Vastus Medialis

[BobO]

Longshot here, does anyone have experience with a sore / strained vastus medialis? It's the teardrop shaped muscle just above and inboard the kneecap.

Bio: 46, M, 185#, intermediate level fitness.

I've been struggling with this for a while now and I'm at a loss for direction. For some background, the origin of the problem can be traced to a single event. I was helping my uncle GPS locate a survey monument corner that fell on the top of a very high, very steep hill. (Here's the funny part) The soles, yes both, on my old reliable field boots decided to depart within a few yards of each other. This left me descending a long steep, rocky drainage in basically moccasins for about two hours. About halfway down I noted a twinge in the vastus medialis of both legs. I figured it was natural since I was constantly catching myself from falling. By the bottom of the hill I could hardly walk, that muscle on both legs felt like the worst bonk, and I was extremely sore for about a week and not out of discomfort for two. I took it easy on the bike for a while and by the time I did a century ride a month later I wasn't giving it any thought as a limiter. However, by the end of that ride I had the same cramped, sore, dead feel in the vastus medialis. I have been taking it pretty easy since then, but every time I ride now, even really easy I seem to aggravate it. I can take time off and get it feeling good, but after even a gentle 2 hour ride this specific location is sore.

Weirdly the soreness appears to be very equal in both legs. This leads me to think that there may be a flaw in my bike fit. As I understand it, moving the saddle aft should recruit the glutes and hamstrings and take some of the load from the quads. While I noted increased use of these two groups when I moved the saddle back, it did not relieve the issue at hand, in fact seemed to worsen it a little. I then moved the saddle fore and this did somewhat relieve the stress on the affected muscle, and allowed for a faster cadence, it notably reduced power particularly in seated climbing and wind.

It has been suggested to me that compartment syndrome may be the culprit, but there was never and redness or swelling. It also seems odd that this would occur equally on both sides. That said, a doctor consult may well be in order.

Anyway, I'm hitting a brick wall with self-diagnosis and was hoping to maybe find someone with a similar experience. Thanks for taking the time to read this.

[jimcav]

"calf heart attack" basically similar overuse/strain, then pain/cramp when working out (running mainly)--solved by ice massage (across the grain), ECCENTRIC exercise (elongate muscle under tension), and gentle stretching where stretch was held 2 minutes

pulled hamstring--ran marathon anyway, hamstring would flare up with anything hard--running, cycling, lifting
solved with eccentric exercises and same 2 min stretching--best thing for me was eccentric, then for stretching (warmed up muscle) was to contract gently against resistance (like an isometric contraction but i provided the resistance) for 10 seconds, then relax the hammy and go into the stretch for 2+ minutes.

I suspect you strained/micro-tears of the muscle and it has for lack of a better word developed small scarring and adhesions--try the seated leg extension thing at the gym--lift up with both, LOWER controlled with just one. do NOT lift up with one leg. Do a weight you can readily lower 3 reps of 8-10, gradually build weight. stretch after this

good luck

[Alan]

I have used eccentric weight lifting to cure tendonitis and it works. Start very light with a second return on the eccentric phase and do the exercises 2X per day if you are very motivated. You can make very quick progress with muscle only issues.

If you want to take something drink tart cherry juice concentrate.

Alan

[BobO]

If you want to take something drink tart cherry juice concentrate.

What does this do?

Thanks for the tips.

[Bob Ross]

I was helping my uncle GPS locate a survey monument corner that fell on the top of a very high, very steep hill.

I realize this has nothing to do with a diagnosis, but I want to know more about this thing you were doing when your shoes self-destructed! What is a "survey monument corner"?

[BobO]

I realize this has nothing to do with a diagnosis, but I want to know more about this thing you were doing when your shoes self-destructed! What is a "survey monument corner"?

Bit of a long description, but it's actually a really cool story.

The US, west of the Mississippi is broken down into Townships and Sections. A section is one mile +/- by one mile +/-. A township is six sections by six sections. This was done partially as a means of facilitating the organized sale of land within the west. Currently this system is the basis of all land boundary surveys in the west. Section corners, and often quarter corners were originally demarcated with native stones with markings chiseled into them. As time has gone on many of these have been replaced with 2-1/2" diameter brass or aluminum disks set on posts anchored in the ground. Modern surveyors do not measure exact sections, but rather, the sections that were marked by the original surveyor. So, it is vital when doing survey work to establish where these monuments actually are rather than where they should be.

My uncle got a job for the Forest Service re-establishing a boundary line between the forest and a private ranch as part of a dispute. In order to do this one first has to locate some "control," meaning section corners. He studied original field notes and maps and plotted the coordinates of the corners on Google Earth. One of the corners he needed to locate fell on top of a very nasty hill. I volunteered to go because 1. I know how to do the job and 2. I'm not past retirement age.

When I was young I worked for this same uncle as a Forest Cadastral Surveyor. We would find the original stones based upon the record notes and replace them with the new aluminum monuments. At the same time we would put in quarter corners if they weren't already there. We also located privately held lands within the forests for land exchanges. The federal government has several internal agencies that do this as well, they get the flat ground. The private contractors get the mountains. I'm in a different field now, but I often recall that being the most fun job I've ever had.

The government hasn't let many of these private contracts in about twenty years, meaning there aren't many young people with experience in the job. It also means that I'm (@ 46) one of the youngest people with actual experience. My concern is that it may have killed the elder man, and since I'm in decent shape,...

Anyway, I got dropped off on the far side of the hill at a fairly high elevation. I was about 1000' vertical and 1500' horizontal from the high point I had to climb over. The corner I was going to was 400' past that high point and 600' below it. It took about ninety minutes to hike in picking my way between rock formations (read cliff faces), then about a half-hour to find that original stone. It sat about three-feet from it's position calculated using the original 1889 field notes, buried in some high buffalo grass. It's always really cool to find the stone described by some guy nearly 150 years ago.

I took its GPS position (x marks the spot), ate lunch, then headed out to where my uncle was, 2500 feet horizontally from me. Per the GPS, I was 2200' above him and the last 900 feet was pretty flat. I walked and crawled down a rocky wash because the buffalo grass was slick as snot on my moccasins and a fall could have been bad. If for no other reason than the GPS unit I had on a survey pole was worth $9000. It took two hours to reach the truck, the last half hour being pretty painful.

[batman1425]

I've dealt with VMO problems in the past myself. VMO injuries are actually very common with cyclist. The VMO doesn't engage until the last 15 or so degrees of movement straightening the leg and for most cyclists with a decent fit on the bike, the leg stays bent within that range at the bottom of the pedal stroke, so the VMO is poorly recruited aside from standing and sprinting efforts.

Over time, this leads to weakening of the VMO, and overdeveloping of the lateral quads and glutes relative to the VMO. For many folks this results in patellar tracking problems or IT band problems. The other common problem is VMO overuse injuries. The other big muscles in the quad/glues do most of the heavy lifting (pun intended), so you often don't know you are overworking the VMO till it is too late - which sounds like what you've experienced.

In my experience, injuries like this are frequently a result of muscle imbalance and recruitment errors. The muscle is underutilized, so it gets weak, and your brain forgets how to fire it effectively and in a coordinated fashion (muscles start to work against one another), so you develop muscle strains and connective tissue issues trying to cope with an unusual work load - in your case hyper extension with hiking

Generally speaking, aggravated muscles and connective tissue injuries take time to heal properly. Tendons and ligaments have poor blood supply, so it takes a lot of time for the body repair them when they get inflamed or injured. The key is rest/smart conservative activity to protect it while healing, stretching, and correcting the muscle imbalance to prevent re-injury.

The VMO is actually a pretty challenging muscle to isolate in exercise but can be done - and this helps both improve strength and neuromuscular recruitment (coordinate firing). One exercise I found helpful is to roll up a towel or sweatshirt and put it under your knee with it slightly bent while sitting, legs extended on the floor. Then try to push the back of your knee toward the floor - the towel will provide resistance. Start out slow and built up over time to develop strength and coordination. You can also try targeted massage to break up any tight connective tissue in the area to improve flexibility. Rolling across a lacross ball is helpful for that - but be carful not to over work it.

[batman1425]

Also - I suspect why you got relief from moving the saddle forward is because that effectively lowers saddle height (assuming you didn't raise the saddle to compensate). Lower saddle, more limited extension at the bottom of the stroke, less VMO recruitment, less pain. But as you mentioned - also a lower power output position. Too low saddle carries with it other problems as well.

Pushing the saddle farther back, effective saddle height increase, more extension, more VMO recruitment, more pain.

[benb]

There are variations of the squat which will hit the VMO.. no need to do anything super exotic.

[batman1425]

The point is isolation with low weight to build coordinate strength in the absence of activity from the lateral glutes.

Another good one is to lay on the floor. Angle your foot at 45deg, and lift the leg using just the VMO.

[BobO]

Thanks again for the tips.

[BobO]

Also - I suspect why you got relief from moving the saddle forward is because that effectively lowers saddle height (assuming you didn't raise the saddle to compensate). Lower saddle, more limited extension at the bottom of the stroke, less VMO recruitment, less pain. But as you mentioned - also a lower power output position. Too low saddle carries with it other problems as well.

Pushing the saddle farther back, effective saddle height increase, more extension, more VMO recruitment, more pain.

I did move the saddle down with the aft movement and up with the fore movement. Though, admittedly, not scientifically accurate I'm sure.

[OtayBW]

If you want to take something drink tart cherry juice concentrate.I don't think he has CRAMPS! Oh. Wait....:D

[sailorboy]

Look into bloodflow restriction with your weight training. New thing in strength and conditioning circles. Limits stress to your damaged tendon or muscle while still getting the development gains and HGH secretion that will fix the muscle.

[Mikej]

Air chair against a wall? Definitely look into the eccentric

[Ralph]

Do you take cholesterol medicine? Pain around the knees is common.

[BobO]

Do you take cholesterol medicine? Pain around the knees is common.

Thankfully no. In fact no medications of any kind.

[BobO]

I think I may have found something thanks in no small part to this; And,... since that other thread got all clustered up I'm moving this over here. I have emphasized what I see as the key points.

Think of the pedal stroke in terms of two muscle groups, glutes and quads. Glutes are the strongest and widest muscle, they're short and have attachment points pretty far down. The result is lots of torque, but not much leg speed. Quads are a much longer muscle, the connective tissue comes over the patella and has a close attachment, so there's lots of leg speed but not much torque. While the two muscles are effective at different parts of the pedal stroke, using the two muscles is not mutually exclusive.

The glutes extend from the hip, so they can only push down. Most people think of "mashing" as only pushing down, so we'll call that a method of isolating just glutes. As the extension is from the hip, there's probably lots of upper body movement - watch Eddy Merckx climbing...

The quads extend from the knee, so they push over the top of the pedal stroke - think forward, not down. There should also be no upper body movement 'cause in extending forward the rider is solidifying their position in the saddle. Quads can generate lots of leg speed, but very little torque, which is the reason most mashers only use one muscle group. Try to push the same resistance with your quads as you can with your glutes and it'll fail in seconds. It's the path of least resistance, people use the muscle that does the job, so they use the glutes only...

The way I see it, you've got both, why not learn to use 'em? Quads have one big advantage over the glutes, they can deliver a very wide range of RPMs, which means they can accelerate the bike. On the flats when the speed can change rapidly, or in a paceline when you need to match the changes of the person in front of you, the quads are better at doing the job. The other compelling argument is fatigue - any muscle does it, having two motors means you can burn one and still get home (before it gets dark). On our gap ride in Vermont, my friend was all done climbing for the day, but we were still miles from where we needed to be. We took the flat way back, in the mid 20's at high cadence - not bad for being "all done" on the hills.

I am naturally a spinner, probably due to my past as a runner. It's very easy for me to spin at 95-100 rpm bringing the pedal over the top and really starting the power stroke at 11:30-12. I had been using, for lack of a better term, this pedal stroke for all purposes including climbing. My theory is that I've been over using the lower quads by pushing the pedal over the top when there is high demand for torque. The last few rides I've taken, I consciously forced myself not to do this. Instead whenever I needed torque, I concentrated on generating force while pushing the lower leg straight down. In my mind I'm now engaging the power at 3:00 though the reality is probably quite a bit earlier.

I deliberately did two hard rides this weekend that went after some of the hills that have given me trouble, 18% grade on one hill. Today, no sore quads.:hello:

At the moment my saddle is further forward and down from where I had it previously. Would it be a wiser strategy to put it back where I had it (I was faster) and work on the new pedal stroke, or leave it where it is then move it later if needed?