Member Case Study: Stretches for Quadricep Pain

author : AMSSM

comments : 0

The soreness still develops during/after strides. I have no problem during or after hill repeats. Any recommendations concerning stretching or specific strength exercises that might help?

Question from bertvl
Typical training does not cause me any injury or excessive soreness. However, when I do running strides, I develop a specific soreness (pain would be a big word) where the right quad connects to the hip bone. The soreness goes away after two or three days.

At the recommendation of a massage therapist, I added the runner's stretch (deep lunge pose) after each run. That does give me an additional stretch in the sore area, but the soreness still develops during/after strides. I have no problem during or after hill repeats. Another curious detail is that my right leg is a bit shorter than the left. Any recommendations concerning stretching or specific strength exercises that might help?

Answer by Kenneth Cayce IV, MD

Member AMSSM
 
Overuse injuries are common in triathletes, and comprise about 68 - 78% of injuries in preseason and competition. These injuries include patellofemoral pain, IT Band syndrome, and quadriceps and calf strains that occur with cycling and running. Running causes the most injuries – not exclusively due to increased mileage, but sometimes due to extra training in swimming and cycling which delays muscle recovery.

I recommend changing your shoes every 300 to 350 miles and possibly obtaining shoe inserts (or custom orthotics) to help with your leg length discrepancy. It is always important to get your bike checked and seat adjusted at least once a year to prevent injuries after training. If this continues to give you difficulty, you will need to follow up with a sports medicine physician in your area.

Training recommendations are as follows:
1. Increase training distance and time by no more than 10% per week.
2. Stretch prior to and after each training episode.
3. Get enough sleep and follow proper nutrition guidelines, which include adequate hydration.
4. Listen to your body. Training more when you are tired or in pain may do more harm than good. Reduce your workouts on these days.
5. Occasionally swim, bike, and run beyond race distance to increase your confidence.
6. Train the race course if possible.
7. Do not train intensely for the two weeks leading up to the triathlon.

Exercises:
-Each exercise should be held or done for 20 to 30 seconds.
-A gentle stretch should be felt in your quadricep muscle with each repetition.
-These exercises should be done in both legs prior to training, after completion of training, and during other times at home.
-Cold therapy is intended to decrease pain and inflammation. You can apply ice for 20 minutes every 2 to 3 hours after any activity that aggravates your symptoms.
-Heat can be used prior to stretching or strengthening exercises for short periods of time.
-Topical ointments may provide some relief of symptoms.

1. Stretch

• Lie on your stomach or stand with support.
• Bend your knee, grasping your toes, foot, or ankle.
• Pull your heel toward your buttock until you feel a stretch in your quadricep muscle.
• Keep your knees together.
• Repeat exercise 5 times with each leg.

2. Flexibility (deep lunge pose)

• Assume the lunge position.
• Lunge forward, leading with the hips. Do not bend at the waist, and keep your chest upright.
• Repeat exercise 10 times with each leg.

3. Strength

• Lie flat or sit with your leg straight.
• Tighten your quadriceps muscle as much as you can while pushing the back of your knee flat against the floor or your hand.
• This exercise can be done while at a desk, etc. and can be done about 100 times a day.

4. Strength

• Lie flat or sit with your leg straight.
• Tighten your quadriceps as much as you can and lift your heel off the floor.
• You may add additional weight if this exercise does not cause pain.
• Repeat exercise 10 times per leg, 8 times a day.

5. Strength

• Use a step or books.
• Place your foot on the step and step up and down. Make sure your feet are shoulder-width apart.
• Lightly touch the heel of the opposite leg to the floor and return to the starting position.
• Repeat exercise 10 times, 8 times per day.

6. Strength

• Stand with your back against the wall. Your feet, again, should be shoulder-wid apart and 18-24 inches away from the wall.
• Slowly slide down the wall and hold for thirty seconds when you feel a burning sensation in your quadriceps.
• This should be done at least 8 times per day.

Kenneth Cayce IV, MD
MAX Sports Medicine Center
Columbus, Ohio

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date: May 8, 2007