Like many cyclists I have seen, he had limited movement in the hamstrings and some decreased movement in adduction (bringing the leg into the body.) In addition, he had pain on the inside or medial side of his hamstrings in the belly of the semitendinosus muscle and the middle of the thigh, or rectisformis muscle, when I palpated them. Lastly, his left hip joint was a bit restricted in movement.
Fatigue and Overload
So how and why did this happen? Well in this case, we don't have a de-conditioned weekend warrior who has an imbalance between quad strength and hamstring strength because those people can have this very same injury just as easily. Was it the old injury to his knee that made him predisposed to this strain in his leg? Maybe to some degree, but the real culprit in this case is muscle fatigue.
Think of your muscles as engines, brakes, stability control and shock absorbers all in one. When the muscles become fatigued from work such as a long, hard climb, they are affected at a physiological level. This affects all fiber types such as type I, IIa, IIb, IIc and III, which can damage and deplete the energy stores. You can still turn the engine on and hit the brakes, but the stability control systems are not up to par and you have no shock absorbers at all.
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In a study done at Duke University (1), they looked at muscle fatigue and susceptibility to strain injury. What they found was that muscles lose 69.2 percent to 92 percent of their ability to absorb shock when they are fatigued. We incur injury to our muscles mostly during eccentric contractions. For example, when we plant our foot down when running during a soccer match or when the body is fatigued and not able to absorb the shock or control the movement as well, this can lead to injury.
Prevention and Treatment
Well now that we know how, why and what to do to prevent and treat this injury, we need to know the initial steps to begin the appropriate treatment. Firstly, playing a rigorous and strenuous sport, such as soccer, after a cycling 100 miles is not conducive to the active recovery which your body needs to rest and heal. Secondly, it is just as important to maintain balance and flexibility in order to prevent these types of injuries.
So, how did I treat my good friend Dave?
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First, I told him to stop the co-ed soccer for a bit because that eccentric loading is a killer for an injury like this. On the bike, I asked him to keep the watts and time down, and I put him into an active recovery mode. I reminded him of the importance of sleep and nutrition and gave him a supplement that helps with recovery. Then, I used electric stimulation, ultrasound, cross friction massage, manipulation and topical creams in an effort to heal the tissue, minimize scar tissue formation and restore proper biomechanics. I also used a special tape called KINESEO tape that helps with support and healing of the injured muscles. Dave was most impressed with the tape.
Dave responded well and was soon kicking my butt in the Assault on Mt. Mitchell, a nice 102 mile ride with over 11,000 feet of climbing in North Carolina, which oddly makes me feel great!
One important last note, it is important not to rush your way back after large and small injuries because cycling biomechanics can get thrown off very easily. After injury, cycling biomechanics are affected at a minimum, which can lead to a chronic injury. Last but not least, I always recommend seeing a specialist that knows about these types of injuries.
More: How to Prevent the 6 Mosts Common Cycling Injuries
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