Nothing here on this injury - hoping others might help inform me. I’m 8 weeks into a severe thigh contusion. A pedal strike flipping me up to my handlebars which applied a tourniquet with my top tube on my upper thigh as I contorted over the handlebars. X-ray and MRI confirm no bone injury.
About a week in I was back on the bike doing short, non-fitness rec rides in the neighborhood waiting for the contusion/swelling to go away. I was ‘re-learning’ to walk during this period as my fine motor function/mechanics got pretty screwy. Critically, my knee flexion was at about 110 degrees which was just enough to spin the pedals.
About 3 weeks in, I had a minor toe stub while walking and it sent me reeling in abject pain up my problem thigh to my pelvis. Since recovering from this, I’m now stuck at maximum 75 degrees knee flexion which is no where near enough to bike or really do any activity. My knee sustained no damage and does not hurt, but my upper front thigh (pain) prevents my knee from bending beyond this. I accidentally went over my flexion limit sitting down on the toilet and it was excruciating and resulting in a minor setback. I’ve stopped all fitness activity since week 3, though I go on 20-30 minute walks now for sanity.
Two weeks ago an updated MRI confirmed diagnosis of moderate grade partial tear of the vastus intermedius muscle and/or muscle contusion with 3x4.5x12 cm hematoma primarily in the vastus intermedius muscle. Proximal and distal tendons and muscle attachments appear intact.
I’m hoping someone on here has experienced or seen something like this? Both PTs seem anxious to over stretch me or perform deep tissue massage and not cause more damage. Progress has just stalled the last 4 weeks and doctor says come back in 4 weeks if no improvement.
Figure I’d close out this thread for future sufferers. The following day after I wrote this ‘depth of despairs’ missive, I woke up and my knee could suddenly bend 25 more degrees. Since then I’ve been on a strict PT regimen and slowly ramping up the bike. Obviously I temporarily lost a lot of fitness and the time away took a particularly hard toll on the high end efforts and hills. I’m doing lots of squat like strength exercises to rebuild the muscle and retrain the neuromuscular system. I suspect this rebuilding is playing into some of the difficulty on hard efforts. At the current rate of improvement, I think I’ll be back to form in 30-45 days.
@MN_XC I know this is an old post, but just want to thank you for following up. I’m on day 15 after wiping out. My vastus intermedius hematoma is about half the size of yours. On day 5, I was in pain, but had 120 deg of flexion. I soon regressed back to 80-85 deg and have been stuck since. Anyway, I have hope that one morning I will wake up and suddenly be able to sit on a toilet seat normally again.
Thanks for the callout. There was just a complete dearth of information when this freak accident happened. Basically I was down for 2 months with no improvement and still walking awkwardly/gingerly. Then one night I woke up in pain (hematoma finally drained???) and then my knee could flex again in the morning. I did 2 months of strength-focused PT while doing Z2 on the bike. I then elected to turn off the strength training and I was flying again.
This was my first sample point that (continuing to do) strength training really impacted my legs ability to do high-end efforts. 2 weeks later all the embedded muscle fatigue (from strength training) was flushed, I could handle hammer rides, and the whole messy ordeal was over. Have hope…. Suspect your recovery time will match how long you are ultimately down.
A severe thigh contusion like that, especially with a hematoma, is a massive recovery. It’s wild how a simple toe stub can set you back so significantly. Patience and consistency in rehab will be key to regaining that flexion.
Alright, I’m going to continue the tradition and close out my story (above) in case it’s helps anyone in the future. I read pretty much every research paper I could get my hands during my downtime, but it was hard to extrapolate from case studies on pro-athletes to my own situation. The mental anguish was real.
It took me about 7 weeks from initial injury before I finally rounded the corner any my function stopped worsening. I started with 120 degrees of flexion in the knee in the first few days after injury, and kept dropping to about 70 degrees by week 6 (couldn’t sit in a chair and let my leg hang). I also had persistent arthrogenic inhibition the entire time and had almost no strength at the end range of knee extension, so my knee would give out while walking. I was on crutches for most of the first 7 weeks. I tried to do some upper body strength work at gym, but the closest I could get to cardio was sitting ski erg. It was super depressing.
During this time, I had x-ray and ultrasound done. The x-ray at 3 weeks showed that my hematoma was calcifying and turning into myositis ossificans, which meant that I was no longer waiting for a hematoma to drain, but rather turn into bone, stabilize, and eventually resorb. My first physio’s advice to not aggravate it and hold off on rehab until the dropping ROM plateaued. I’m still not sure if this was the right advice, but I ended up scheduling in with another more experienced physio around week 7 just when things stopped getting worse (my research says week 8-12 is when the bone matures and the hematoma becomes metabolically less active). We immediately started working on increasing stretching and strength. The improvement after 2 weeks was unbelievable.
By week 10, I was back to baseline knee ROM, but had a severely atrophied quad, some remaining VMO inhibition, and a bit of pain in the knee joint (presumably from altered gait mechanics over the last 2 months). I could cycle and jog with no pain though.
Now I’m just working on building the strength and cardio back up as my fitness has taken a serious hit. I missed a big chunk of the season, but I’m pretty pleased with how quickly function came back once I started rehabbing. The first 6 weeks were absolutely awful and felt like there was literally no end in sight, so I’m feeling pretty grateful.
Final note, my physio said that he’s dealt with a bunch of cases of myositis ossificans. He’s only ever seen really good outcomes (no surgery and no prolonged disability), so don’t let the case studies freak you out too much.