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Possible muscle tear (strain) vastus lateralis? Rehab and lesson learned.

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  • Possible muscle tear (strain) vastus lateralis? Rehab and lesson learned.

    All,

    TLDR;
    Is the Starr protocol (or similar) my best bet at getting back up to speed after a likely muscle belly strain to the vastus lateralis?

    SCENARIO:
    Just coming off an "injury" (strain or other) in the lower back and was likely too aggressive (too much too early) when squatting what started as a solid single at 435 at an RPE of 8 ended with a likely strained quad. The squat felt heavy as usual, but descent was well controlled, hit depth and with no noticeable sticking point or slow down, brought the bar back up about 1/2 way when I heard/ felt a tearing sensation on the surface of vastus lateralis (about 5-6" above the patella and just above where the TFL runs along the outside of the femur). It was not really a snap or pop like in past tendon/ ligament tears that I've experienced. The feeling was oddly specific of a flat sheath of fibers ripping apart like nylon webbing. I instantly buckled under the load and sent the bar to the safeties.

    LESSON OF THE DAY:
    While I was not babying the low back during the squats, I was likely still relying more on the quads (less on the back) than I had previously trained for at that weight, even if it felt light. (I tend to rely on the back to get the squat going back up (see back injury above)). I did have ever so slightly sore quads (HIIT and warmup weight low back rehab squats 2 day prior to this), but there was nothing else unusual about the set in any way, except for maybe coming off of a back injury too soon for my mind to completely trust in it.

    SYMPTOMS/ REHAB:
    ~35 years old male, 215lbs 5'6" - 8th week of Bridge 2.0
    0 hrs post incident - little to no pain unless loading the muscle. I tried to assess range of motion, but did not try to flex the knee past 90. Completed bench press with no leg drive and called it a day.
    0.5 hrs post incident - Started ibuprofen and RICE protocol. Began researching subject.
    24 hrs post incident - little to no pain, but slightly more pain when loading the muscle than at 0 hrs with no swelling or noticeable changes. - Did LISS (bike for 20 mins) with moderate discomfort like a really sore muscle.
    48 hrs post incident - really tight with more pain first thing this morning. Did week 8 bridge 2.0 pin squats with a knee wrap around the thigh. - no pain up to 50% 1RM for 3. I did 1x5 at 63% and 2x5 at 65% mainly due to pain impacting the form out of the hole. Pain was consistent (not worse/ better) throughout the session.

    Thanks for any and all advice.

    Best,
    Nic
    Last edited by phonics; 09-05-2018, 03:56 PM. Reason: Update

  • #2
    With regards to GPP and other BB exercises, would I limit all training for the first couple of weeks to just the squat rehab or should I continue exercises that don't use the quad (abs and upper back work, floor press, etc.). I'm not sure why I could not continue these from a recovery resources standpoint, but have heard otherwise for other lifters in this situation.

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    • #3
      I don't know that it's any better than following your normal, planned training and seeing if the "strain" is even that big of a deal. I've tweaked things before that I thought for sure would be a problem the next time I trained. The next time I trained, I warmed up as usual and it wasn't a problem. Perhaps you could do your next planned squats and assess then?

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      • #4
        Thanks for the advice Dave. Given the low amount of pain I'm experience the morning after, I will give that a go. I didn't change things up for the back pain (other than lowering intensity for a few workouts) and it was back in action almost immediately*. Even if I used the STARR protocol, I would have used weights that allowed me to maintain good form, but still challenged me over a greatly reduced schedule so as to not detrain horribly.

        *I was concerned that returning to the full routine would tempt me to get back on track with weights that I wasn't ready for by shifting the load (consciously or not) to another muscle group as was the case for the low back pain.

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        • #5
          UPDATE:
          Injury occurred 1st day of 8th week during Bridge 2.0

          0 hrs post incident - little to no pain unless loading the muscle. I tried to assess range of motion, but did not try to flex the knee past 90. Completed bench press with no leg drive and called it a day.
          0.5 hrs post incident - Started ibuprofen and RICE protocol.
          I began researching subject.

          24 hrs post incident - little to no pain, but slightly more pain when loading the muscle than at 0 hrs with no swelling or noticeable changes.
          I did LISS (bike for 20 mins) with moderate discomfort like a really sore muscle.
          48 hrs post incident - really tight with more pain first thing this morning. No blood beneath the skin or other sign of distress to the area, but no stability issues either.
          I did Day 2 of Week 8 bridge 2.0 pin squats with a knee wrap around the thigh. - no pain during warmups up to 50% of 1RM (470lbs - comp SQ). I did 1x5 at 63% and stopped at 2x5 at 65% mainly due to pain impacting form out of the hole. Pain was consistent (not worse/ better) throughout the session. Continuing with RICE and Ibuprofen 2x (AM/PM)

          Comment


          • #6
            You likely do not need to limit quadriceps exercises so much as the speed/intensity of your exercises, but this is still mostly symptom dependent in terms of intensity. It is impossible without evaluation to determine if you did indeed suffer a "strain." However if we operate under the assumption you did, and symptoms are resolving with normal activities within 96 hours then you can start reintroducing squats. If anything a case could be made with decreasing intensity and adjusting volume (I tend to recommend a slight increase) as you build back up. The big thing with strains as they tend to give a residual strength deficit which is why I would advocate continuing to do what you can under the premise of not focusing on any explosive cues. Much to the chagrin of some clinicians I typically will introduce a split squat to training as an additional exercise as it can help you perceive a residual difference in strength. Obviously the ultimate goal is to get to where this feels 100% side to side, but even if it feels 80% you are fine to continue training, just lay off the fast stuff until symptoms completely resolve.

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            • #7
              UPDATE:
              Injury occurred 1st day of 8th week during Bridge 2.0

              72 hrs post incident - Much less pain/ tightness this morning, which is good considering that I will be climbing a ton of stairs today at work.

              I appreciate the advice Dr Miles. I will make the changes accordingly as I head into the Hypertrophy 2.0 Template Monday.

              Thanks again.

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