Forward: Dr. Bell has received several variations of this questions over the past few months. For this month’s Fitbit, he thought it would be pertinent to address this issue with all IFPA Trainers in case your client experiences similar injuries.
Dear Dr. Bell, looking for some insight if you have ever heard of this issue. I was performing ATG Squat drop sets. On my 4th set I felt my hip flexor pop at the bottom of the Squat. I stopped and stretched, but it was extremely painful. Now it hurts to lift and rotate internally. Have you had any experience with a sudden snap at the bottom of a Squat? What can I do to rehab it? Any info is greatly appreciated!
Dr. Bell’s Response:
It would have been helpful for you to pin-point for me precisely where the pain is occurring, but to answer your questions, quite a few things can go wrong when you are performing “Deep Squats”, under-load and using a high intensity program like Drop Sets. Some of us old-time Weight-lifters refer to Drop Sets as “Stripping” since you perform a set to failure and immediately “strip” weight off the exercise to continue with as many reps as you can do.
Before I give you some Rehab advice, I must warn you that you should see a doctor first. You may be thinking you have a Tensor Fascia Lata (TFL) injury, and the probability is you are correct, but there is a possibility it could be something more serious.
I am required to provide you with the following warning. If you experience ANY of the following conditions you are to seek medical help as soon as possible:
(1) Pain in the hip accompanied by numbness or tingling of the lower leg or foot.
(2) Pain in the hip that radiates down the thigh and lower leg.
(3) Pain in the upper hip, groin, or thigh that recurs every time you exercise
(4) Pain that awakens you at night, or prevents sleep.
(5) Having your hip collapse under you while you are exercising, walking, or running. Any hip collapse is cause for grave concern.
Based on the information you have provided however; my best guess is you violated more than a few IFPA Safety Guidelines that resulted in you Overstretching and tearing your TFL. I suspect you were very fatigued from your Drop Sets, bounced at the bottom and your TFL paid the price.
Sports Medicine doctors will separate muscle tears into 3 categories or Grades:
Grade 3 Muscle Tears: Indicates the worst muscle tears, where the muscle actually pulls apart. You may hear a popping sound when the muscle tears and may feel a hole in the muscle at the point where you feel tenderness or soreness.
Grade 2 Muscle Tears: Muscle strains are not as bad. You may feel a pulling sensation and know something is wrong, but it really is not dreadful.
Grade 1 Muscle Tears: Involves the least pain and discomfort. The muscle strain feels tight. You know something’s happened, but it doesn’t seem like much.
What do you do about it? For the Grade 3, if you feel something pop and you’re immediately unable to move, SEE A DOCTOR! Aspirin is not going to solve the problem… YOU NEED A DOCTOR! And the doctor you see should know how to treat an athlete!
If you go to doctor who is not used to treating athletic injuries, the likelihood is that you’re not going to get proper care. You might be told to rest for too long, or put on crutches or in braces or splints. Muscle tears must be treated aggressively, and rest is not the answer. It will take you forever to recover with these inaccurate sports medicine prescriptions.
The milder ones you want to try and take care of yourself, so here is how you do it:
If possible: immediately begin gentle stretching. Remember your IFPA Personal Training Flexibility Guidelines. Stretch at 30% with 100% reaching the point of pain (in a non-inured muscle). If it is too painful to stretch immediately, then wait up to 24 hours, but you should begin to stretch as close to immediately after the injury as you can tolerate the pain or discomfort.
Pain is your guide. Keep the stretch just on the edge of painful. The more stretched-out you can make the muscle, the better off you’ll be at achieving full recovery. Listen to YOUR body. You will sense a difference in the discomfort of stretching damaged muscle, versus the difference in pain from doing more damage to the muscle.
Muscles are contained in tough, grisly tubes called fascia. Even though a muscle may tear, it’s likely that it’s fascia will not. When you stretch, you stretch the fascia as well as the muscle, making the fascia’s tubes longer and narrower. You tighten the tube around the injured muscles and reduce the bleeding from the torn tissues. You internally compress the muscle, curtailing bleeding, which is very good, while stretching the muscle, which is an essential incentive necessary to encourage the muscles repair.
If you suffer only a mild strain and get up the next morning to find the muscle tight and it hurts when you move it, if you decide not to use until it’s really well, then you can turn a minor injury into a really sever tear. In athletic injuries, the way you treat the injury determines disability much more than the magnitude of the injury. A small tear you coddle and baby while it heals on its own, can be a lot more disabling than a substantial tear that is dealt with effectively. With muscle tears, you must work it for it to heal.
In any muscle tear, find the motion that gives the most discomfort and gently repeat it, stopping just short of real pain.
Using the discomfort you described as an example of a rehab exercise “…Now it hurts to lift and rotate internally…”
You should lift the leg as high as you can on its own, then use your hands wrapped around your lower leg, below your knee, to pull your leg as high as you can manage; Hold for 30 seconds, after 30 seconds you should feel the target muscle(s) loosen, now take the leg into a slightly deeper Developmental Stretch, for another 30 seconds; then try to hold your leg in that position while gradually loosening your pull with your hands, then release and try to slowly lower your leg to the ground. Do 5 Reps, alternating legs to give your injured leg rest and to maintain symmetry.
The Next part of your rehab plan is to strengthen the damaged muscle. Start back with low weights (load), slow-controlled repetitions and a manageable level of discomfort. Keep the discomfort at a level that you are sure is not creating any additional damage, only incentivizing the muscles to repair itself.
The Exercise Prescriptions for muscles tears:
First: The Stretching Prescription
- Frequency: 3 or more times/day, every 4 hours
- Intensity: Stretch at 30% of MAX
- Time: 5 reps of 30 + 30 secs (never 90 secs or more)
- Type: Static Stretches or PNF
Second: The Strength Prescription:
- Frequency: Every day at lowest intensity
- Intensity: Very Low
- Time: One set of 15 reps
- Type: Low intensity and build slowly: GPO
The foundation of all Exercise Prescriptions is provided for you in detail in the IFPA Personal Trainer Certification Course. This course also covers all your Safety Guidelines and Key Teaching Points for all your training needs. This is to ensure that the rash of injuries you routinely see occurring in gyms rarely occurs with an IFPA Certified Personal Trainer and never occurs when you strictly adhere to IFPA Guidelines.
In my career as a personal trainer I have trained over 5,000 different bodies and never once has an injury occurred during one of my personal training sessions. And this includes the highly intense personal training sessions with World Class professional and amateur Olympic Level Athletes, as well as Safety Critical: Paraplegics.
The IFPA Sports Medicine Specialist Certification Course provides you with the detailed information you need to know for the treatment, care, and prevention of the typical dysfunctions and injuries your personal training clients will need your assistance to correct. Long standing injuries such as the “Hamstring Pull” your personal Training client experienced 10 years ago can still be rehabbed with immense success, though it will take much longer than the personal training client who followed your advice immediately post injury.
To be knowledgeable is to be prepared and please remember the old axiom:
“Knowledge is Power” Is incorrect! Modify it and live by: “The USE of Knowledge is Power!”
Dr. Jim Bell