Suspected strained adductor... tips??

[CritCross]

After a slow summer I began training again this fall. About a week into training I was feeling good and gave it a little bit more juice and rode up a steady hill in my drops. (Should mention that only bike position change was lowering my bars one spacer. I have since put it back up). All was fine until right at the top when I had already eased up, I had sharp pain radiating down my inner left thigh and around the inside/bottom of my left knee.

After much looking around online and talking with some folks, I think I've figured that I've strained my adductor muscle. I did what I've always done with injuries... laid off for 3-4 days, did some 20 on, 20 off ice and stretched in the AM. But I still couldn't ride pain free.

Now over a month and a half after the initial injury I'm only able to ride steady flat miles, but I can't really pull up with my left leg (the same side I strained the adductor on). So I can ride to keep me sane, but it's not even that useful for base miles, and I'm thinking I'm just delaying getting to 100%.

Anyone have any tips?? I've heard of some people having success with deep muscle massages to get some friction directly on the injured site... something I'm going to try soon hopefully. Thanks for your thoughts.


Erik

 

[brianf7]

Sounds to me you may have a very tight hip flexor as underlaying cause.

the oppersite side.

Gentely try a lunge and see if you can stratch it. dont go too hard at it or you will suffer little bit each day.
How much walking do you do if your like me too stuffed after riding so it gets tighter untill it causes problems.
next the lower back and then the knees and soon your hip starts to rotate.

Get out and walk a bit up hill see what happens

 

[fatandfast]

Your range of motion while clicked into your pedals is very limited. You should ensure your seat height is good and ensure that your foot and shoe position is "sqaure". Many people have problems with pronation due a lack of shoe adjustments and low saddle height. Best advice is always rest it

 

[CritCross]

thanks for your thoughts so far- I have added some hip flexor stretches to the regiment... they feel pretty good, so hopefully I'll see some improvement in the next week.

anyone have a good sense of how hip flexor or adductor strains can manifest in knee pain/discomfort? I don't feel much off the bike, but on the bike I'll feel rather tender on the inside (medial) and below the knee. I've been icing where that bothers me, but should I be icing further up where the problem may be originating??

thanks a lot.
Erik

 

[brianf7]

Hip flexors tighten up by sitting on your *** too long every day get out and walk weight bearing exercise.

Its just a common thing with most people especialy people who sit at a desk all day.
You dont use them so the get weak think strong muscles are long weak musles shorten.

Google a few exercises that stregnthen the hips all around it wont go astray in winter .

If you just sit and do nothing they turn to calcium move it or loose it.

Knee pain can come from the hip get it all working in line get a vidio on your back side while on the tyrainer and see what is happening is the hip droping down on one side.

Last resort write to Steve Hogg on CN fittness and read his old posts on hips & knees

regular stretching while your joints are warm after riding.

 

[therealdjamolidineabdoujaparov]

Tailor's Muscle

Hi Erik,

I have just read your comment and will throw in my impressions. From the location of pain you describe, one possibility is that the initial injury was an adductor strain with radiation beyond the knee joint. Due to the decreased relative contribution of the hip adductors in cycling, I believe this is less likely. Alternatively, two muscles that attach below the knee joint that are capable of producing the pain you describe are gracilis (also a hip adductor, but crosses the knee joint), and sartorius. The action of sartorius is to flex the knee, flex the hip, and internally rotate the hip. When cycling and strongly pulling up on the pedals (as in a seated, low cadence climb), sartorius is powerfully contracting and can lead to both a tendon friction injury across the medial joint line (inside of the knee) and also an inflammation of the bursa (fluid filled sac designed to reduce friction) at its insertion (attachment) below the knee. Inflammation of this bursa (pes anserine bursa) produces a particularly exquisite burning pain. If it is one injury, sartorius fits the bill. If a secondary injury followed then it requires more posts...

Without a physical examination, the diagnostic gamblers would put their money on "too much too soon".

--Resisted adduction exercises (gradually increasing resistance) will rule out or confirm adductor involvement (adductor magnus, longus, brevis, and gracilis)

--Resisted hip flexion exercises (gradually increasing resistance) with your knee kept straight will rule out of confirm hip flexor involvement.

--Resisted hip flexion (gradually increasing resistance) with your knee bending at the same time (like kneeing someone in the groin), will confirm or rule out sartorius involvement.

Treatment for a sartorius strain / tendon inflammation / bursa inflammation are all fairly similar. Graduated return to all aspects of training load including distance, intensity, hills, frequency etc. Ice after every ride. Self-massage of sartorius muscle belly prior to ride and several hours after (no need to torture yourself, just trying to ease muscle spasm), local application of topical anti-inflammatory such as voltaren gel prior to ride, and warm-up appropriate to stage of training program.

Be flexible with you return to training, it is unlikely to be a linear path.

A physical examination by a physical therapist or doctor with an interest in sports (preferably cycling) would be of great value because accuracy of symptom location and exacerbation is very difficult (not impossible) over the net.

If you are keen to describe more details of the symptoms, I would be happy to respond.


B Exercise Science
B Physiotherapy
M Science in Medicine (Pain Management)
Final year med student

 

[fatandfast]

Hi Erik,

I have just read your comment and will throw in my impressions. From the location of pain you describe, one possibility is that the initial injury was an adductor strain with radiation beyond the knee joint. Due to the decreased relative contribution of the hip adductors in cycling, I believe this is less likely. Alternatively, two muscles that attach below the knee joint that are capable of producing the pain you describe are gracilis (also a hip adductor, but crosses the knee joint), and sartorius. The action of sartorius is to flex the knee, flex the hip, and internally rotate the hip. When cycling and strongly pulling up on the pedals (as in a seated, low cadence climb), sartorius is powerfully contracting and can lead to both a tendon friction injury across the medial joint line (inside of the knee) and also an inflammation of the bursa (fluid filled sac designed to reduce friction) at its insertion (attachment) below the knee. Inflammation of this bursa (pes anserine bursa) produces a particularly exquisite burning pain. If it is one injury, sartorius fits the bill. If a secondary injury followed then it requires more posts...

Without a physical examination, the diagnostic gamblers would put their money on "too much too soon".

--Resisted adduction exercises (gradually increasing resistance) will rule out or confirm adductor involvement (adductor magnus, longus, brevis, and gracilis)

--Resisted hip flexion exercises (gradually increasing resistance) with your knee kept straight will rule out of confirm hip flexor involvement.

--Resisted hip flexion (gradually increasing resistance) with your knee bending at the same time (like kneeing someone in the groin), will confirm or rule out sartorius involvement.

Treatment for a sartorius strain / tendon inflammation / bursa inflammation are all fairly similar. Graduated return to all aspects of training load including distance, intensity, hills, frequency etc. Ice after every ride. Self-massage of sartorius muscle belly prior to ride and several hours after (no need to torture yourself, just trying to ease muscle spasm), local application of topical anti-inflammatory such as voltaren gel prior to ride, and warm-up appropriate to stage of training program.

Be flexible with you return to training, it is unlikely to be a linear path.

A physical examination by a physical therapist or doctor with an interest in sports (preferably cycling) would be of great value because accuracy of symptom location and exacerbation is very difficult (not impossible) over the net.

If you are keen to describe more details of the symptoms, I would be happy to respond.


B Exercise Science
B Physiotherapy
M Science in Medicine (Pain Management)
Final year med student

Wondering if you find off cycle exercise a better rehab for injuries like this? Lots of Dr.s I have seen give advice like complete deletion of the exercise that is causing the pain and or injury. For me and others like me, finding a new exercise that is a substitute is difficult if not impossible.

 

[CritCross]

fatandfast:

thanks so much for taking the time to think/write back.

Two things that come to mind that may help to figure out what is going on. First: When I was riding after the injury and I was feeling discomfort in the medial portion of my knee and up towards the groin, if I got out of the saddle for a few seconds, the discomfort would vanish, and would only slowly work its way back.

Second: While off the bike I can often feel discomfort / ache on the medial side of the BACK of the knee (usually much 'duller' and located on back instead of side/front compared to pain experienced while riding). I'm not sure if that ties in with your thoughts of the sartorious being the culpret. This discomfort is helped with hamstring and groin stretches it seems.

Thanks,
Erik

 

[titan_90]

fatandfast:

thanks so much for taking the time to think/write back.

Two things that come to mind that may help to figure out what is going on. First: When I was riding after the injury and I was feeling discomfort in the medial portion of my knee and up towards the groin, if I got out of the saddle for a few seconds, the discomfort would vanish, and would only slowly work its way back.

Second: While off the bike I can often feel discomfort / ache on the medial side of the BACK of the knee (usually much 'duller' and located on back instead of side/front compared to pain experienced while riding). I'm not sure if that ties in with your thoughts of the sartorious being the culpret. This discomfort is helped with hamstring and groin stretches it seems.

Thanks,
Erik

I am not a doctor or pt but, my recommendation to you is to stay off the bike until the pain goes away and see a sports doctor and to get a professional fit. It simply could be too much too soon but, my personal experience with knee problems is if not treated correctly can be chronic and debilitating. I messed up my knee while cycling(similar to you I felt the pain at the top of the hill and in the inside of my thigh and around the inside and bottom of my knee also in my left leg) and thought I could self treat it so I took a few days off from cycling and then I went for a short ride and the pain returned worse. After 6 weeks off of the bike I took a twenty minute flat spin and boom it came right back and worse again. What I had was Patellofemoral Pain Syndrome(runners knee). I needed a few months of rehab and orthotics to treat a foot Pronation I have along with cleat wedges for cycling. I needed to make some small adjustments to my bike to get a proper fit as well as going to a compact crank with 170mm arms from a standard with 172.5 mm arms.

 

[therealdjamolidineabdoujaparov]

fatandfast:

thanks so much for taking the time to think/write back.

Two things that come to mind that may help to figure out what is going on. First: When I was riding after the injury and I was feeling discomfort in the medial portion of my knee and up towards the groin, if I got out of the saddle for a few seconds, the discomfort would vanish, and would only slowly work its way back.

Second: While off the bike I can often feel discomfort / ache on the medial side of the BACK of the knee (usually much 'duller' and located on back instead of side/front compared to pain experienced while riding). I'm not sure if that ties in with your thoughts of the sartorious being the culpret. This discomfort is helped with hamstring and groin stretches it seems.

Thanks,
Erik

You're absolutely right, posterio-medial knee pain and more proximal groin pain does essentially rule out sartorius involvement. If hamstring and groin stretches ease the pain, then continue++. Find an anatomy text or pictures on-line and try to correlate your symptoms to structures which fit your symptoms. The symptoms you describe in the last post have a better fit with semi-membranosis (or semi-tendinosis if it crosses the knee joint more anteriorly) and adductors including gracilis. Staying off the bike is a safe option which is why it is so often recommended by doctors. "If that activity hurts then stop doing that activity". This usually isn't entirely satisfactory to most athletes.

The average length of time set aside for stretching is poor. Less than 10 minutes a day total would be the norm. Increase this substantialy given constraints in you life e.g. family, work, kids, study. Go gentle. Duration of stretch is more important than intensity. The stretch shouldn't hurt, and it shouldn't cause pain the next day either. The effort and discipline required to train at high intensity, in the cold, or in the rain, is high. The effort required for stretching is generally quite low. The effort to benefit ration of stretching is very high and maximises the response to the nasty stuff out on the bike. The training is the hard work. Stretching, adequate sleep, appropriate diet, sports psychology is much less unpleasant.

If some simple adductor and hamstring stretches will resolve your problem, then the answer is straightforward. Do them religiously. An hour a day on those two areas would not be excessive in the ideal world.

You can see how more information is invaluable and you are working out the problem on your own.

I would be interested in your progress over the next couple of days and weeks.

 

[Anonymous]

I had this problem, and unfortunately, there is no better remedy than rest. It took 3 months to disappear.

Two other things that I believed helped me.

1) Stetching the hip flexor muscles.

2) Shorter crank arms - went from 175 to 170.

Now i'm over 6ft and 170s are definately not recommended for my height, but I had the same sharp pain deep inside the inner thigh/groin area that got aggravated with climbing in my 175 crank bike. On my 170 crank bike, no probs. Note the 170 bike was pretty much setup the same as the bike with 175s, obviously except the crank size.

Occasionally feel the slight pain when I switch back to the MTB (175s) for a ride, but its not as bad due to the wider Q-factor (well, thats why i think there is less/no pain on my MTB with 175 cranks)

I believe those two factors helped, but I also spent alot of time off the bike (about one month) and if you can deal with the craziness of no exercise, its prob a good idea.

Dunno if that helps you, but just my thoughts, becoz your description in the OP sounds just like what I had. Probably best to see a sports doctor tho. Aggravating these injuries by ignoring the problem will always make it worse, and possibly even chronic, so take it easy and best wishes becoz injuries absolutely suck. I've had too many of these nagging annoying injuries, so i feel your pain

 

[daviel]

I have had a pain in my left hip for several months now that I self diagnosed as a hip flexor strain and mentioned it to my doctor when I was at his office for something else. He suggested an x-ray. The x ray disclosed bilateral avascular necrosis in both hips - neither femur's ball joint is getting blood supply. Probably hip replacements for me soon. I have an appt Feb 15th with an orthopedic physician. Looks like my exercise plans are set out for me in the future and they probably include a lot more swimming.