Are these symptoms consistent with a muscle strain?
February 27, 2017 9:28 AM   Subscribe

I experienced a sharp twinge in my hamstring muscle while cycling about 6 months ago. It has become recurring. My (sports medicine) doctor is treating it as a muscle strain and I am performing physical therapy exercises following that diagnosis. Progress has been slow. I am getting a second opinion this week. What alternative issues should I be trying to rule out?

The main symptom is a sharp twinge in what feels like the belly of the right hamstring muscle, about 5 inches above the back of the knee. I typically experience it about 45 minutes to an hour into a bicycle ride. It comes on without warning and occurs as the leg reaches full extension. Once the first twinge occurs, it's very sensitive for about a minute and walking or further pedaling is likely to cause another twinge. If I wait it out a bit, it goes away and I can pedal home without additional pain.

The area is not tender to the touch. There is no bruising. There is no loss of strength or range of motion. The physical therapist doesn't feel any difference in the muscle tissue between legs. The physical therapist can't replicate the symptoms in a controlled setting. I sometimes experiencing tingling or itchiness that feels as though it's coming deep within the leg muscle, which usually begins a few hours after experiencing a twinge. I have received an X-ray but not MRI or any other imaging.

Treatment at this point consists of eccentric hamstring exercises, hip exercises, core strengthening, foam rolling for the hamstrings and calves, and hamstring stretches. Cycling and other activity has been encouraged to the extent that it is not painful. That's all great stuff, but I don't feel as though I've made measurable progress on the pain front (I still get twinges every few weeks).

I want to make sure that I am treating this properly and don't risk turning this into a bigger issue down the line. The physical therapist has made enough comments about my problem being 'unusual' or 'interesting' that I want additional confirmation that I'm being treated for the right thing.

I am going in for a second opinion later this week to another sports medicine doctor. Does this sound like it could be something other than a muscle strain? Should I push for an MRI? What are some alternative diagnoses to ask about?
posted by cobro to Health & Fitness (10 answers total)
IANAD. I would ask about the possibility of referred pain. Six months seems like a long time for a muscle strain; most resolve in 10-12 weeks with correct treatment.
posted by xyzzy at 10:01 AM on February 27, 2017 [3 favorites]

Have you tried monkeying with your saddle height a bit? Sounds muscular to me but they can take forever to heal in my experience. Yoga and cyclobenzaprine.
posted by H. Roark at 10:09 AM on February 27, 2017

Started on the bike and only happens on the bike? Not while walking/standing or other activities? My guess is that something isn't perfect in your bike fit and you keep reaggravating it.

If you haven't had a complete bike fit (one you paid for, not the 20 minute one at the bike shop), then I'd probably start there. Most fits get seat height correct, but things like pedal width and cleat adjustment require more time and expertise.
posted by 26.2 at 10:47 AM on February 27, 2017 [2 favorites]

I agree with asking about referred pain. I've had hamstring pain that has similar characteristics - no knot in the muscle, no bruising or tenderness, some weird tingling - and it turned out to be referred pain from my piriformis muscle.
posted by Sabby at 10:59 AM on February 27, 2017 [1 favorite]

Referred pain. I'm only ever a recreational cyclist, but all of my running injuries were not trauma to the spot that hurt, but severe tightness or injury in the muscles, ligaments, and/or tendons that supported or moved the spot that hurt. Thus, pain directly around, but not on top of or behind, my kneecap was not a knee problem but hip flexor tightness. Bet you a dollar that something needs to be stretched, massaged, foam-rolled, and lacrosse-balled--I just don't know what.
posted by radicalawyer at 11:14 AM on February 27, 2017 [2 favorites]

I know early movement is what's supported by most physios these days, but IME, rest is underrated. Sometimes that's the only thing that'll do it for soft tissue injuries (various kinds), at least for me. (You could be reinjuring a strain, constantly.) Have you tried completely abstaining from activity, other than necessary walking, for 4-6 weeks?
posted by cotton dress sock at 11:43 AM on February 27, 2017

Physical therapy usually helps assuming that the area they're working on is the problem area. Your therapist basically admitted they didn't think your diagnosis was correct but refrained from directly contradicting your doctor. But they said it enough times for you to get the hint.

So add me to the referred pain camp and look for the possibility it's something/somewhere else that's the real problem. But I would let the second doctor learn your history and examine you first before suggesting anything.
posted by tommasz at 12:48 PM on February 27, 2017

Seconding recommendations to check bike fit. I'm always amazed at how a few mm change in seat, cleat, stem, etc. position can make a large difference in performance and feel.
posted by jetsetsc at 1:23 PM on February 27, 2017

At the time of the injury my bike was self-fitted based on what felt 'right'. I'd make little adjustments here and there. A month after the injury I got fitted at a university sports physiology lab. They kept the reach and drop the same while moving the saddle a few mm up and back. They also added some wedges under the cleats. Overall it felt like an improvement and it helped correct some minor knee pain I had been having, but it hasn't resolved the larger hamstring issue.

The most I've completely rested from cycling was about 2 weeks. During that time I just focused on strengthening exercises and yoga. It's hard to say whether that helped or not, and I felt the twinge soon after resuming cycling.

Referred pain seems to be a common theme here. I'll keep that in mind but let the doctor make his assessment first. Thank you for all the replies.
posted by cobro at 2:46 PM on February 27, 2017

Has your PT tested for sciatic or femoral nerve tethering?

When it comes on, does pedalling toes down (especially when the knee is extended) help at all?
posted by flutable at 7:01 PM on February 27, 2017

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