Big race after a bike crash

author : AMSSM

comments : 0

Can I cram for my big race after having to break from training due to a crash?

Beginner Triathlete Member Question:

"I crashed my bike four weeks ago getting ready for a 70.3 four weeks from this weekend. I was training great and feeling really confident until this big setback. I severely bruised my thigh (and my ego) and just now getting back to training beyond swimming. I have been riding a stationary bike daily for 30-45 minutes and increasingly putting more and more tension on. I hope to get on the bike this weekend and then start running the middle/end of next week. Any advice on how to cram when I have a decent base level of fitness?"

Answer by Aaron D Campbell MD, MHS
Member AMSSM

Thigh injuries can be very painful and frustrating. Without understanding much about the more specific location of your pain, what it feels like, and what your limitations have been, I’ll try to give you some points on how to approach this. When I hear, “thigh," I think of the quadriceps. Assuming you did not sustain a small type of femur fracture, I would consider this to be a quadriceps (or just quad) contusion. This is like a bruise to the muscle, but there could have been a hematoma (bleeding) involved. A strain or strain is also possible, but does not sound like what you are describing. A quad contusion could easily take several weeks to heal, and sometimes a couple of months, where pain and weakness are the primary issues. This does not mean you will be feeling terrible and not able to do what you want, but it does take time, and “cramming” for an event really isn’t an option. 

Serious quad contusions, can lead to what we call “compartment syndrome”, where substantial muscle fibers are torn, leading to bleeding that can compress nerve fibers, leading to significant weakness in your lower leg, numbness in your lower leg or foot, or other neurologic deficits. If this type of injury had happened to you, I would have expected you to end up in the ER, either immediately, or within a few days due to the seriousness of the injury. This hones things into the contusion, which may still involve a smaller hematoma, but less serious. 

If you came to my clinic, I would likely get an Xray to make sure there was no fracture. Next, I would do a full exam to see where it hurts and assess for weakness, range of motion, and any neurovascular deficits. Additional imaging that may be helpful would be an ultrasound to look directly for a hematoma. Sometimes these can be drained, but after several weeks, there develops a blood clot that is difficult to drain. This is not the same type of blood clot that is in your veins and life threatening, rather a clot that sits around the injured muscle. Depending on what was found, light massage, ice/heat contrast therapy, and strengthening exercises, likely through a physical therapist would be indicated for the treatment plan.

I recommend being patient with this injury, trying the interventions I just mentioned, and consider getting checked out by a sports medicine doctor to further evaluate. This can help understand the prognosis of your injury, when it would be expected to be feeling better or back to normal. In the meantime, slow down your activities. The cramming concept doesn’t work for injuries as a rule. If you’re hurt, it’s best to back off on what you are doing and allow the injury to recover, utilizing some of the modalities I’ve described above. At that point, you would train out of the injury to get back where you were, then progress forward. Good luck!

- Aaron D Campbell MD, MHS, University of Utah Healthcare

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date: December 1, 2016