PDA

View Full Version : Injury help



chris mason
08-13-2009, 09:42 AM
Ok, training has been going great. I was finally getting my squat back to par when I incurred a small tear to my left quad (essentially right in the middle of the quad and it is a deep muscle). I know there was a small tear as I had about a 2.5" diameter bruise on my inner thigh the next day. The pain was very minor and I resumed squatting the next week as it felt a lot better. Well, 3 sessions later I added knee wraps and smoked a PR (well, the best I have done in a long time), but in doing so tore the muscle again this time a bit worse. I have more pain this time, but less bruising (and the bruising was not bad either time). Go figure? Anyway, my question is what would anyone here recommend who has experienced something similar. I have my own thoughts, but I am always looking for novel ideas.

Future
08-13-2009, 09:47 AM
No idea but obviously I am sorry. Very deflating to get an injury.

dbc3po
08-13-2009, 09:51 AM
I tore mine pretty severely. Best advice I got was to take prednisone to prevent any calcium deposits form forming in the tear. If that happens it will require surgery. I started back squatting 3 weeks after that using a lighter weight for high reps to a high box. I lowered the box and reps while upping the weight over a period of about 1.5-2 months. after that I was stronger when I resumed normal training than I was before the injury. I dont know if you use AAS (not my business) or not but if you do stay on them. This was told to me by a doctor. Also one thing to look at may be the use of igf injected directly to the tear. I have been told by several people that the recover the best form injuries in that manner.


Have you lost any range of motion? That was my biggest thing to over come.

=Travis=
08-13-2009, 09:52 AM
Just chill out for a while. I had a tear in my right quad about 5-6 months ago and really just took a week off of squatting, then went light my first week back and I PRed the week after that. I guess it depends on the severity. I had a much more serious tear in one of my calves that took much longer to come back from and for that I did a lot of high rep (20 rep sets) low weight squatting and came back slowly after about two months of gradual weight increases.

getting there
08-13-2009, 09:58 AM
Aside from icing and ibuprofen, try massaging the area affected and gentle stretching. When you massage though try to massage in the direction of the muscle fibers. Back off on any direct quad work, i.e. squats. If you must squat, and I know I would just go light. I know that whenever I pull a hammy, and I do it often, when I go to squat I get a small foam pad and place it on the tender spot and wrap it on with kind of tight with an ace bandage.

Beverly McD.
08-13-2009, 09:59 AM
Any time you have a tear you will have some scar tissue. The second injury may be a case of tearing the scar tissue loose from the first injury.

Ice it and do some very gentle stretching along with massage. The idea is to keep the scar tissue elongated so it doesn't tear loose every time you stress the area. Muscle tissue is pliable, but scar tissue isn't, so it can be a challenge to keep from damaging the same area over and over again. Massage and gentle (no pain) stretching are probably your best bet.

slashkills
08-13-2009, 10:03 AM
Any time you have a tear you will have some scar tissue. The second injury may be a case of tearing the scar tissue loose from the first injury.

Ice it and do some very gentle stretching along with massage. The idea is to keep the scar tissue elongated so it doesn't tear loose every time you stress the area. Muscle tissue is pliable, but scar tissue isn't, so it can be a challenge to keep from damaging the same area over and over again. Massage and gentle (no pain) stretching are probably your best bet.

Agreed. I had a small tear in my rotator cuff and all that can be done is light stretching, massage techniques, and ice. Good luck chris

chris mason
08-13-2009, 11:18 AM
I tore mine pretty severely. Best advice I got was to take prednisone to prevent any calcium deposits form forming in the tear. If that happens it will require surgery. I started back squatting 3 weeks after that using a lighter weight for high reps to a high box. I lowered the box and reps while upping the weight over a period of about 1.5-2 months. after that I was stronger when I resumed normal training than I was before the injury. I dont know if you use AAS (not my business) or not but if you do stay on them. This was told to me by a doctor. Also one thing to look at may be the use of igf injected directly to the tear. I have been told by several people that the recover the best form injuries in that manner.


Have you lost any range of motion? That was my biggest thing to over come.

No, no, it is not that severe thankfully.

Pete22
08-13-2009, 11:35 AM
Matt Kroc had a pretty severe quad tear a while back, and he was advocating getting back to working the muscle as soon as possible without re-injuring it (fine line). High rep light squats and leg extensions to get blood in the area and promote healing.

Ben13
08-13-2009, 11:51 AM
Chris,
I tore my quad last year squatting. It sounds as though mine was a lot more serious, bruising from the waist down. I did see that you had your knee wraps on after the initial minor tear, it may be better to work, if possible, with out the wraps for a while. Pending where the injury is it may be placing to much stress on the area...just a thought, I know that it is has been a year and I am still apprehensive to wrap, I actually just did for the first time doing reverse bands with some real weight this past week. Again, I had over 20 sessions of physical therapy and couldn't walk for a week, so my knowledge is for the most sever tear with out having surgery. Good luck with the injury and just stretch and take extra time, you definitely do not want to further injure the area. One leg extensions did help a lot as well as one leg presses to get loose and warm.

Sean S
08-13-2009, 12:57 PM
Here's a muscle belly injury rehab protocol posted as a sticky over at Mark Rippetoe's forum at strength mill. I believe it's a protocol be got from Bill Starr. I used the principles from it to rehab a minor adductor/hamstring strain. It came back stronger, faster, and not as tight doing it this way vs. the first time I injured the same area and just rested.

Travis Bell
08-13-2009, 01:16 PM
What were you doing for your squat routine?

chris mason
08-13-2009, 01:23 PM
Well, when I first did it a few weeks ago we were box squatting with bands. This most recent one was my 3rd week of free squats.

chris mason
08-13-2009, 01:24 PM
Chris,
I tore my quad last year squatting. It sounds as though mine was a lot more serious, bruising from the waist down. I did see that you had your knee wraps on after the initial minor tear, it may be better to work, if possible, with out the wraps for a while. Pending where the injury is it may be placing to much stress on the area...just a thought, I know that it is has been a year and I am still apprehensive to wrap, I actually just did for the first time doing reverse bands with some real weight this past week. Again, I had over 20 sessions of physical therapy and couldn't walk for a week, so my knowledge is for the most sever tear with out having surgery. Good luck with the injury and just stretch and take extra time, you definitely do not want to further injure the area. One leg extensions did help a lot as well as one leg presses to get loose and warm.

You are correct. The knee wraps let me go heavier and thus place too much pressure on it.

chris mason
08-13-2009, 01:24 PM
Here's a muscle belly injury rehab protocol posted as a sticky over at Mark Rippetoe's forum at strength mill. I believe it's a protocol be got from Bill Starr. I used the principles from it to rehab a minor adductor/hamstring strain. It came back stronger, faster, and not as tight doing it this way vs. the first time I injured the same area and just rested.

Thanks! I'll check it out.

Notorious
08-13-2009, 03:14 PM
Thanks! I'll check it out.

This is the protocol (quoted from Strength Mill forums):

"Here is the tried-and-true injury rehab method for muscle-belly injuries we got from Starr and that has worked for years better than any other method I've ever used. It also works well on orthopeadic injuries in general, and should be tried before anything more elaborate is used. Wait 3-4 days until the pain starts to "blur",which indicates that the immediate process of healing has stopped the bleeding and has started to repair the tissue. Then use an exercise that directly works the injury, i.e. that makes it hurt, in this case the squat. Use the empty bar and do 3 sets of 25 with perfect form, allowing yourself NO favoring the injured side. If it's ready to rehab you will know by the pain: if the pain increases during the set, it's not ready, if it stays the same or feels a little better toward the end of the set, it is ready to work.

The NEXT DAY do it again, and add a small amount of weight, like 45 x 25 x 2 , 55 x 25. Next day, 45 x 25, 55 x 25, 65 x 25. Continue adding weight every day, increasing as much as you can tolerate each workout. It will hurt, and it's supposed to hurt, but you should be able to tell the difference between rehab pain and re-injury. If you can't, you will figure it out soon enough. This method works by flushing blood through the injury while forcing the tissue to reorganize in its normal pattern of contractile architecture.

After 10 days of 25s, go up in weight and down in reps to 15s, then to 10s, and finally to fives. During this time do NO OTHER HEAVY WORK, so that your resources can focus on the injury. You should be fixed in about 2 weeks, squatting more than you hurt yourself with.

This method has the advantage of preventing scar formation in the muscle belly, since the muscle is forced to heal in the context of work and normal contraction, using the movement pattern it normally uses. The important points are 1.) perfect form with 2.) light weights that can be handled for high reps, 3.) every day for two weeks, and 4.) no other heavy work that will interfere with the system-wide processes of healing the tear.

It is also very important through the whole process of healing the injury that ice be used, during the initial phase after the injury and after the workouts. Use it 20 on/20 off, many times a day at first and then tapering off to morning, after the workout, and before bed. Ice is your best friend in a muscle belly injury, holding down inflammation and fluid accumulation ("swelling") while at the same time increasing beneficial blood flow through the injury. But DO NOT USE ICE MORE THAN 20 MINUTES AT A TIME. More than that can cause more damage than it repairs.

This may actually be the most useful post on this entire little forum of mine, and if you use this method exactly you can save yourself many weeks of lost training and long-term problems with muscle-belly scarring. Try it and see."

vdizenzo
08-13-2009, 04:35 PM
Sorry to hear it Chris. I had a small tricep tear that stuck around for a little while. Like everyone said, ibuprofen, massage, and ice (use a dixie cup and push that ice and hold it deep into the quad). I also avoided things that hurt it. Kept bench work light for about 3 weeks. Have never had a problem since. Best of luck in the healing process.

Travis Bell
08-13-2009, 09:07 PM
Well, when I first did it a few weeks ago we were box squatting with bands. This most recent one was my 3rd week of free squats.

How many times a week are you squatting? What's your stance like?

thewicked
08-13-2009, 11:44 PM
Any time you have a tear you will have some scar tissue. The second injury may be a case of tearing the scar tissue loose from the first injury.

Ice it and do some very gentle stretching along with massage. The idea is to keep the scar tissue elongated so it doesn't tear loose every time you stress the area. Muscle tissue is pliable, but scar tissue isn't, so it can be a challenge to keep from damaging the same area over and over again. Massage and gentle (no pain) stretching are probably your best bet.



QFT!

along with slowly bringing the weights back into play over time.. until then... working lighter via rehabilitation with circumvential techniques will bring you back....


or at least keep you out of the old folks home for awhile ...

AND it sounds like you're squatting too much... hit me up later on the celly and i'll go into more detail

dbc3po
08-14-2009, 09:51 AM
Glad to hear it wasnt to bad Chris. Biggest thing for me was the mental part of coming back. I wish you a speedy recovery, as the others have said its hard to beat ice, rest and stretching.

Ryan Celli
08-14-2009, 09:56 AM
Chris,

I tore my adductor in 06. It burned like I had a lit match to it immediately. It didn't bruise for 3 days???, then a quarter size purple mark (it looked more like a welt) showed up. By the end of the day it was bruised from my calf to my hip.

I did it raw squatting on the way up out of the hole on a max attempt.

I was squatting the next week, on a high box, close stance, just the bar for sets of 20-50. Each week I would add a little bit more weight. I was also deadlifting too. I had to pull conventional, out of the rack above knees. Same thing, went from using the bar to each week adding weight. So basically, I had to do the opposite of what I was used to. I had to take my adductor out of it.

I ended up going to the doctor, and getting some PT. There they did heat to start, massage, utrasound and exercise, and isometric work, then ice.

It took forever to get better. No deep squats or sumo deads for a long time. Even when it got better It would act up here and there.

THE best things I did for it was - deep tissue massage, light stretching, and band work. By band work I mean, using the jump stretch bands to stretch with and push and pull against.

For you I would recommend, finding a deep tissue massage person. Then heat before any exercise. Light, light stretching, maybe some wider stance high box squats and leg extensions with very light weight and 20-50 reps. Once it gets a bit better, some bulgarian split squats with restricted range of motion....maybe? This are going to really put alot of stress on the quad, so only do when it is really healing up, and of couse with no weight. I would actually use something to assist you up. you can choke a band on something for you to hold onto for balance and assistance. Follow all exercises by ICE. Just remember to limit range of motion all everything at first!!! Then every few weeks increase it a small amount.

To keep your squat up, you'll need to do alot of hamstring work and glute work. Good morning might be your best bet.

So sorry to hear this, I hope it heals fast!

OH>> and don't forget to take your ETS.

Ryan

martin
08-14-2009, 12:03 PM
This is the protocol (quoted from Strength Mill forums):

"Here is the tried-and-true injury rehab method for muscle-belly injuries we got from Starr and that has worked for years better than any other method I've ever used. It also works well on orthopeadic injuries in general, and should be tried before anything more elaborate is used. Wait 3-4 days until the pain starts to "blur",which indicates that the immediate process of healing has stopped the bleeding and has started to repair the tissue. Then use an exercise that directly works the injury, i.e. that makes it hurt, in this case the squat. Use the empty bar and do 3 sets of 25 with perfect form, allowing yourself NO favoring the injured side. If it's ready to rehab you will know by the pain: if the pain increases during the set, it's not ready, if it stays the same or feels a little better toward the end of the set, it is ready to work.

The NEXT DAY do it again, and add a small amount of weight, like 45 x 25 x 2 , 55 x 25. Next day, 45 x 25, 55 x 25, 65 x 25. Continue adding weight every day, increasing as much as you can tolerate each workout. It will hurt, and it's supposed to hurt, but you should be able to tell the difference between rehab pain and re-injury. If you can't, you will figure it out soon enough. This method works by flushing blood through the injury while forcing the tissue to reorganize in its normal pattern of contractile architecture.

After 10 days of 25s, go up in weight and down in reps to 15s, then to 10s, and finally to fives. During this time do NO OTHER HEAVY WORK, so that your resources can focus on the injury. You should be fixed in about 2 weeks, squatting more than you hurt yourself with.

This method has the advantage of preventing scar formation in the muscle belly, since the muscle is forced to heal in the context of work and normal contraction, using the movement pattern it normally uses. The important points are 1.) perfect form with 2.) light weights that can be handled for high reps, 3.) every day for two weeks, and 4.) no other heavy work that will interfere with the system-wide processes of healing the tear.

It is also very important through the whole process of healing the injury that ice be used, during the initial phase after the injury and after the workouts. Use it 20 on/20 off, many times a day at first and then tapering off to morning, after the workout, and before bed. Ice is your best friend in a muscle belly injury, holding down inflammation and fluid accumulation ("swelling") while at the same time increasing beneficial blood flow through the injury. But DO NOT USE ICE MORE THAN 20 MINUTES AT A TIME. More than that can cause more damage than it repairs.

This may actually be the most useful post on this entire little forum of mine, and if you use this method exactly you can save yourself many weeks of lost training and long-term problems with muscle-belly scarring. Try it and see."

I did similar to an adductor 3 weeks out from a meet and asked Matt Kroc for help and this is pretty much what he told me to do. It worked :)

You can quite easily self massage the quads. You need to try to 'smooth' the muscle in the direction of the fibres to help ensure good healing. Go easy on it and build it up.

M

JK1
08-14-2009, 05:03 PM
I tore mine pretty severely. Best advice I got was to take prednisone to prevent any calcium deposits form forming in the tear. If that happens it will require surgery. I started back squatting 3 weeks after that using a lighter weight for high reps to a high box. I lowered the box and reps while upping the weight over a period of about 1.5-2 months. after that I was stronger when I resumed normal training than I was before the injury. I dont know if you use AAS (not my business) or not but if you do stay on them. This was told to me by a doctor. Also one thing to look at may be the use of igf injected directly to the tear. I have been told by several people that the recover the best form injuries in that manner.


Have you lost any range of motion? That was my biggest thing to over come.

I'll admit I have a bias against corticosteroids because of the nature of my patients, but I WOULD NOT recommend pred for a muscle belly tear. Corticosteroids will help reduce inflammation, but they'll inhibit healing, even at low doses. Calcification is going to develop as a result of scar tissue formation and poor healing. I'm not sure what you are trying to say or where you are getting that information from, but I disagree with it.


The Bill Star information is good, but there is some information missing in terms of a muscle belly tear. What he wrote is more appropriate for a severe strain/sprain, although alot of it applies to tears also.

In my opinion and from my experience with my own injuries, the course of therapy for a muscle belly tear---grade 1-2 where you've got some loss of function, but not complete tear or detachment from the bone should include the following:

1) use pain as your guide, if it hurts severely, DON"T DO IT. You are injured, its going to hurt some, thats your bodies way of telling you: Hey stupid, this hurts. Just don't be an idiot and try to push through the pain. Listen to your body there is a difference between rehab pain and injury pain.

2) you need to do what you can to facilitate blood flow to the injured area. its blood that is going to carry the materials necessary for the muscle to heal. This means active rest. The worst thing you can do is immobilize a tear like that (a tendon detachement or a complete muscle belly tear is a little different because you have to allow for tendon healing). In the case of a leg injury, simply walking will make a difference. Also, remember that form follows function in the case of muscles. You want those muscle fibers to reallign themselves in the same position they were before they were injured. Using the muscle will facilitate this. Sitting down in a chair with your leg propped up will not. You'll develop a massive scar and lose function. Its much easier to prevent scar formation than to try to get it to go away once its there.

3) Remember that with a muscle tear, you will have some contraction of the muscle. Passive stretching to maintain normal ROM is very important. Just don't over do it. Start slow and go from there. You will also likely have loss of flexibility in noninjured muscles---for example with a calf tear, its not uncommon for the hamstrings to become extremely tight. With a quad tear, you can see extreme tightness in the lower back/glutes, etc. Make sure to stretch those muscles too.

4) there will be loss of muscle strength with a muscle tear not because of loss of function of the muscle, but becuase of the brain shutting down neuroactivation of that muscle in an attempt to prevent further injury. You will have to work to regain this. It may simply mean starting out with bodyweight exercises---working to regain static and eccentric strength, then working on concentric strength. So in other words, don't just load the bar up with weights, start with bodyweight exercise and then start adding weight. Everyones a bit different with this and it varies with the nature of a specific injury, so you may be doing bodyweight only squats one day and three days later handling substantially more weight. Thats fine. Use of EMS or TENS will help prevent this loss of strength. If you have access to it, use it.

5) you must control inflammation. inflammation is the key for the body to form scar tissue and its what facilitates pain with an injury. This means appropriate use of NSAIDS, use of ice, massage, ROM therapy, Nutrition such as Fish Oil intake, etc to keep inflammation under control. The more inflammed that area is, the more its going to hurt and the more the body is going to try to fix the problem by laying down scar tissue. Eating a decent diet will help an injury heal. Eating **** will not.

6) be patient. You are hurt, your body will heal if you give it a chance. Get stupid and you will probably end up reinjuring it.

dbc3po
08-15-2009, 07:44 AM
[QUOTE=JK1;2193056]I'll admit I have a bias against corticosteroids because of the nature of my patients, but I WOULD NOT recommend pred for a muscle belly tear. Corticosteroids will help reduce inflammation, but they'll inhibit healing, even at low doses. Calcification is going to develop as a result of scar tissue formation and poor healing. I'm not sure what you are trying to say or where you are getting that information from, but I disagree with it.


This info is from a sports medicine doc. He is actually the most sought after doc in the area by all high schools and colleges. This is one guy I have been to I actually feel knows his stuff. He was very good with his thoughts on rehab. He actually agreed with my rehab plan that I mentioned before. Basically the prednisone was prescribed for about 5-7 days(cannot remember the exact prescription). Your right your going to get some calcium deposits as a result of scar tissue but its was prescribed to keep the tear from healing as a calcium deposit. Although I wasnt suing anabolics he told me that that would have been the best time to be on them.

BTW I personally hate prednisone. I feel like death warmed over on the stuff but it did help.

JK1
08-15-2009, 02:36 PM
[QUOTE=JK1;2193056]I'll admit I have a bias against corticosteroids because of the nature of my patients, but I WOULD NOT recommend pred for a muscle belly tear. Corticosteroids will help reduce inflammation, but they'll inhibit healing, even at low doses. Calcification is going to develop as a result of scar tissue formation and poor healing. I'm not sure what you are trying to say or where you are getting that information from, but I disagree with it.


This info is from a sports medicine doc. He is actually the most sought after doc in the area by all high schools and colleges. This is one guy I have been to I actually feel knows his stuff. He was very good with his thoughts on rehab. He actually agreed with my rehab plan that I mentioned before. Basically the prednisone was prescribed for about 5-7 days(cannot remember the exact prescription). Your right your going to get some calcium deposits as a result of scar tissue but its was prescribed to keep the tear from healing as a calcium deposit. Although I wasnt suing anabolics he told me that that would have been the best time to be on them.

BTW I personally hate prednisone. I feel like death warmed over on the stuff but it did help.


This isn't the appropriate place for a medical case discussion and I don't want to get into an argument with you about how the doctor treated you because I don't know all of the information about your injury and you are technically the wrong species for me to treat and above all what was done worked for you, so you can't argue with the final outcome....... however, it still concerns me that a corticosteroid was prescribed for a muscle tear. I did make a quick run through the literature online this morning, and apparently there is more corticosteroid prescriptions for this type of injury than I realized too.

There is some outdated information (I may be wrong with this, its been a while since I had time to fully puruse the literature) where prednisone was suggested for muscle tears or severe muscle contusions, however, the current literature that I'm aware of all state that there is little evidence to support the use of corticosteroids (and thats from a paper thats 5 years old) with muscle strains or tears. What I found really interesting is the current argument on not using nonspecific COX inhibiters (ie advil) too.

Looking at things from a purely physilogical basis, prednisone as a corticosteroid is a GREAT antinflammatory agent. Getting inflammation under control will make you feel bettter---there won't be as great of a loss of function and you won't have as much discomfort. However, the must be a degree of inflammation for the body to have the stimulus it needs in order to heal. There is information that indicates that the use of corticosteroids will significantly slow wound healing. I'm still not sure I understand what you are talking about with calcium, because when the body heals, it forms scar tissue first, then ossifies (calcifies) that scar tissue if there continues to be instability in that area. I think we may be losing something in the conversation, but its probably not important. Again, the bottom line is you healed.

dbc3po
08-15-2009, 05:13 PM
JK1 dont get me wrong man Im not trying to argue with you please do not take it that way. What the doctor meant by the calcium deposit was he didnt want the tear to heal with a mass of calcium in it where it would just tear again as soon as I put any stress on the quad. I truly respect your input and think this all good info for Chris or anyone else who may have an injury or muscle tear they are trying to overcome.

One thing I will say is prednisone is very hard on you when you take it. I have been prescribed it 3 different times and I tell you it makes me honestly want to die. The best corticosteroid I have been prescribed was something called decadron for a herniated disc. It worked without nearly the same death feeling of the prednisone(may have been the pain killers i was on though). Either way you have a very valid point about the dangers of corticosteroids.

therman12
08-15-2009, 05:51 PM
i would say foam roll it and put some DMSO on then ice.

JK1
08-15-2009, 07:09 PM
JK1 dont get me wrong man Im not trying to argue with you please do not take it that way. What the doctor meant by the calcium deposit was he didnt want the tear to heal with a mass of calcium in it where it would just tear again as soon as I put any stress on the quad. I truly respect your input and think this all good info for Chris or anyone else who may have an injury or muscle tear they are trying to overcome.

One thing I will say is prednisone is very hard on you when you take it. I have been prescribed it 3 different times and I tell you it makes me honestly want to die. The best corticosteroid I have been prescribed was something called decadron for a herniated disc. It worked without nearly the same death feeling of the prednisone(may have been the pain killers i was on though). Either way you have a very valid point about the dangers of corticosteroids.

Its all good. No worries on my part and I don't want you to think I was trying to cut you down or something for what your doctor prescribed.... Like I said before, the bottom line is you recovered from that injury. Thats the important thing as far as I'm concerned.



Decadron is the trade name for dexamethasone. Dexamethasone is a corticosteroid also. In my line of medicine, the general thought is its about 6-8 times more potent than prednisone in terms of antinflammatory properties. It also has a longer half life and will remain active in the body longer. Prednisone has some mineralcorticoid (ie will effect electrolytes) which some think may lead to the "feeling like ****" some individuals have when they take Pred.

Both drugs will also cause a "steroid euphoria' in some individuals. Basically its a response to the drugs on how the body handles stress---remember corticosteroids are a "stress" hormone.