Road Cycling - Vastus Medialis Pain/Strain

I don't think anyone will know this (because I've been to five physical therapists $$$, and they don't know), but it's worth a shot.......

When I do a very hard ride (any maximum or close to maximium efforts over any distance/time: sprints, time-trial, whatever) both my vastus mediali become very sore and strained toward the end, and very, very sore for up to 5 days after. The pain is similar to that experienced after a super-hard weights workout ("D.O.M.S.). It feels as though the mediali can't keep up with the laterali (hope that's the correct plural) and the other muscles.

I've raced and trained on and off with the same position for 18 years, so I'm confident the problem is NOT positon (I've changed literally EVERYTHING to make sure), it's something that's going on with my physiology, possibly caused by my lack of abdominal work over the last 5 years. The condition was preceeded by a big jump in cycling duration and intensity over a period of a few months that resulted in some hypertrophy of both my laterali.

Deep tissue massage and stretching helps a little, but what seems to make the most sense is some information I got from a guy called Sam Visnic who told me about the importance of abdominal strentgh, core strength in general, pelvic tilt, femur rotaion, petallar tracking, etc. All of these can be affected by having weak abs.

Any ideas? PLEEEEEEEEEZ :(

I'm sure one of the therapists covered this, but I'm wondering what you're doing to reinforce the 'antagonist' muscles and perhaps the stabilizers and assistors?
from what I understand, the quad muscle group's opposing (antagonist) group is the hamstrings. they need a balanced relationship for optimal performance, right?
perhaps concentrating on working out the hamstrings a bit might support the quad problems you're having to a degree. I'm sure it's not that simple but maybe that could help?

It's true, weak abs can cause all sorts of problems. Apparantly it can contribute to a chain reaction that includes gluteus minimus strain, low back strain, plantar fasciitis and shin splints, along with the conditions you've mentioned.

"I'm no doctor, but".....
you may also want to concentrate on IT band inhibition (stretch and massage), and some seated leg extensions with your toes pointed outward to strengthen the VMO. Other possible contributors could be "Q-angle" (too narrow bottom bracket?) or excess pronation; both of which can put added strain on the VMO, but you said the problem was not position. Did you put in a new bottom bracket without really checking the width?

An osteopath who is trained properly in manipulation should be able diagnose if and where you have imbalances or what's pulling on what. (e.g. imbalances in the myofascial chains). He should also prescribe various stretches and specialized (weird) exercises if there's imbalances, in addition to doing manipulation on you. I dunno where you live but I have heard that most US osteopathic schools aren't giving as much training in this area as they should compared to other countries.

I have read that "sports kinesiologists" have similar training in soft tissue manipulation but I've never dealt with one..

I'm not a doctor either, but I had a similar problem during the winter skiing season. After about a 8 runs or so, I noticed that I had similiar pain, especially after running moguls or deep powder.
A ski instructor told me to only do partial squats, instead of full squats, which can be hard on the knees, dpending on the person. Do the squats slowly, and hold them in various degrees to help with variable degree strength depending on ski stance and posture.
Also, what helped alot, was I started doing "Butterfly" stretches everyday during my stretching routine, which I had never really done alot of. Butterfly stretches help alot with pelvic rotation, and not only stretch the inner thigh but a good portion of the quad as well.
Also, when doing partial squats, I will do them at varying angles of attack to assist in strengthen the stabilizers throughout the entire region of the leg from top to bottom as well.
I know this seems to pertain more towards skiing, but it may help apply here as well.

Patriot

P.S. Don't forget the hamstrings either.

Thanks very much guys -- now I've just gotta find out what "butterfly stretches" are :D

This problem of mine has been going on for a while, and I'm tipping it'll still be bothering me in the following months, so, if anyone is reading this, no matter how far into the future, even five years from now (!!!), I'll still appreciate any suggestions. :)

I'm not a doctor either, but I had a similar problem during the winter skiing season. After about a 8 runs or so, I noticed that I had similiar pain, especially after running moguls or deep powder.
A ski instructor told me to only do partial squats, instead of full squats, which can be hard on the knees, dpending on the person. Do the squats slowly, and hold them in various degrees to help with variable degree strength depending on ski stance and posture.
Also, what helped alot, was I started doing "Butterfly" stretches everyday during my stretching routine, which I had never really done alot of. Butterfly stretches help alot with pelvic rotation, and not only stretch the inner thigh but a good portion of the quad as well.
Also, when doing partial squats, I will do them at varying angles of attack to assist in strengthen the stabilizers throughout the entire region of the leg from top to bottom as well.
I know this seems to pertain more towards skiing, but it may help apply here as well.

Patriot

P.S. Don't forget the hamstrings either.

When I was in rehab for a torn ligament in my knee, the two exercises I performed to strengthen my quad were leg presses and quad extensions. However, in both cases, I was not allowed to exceed an arc of 30 degrees; my PT claimed that the middle 30 degree of motion is where the joint suffers the most stress. I wonder if this also helped to balance the strength training across my quads as well, and so perhaps you should consider doing this type of lifting as well. For biking, I expect that lower weights and higher reps are the most appropriate.

Unfortunately, I have heard that some folks never get to the bottom of what's ailing them. As a result, their condition only resolved by stopping the aggravating activity entirely for a period of time (1 month) before working their way back into it until they achieve pre-injury level.

There's my $0.02; hope you're feeling better soon.

Butterfly stretches are a follows...

Sit on the floor with your legs in front of your like you were to lean forward to stretch and touch your toes.

Then while sitting straight up, bend at your knees, and pull your feet/ankles straight towards your groin.

Now your are sitting with your heels up against your butt and your knees in the air with your arms between your legs (knees angled out), holding your ankles.

Now your legs are up at an angle, and as you rotate your pelvic joints, slowly use your elbows to gently push your knees downward towards the floor. Kind of like doing the splits etc, but holding your ankles the whole time. Do this up and down over and over. As they days go by, your knees will get closer and closer to the floor as your muscles limber up. It will also help with pelvic joint mobility.

You will be stretching your inner thighs just like when doing the splits, but also stretching the inner sides of your quads as well. This is a great stretching excercise for skiers and martial artists (I used to take Tae Kwon Do).

And there you have it.

Patriot