute walks once a week.

Tried ice dipping & ice cups this past weekend - seemed to help with the upper thigh pain, but no change right above the knees.

Also your comments on exercise are right on - my issue is that the threshold is very low and "sneaky" - - I feel little to no pain while doing the low stress activity, but then the quads flare up that night or the next day. Seems like I always over do it.

Looking forward to comments on quad icing and other to do's.

Plan on making soup tonight - can you guess what kind?!

Ed

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Joshua Comments:

Yeay! Bone Broth!

Ok, let's just say that the hour of two low a gear just took your system past a certain threshold, and now it is very unhappy. Irritation and inflammation, possibly some wear and tear damage, but I can't imagine it being anything more than -very- minor usual wear and tear injury, that has probably already healed and now you're left with the fallout.

So.

Here's how I think you should ice your quadriceps tendonitis.

1. Wear shorts for a few days.


2. Freeze a 2 litre pop bottle (full of water, I've never actually frozen soda), or the next size down.


3. With some frequency throughout the day, the more the merrier, use the frozen bottle on your thighs, 3ish minutes per side per time.


4. Use the bottle kind of like a rolling pin, up down, and around the area above the knee. Dig in if you want to.


5. If you need to, use a -tiny- bit of lotion or oil so the plastic doesn't stick to your skin.
But you want some stretch and pull, more than you want a slick glide across the skin.


6. Experiment with it and see what works.


7. Imagine that your thighs are dry crunchy sponges, and your using a rolling pin to make them soft, squishy sponges.


This option covers more real estate than an ice cube, is heavier so you can get the cold deeper, can use both hands for leverage, pressure, and movement.

Thoughts, comments, questions?



Aug 03, 2009
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PART 3 - Quad Injury from Biking.
by: Ed (Columbus Ohio)

Many thanks again for your comments!

My 1st thought was how to freeze the bottle w/o cracking it - but I'll figure it out. Had been using a mega ice cup - 5 inches across, but I'll try the roller. My PT had me using a rolling pin, so you're one up on him with adding the ice!

As mentioned before, I tried ice dipping in a large bucket this past w/e. So - - should I just roll or dip and roll? Ice dipping more effective on thinner body parts?

Also - ok to check in a week or so to provide feedback??

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Joshua Comments:

Absolutely it's ok to check back in whenever with feedback/update/questions etc.

Eventually I'll get to busy on here to keep up, but until then, feel free to use me.

So.

You can dip up to your thigh? Do you bend your knee and stick it in, or is the thing deep enough to get foot in and cover up to mid thigh??

If you can dip, awesome. If you have a cold body of water around to jump into a few times, awesome.

Consider it ice dipping for all over inflammation removal, and the frozen water bottle/rolling pin is for getting the cold deeper, and for manual manipulation of skin/connective tissue/muscle/tendon.

I guess you could use a metal rolling pin, though I wonder how long that would stay cold once you pulled it out of the freezer.

The bottle shouldn't crack, assuming that it's plastic,and you don't fill it up too full before putting into the freezer.

And, you don't really want it to roll. You more want it to drag. Catch the skin and add some stretch/pull while you drag it around.

And, maybe that 5" ice cube is just as good as a bottle, as it covers a good span. I think how the bottle has the edge is that it won't melt, and you can use both hands to really work the bottle into and over and around the structure.





Aug 04, 2009
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Part 4
by: Ed (Columbus Ohio)

I used a wood storage bucket to dip - it's about 16 inches deep and oblong so with a bent knee, I can get almost to the top of my thigh.

Your comments have helped me realize that a big part of my issue is muscle tightness (I think my quads are so tight that your guitar bloggers could play a tune on them!). See question #1 on original post.

Stretching and flexibility have never been my forte - so that is probably contributing to the issue. Bought some magnesium malate last night to help them relax.

Broth is still cooking - - never thought I'd pay $5 for bones and look forward to the meal. Not sure about aroma yet, but it will not stop me!

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Joshua Comments:

Yeah, really, who buys bones for anything?!?

That Ice Dipping system sounds good.

And definitely, too tight muscles (and too tight connective tissue, constrictive) can be an issue.

The upside to using the frozen water bottle is that you are, in effect, stretching the tissue.

Hook it in, drag it in any particular direction, and it is a direct stretch of the tissue.

Keep me updated. :)





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