Background about the person and their injury:
B is a well-respected powerlifter in San Diego. He had been training very hard for the annual KERN US open competition. This event was set to take place in less than 3 weeks. B came in to our office with right lateral quad strain after attempting to back squat over 800 lbs. During the concentric phase of the motion (coming back up from a full squat), B experienced a strong pulling sensation in his right lateral quad. From that point on, B was unable to train and the following morning he could barely walk and could not perform a squat even with no weight on his back.
Important Clinical observations:
Interestingly, measuring his pelvic alignment and tilt did not reveal much. His hips were symmetrical and his pelvis was aligned.
Manual Muscle Testing revealed significant weakness on his whole left lower body. It was as if he had no ability to fire his pelvis stabilizing muscles, particularly the piriformis and his glutes. His hamstrings were also noticeably weaker on the left. Could this asymmetry have lead to his right leg working harder than the left causing it to become injured??
A Functional Squat Assessment was performed, but B was only able to squat to about 35 degrees before he felt pain in the injured area. We were not able to discern any additional information about his movement patterns from this test.
We then proceeded to rule out TFL muscle involvement. Palpation revealed significant sensitivity on the lateral quad (Vastus lateralis). There was no bruising but the area felt stiff and tender.
Through additional testing we ruled out the likelihood of an irritated lumbar disc, lumbar facet or Sacro-iliac joint involvement.
Right lateral quad - Vastus Lateralis (VL) strain with possible tearing.
Appropriate Treatment Guidelines:
Increase local circulation and self- repair at the injured area.
Reduce inflammation and muscle spasm.
Increase proprioception and ability to fire the muscles of the left leg
Restore local proprioception and muscle firing capacity to injured leg.
Treatment protocol included:
Acupuncture needling was performed on the motor points of the lateral quad (VL) achieving a twitch response.
Myofascial work to ‘clean and release’ formed adhesions along the fascial lines extending from upper thigh down to the injured area.
Acupuncture was given to the whole back side of the body to improve the neurological communication and proprioception between the lower back and the primary muscles that move the left and the right legs.
Exercises to strengthen underactive hip abductors were prescribed.
Patient felt significant improvement. After one treatment he regained his full range of motion in his squat.
Coming back for his second visit he admitted to having significantly less tension in the posterior chain and an improved ability to fire the muscles of his left leg. After 3 additional visits, B felt an overall sense of readiness to tackle the event. At the Kern US Open, B reached a new Personal Record (PR) for total weight lifted of 2,160 lbs. He PR’d all three categories; Bench Press, Back Squat, and Deadlift. B was pleased with his overall performance and felt encouraged to set new lifting goals for his next event.