Vastus Medialis Fatigue

[Sasha Pachev]

I noticed that during and particularly after the St. Jude Marathon my vastus medialis muscles on both legs were very sore and felt overworked, while the rest of the quad in comparison felt like I almost had not run. The hamstrings felt like they have worked as well, but not as bad as vastus medialis. I am curious to know what that means. What would you have to do to put an usually disproportionate load on vastus medialis?

[Josse]

I think differant courses, differant stresses, or just how we feel that day (remeber you were fighting a cold) can cause differant group of muscles to be sore.  I have had this after a marathon only it was my Vastus Lateralis muscle.  You just need some rest and a good massage.  Also you have ran a whole lot of miles, races and marathons this year.  Your body gives you signals it is worn out listen to them.

[Dale]

I'm certainly not an expert in the matter, but a quick google search shows that muscle is key in knee stabilization and correct kneecap tracking.  Have you had any accompanying knee pain, or do you have biomechanical issues that would lend themselves to PFS?  If so, maybe it's just manifesting differently for you (or giving you an early warning).  Straight leg lifts appear to be one exercise that'll help strengthen that particular muscle group.

[Sasha Pachev]

I do have occasional tenderness in the right knee at the end of a long run. If I run on the track, it can digress to more than tenderness and transition into a full-blown debilitating injury at times, which is why I hardly ever go to the track.

[Josse]

When I was working out today, this came to mind.  All of our Vastus muscles except the intermedus should be free moving, in other words not vaccum packed to the bone.  When we do alot of running sometimes this happens and can cause pain in the quad or knee.  To treat this I would use some deep cross fiber friction on the muscle or muscles that are doing this.  Take that quad muscle with your nuckles and with quick motion move the muscle ack and forth, medially to laterally.  If this doesn't make scence I would be willing to show you.  Just let me know,  I fully believe in self care.

[Dale]

http://www.drpribut.com/sports/spknees.html
This site focuses on the knee side of things, but if you read in the Causes: seciont you'll see that Vastus Medialis stablizes the larger quad muscles.   That can manifest as PFS pain.  Sounds like your symptoms are a bit different, but similar enough that perhaps some strengthening of that muscle group might do some good.  I know refocusing on some exercises to strengthen the stabilization muscles has helped me reduce some of my intermittent knee and ITB pain as of late, which manifested during my last couple of marathons.  Just some thoughts...

[Michelle Lowry]

Hey Sasha, my legs start to get all kinds of odd pains when I need new shoes.  Have you gotten new trainers yet?

[adam]

Sasha,

Just out of curiousity, why do you think it is the vastus medialis? There are many muscles and muscle attachments on the inside of the leg above the knee. Iit would be hard for me to tell determine possiblities unless you described where on the inner thigh it is and when you feel it the most (uphill, downhill, or what phase of running).

My first thought though (because of the hills) would be the upper portion of the adductor magnus, but more likely the pectineus, since running the on the numerous hills would increase the  intensity of hip flexion, which you have not trained for. But this would probably only be the case if you felt your fatique on the upper 2/3 of the inner thigh.

It is possible that the situation could also be nervous, as portions of the inner thigh innervated by the obturator nerve may have been fatiqued for various reasons and decreased their firing rate to below what you are used to. (I'm assuming that where you feel the fatique is the inner thigh, on the lower half, but still above the knee- since you believe it to be vastus medialis. Otherwise it may be femoral).

In any case, you would probably benefit by incorporating a few more hills into your workouts and doing some work on a thigh master or stretch bands. Most runners have strong quads/hamstrings due to the forward motion of running, but fail to strengthen the inner and outer portions of the leg on a focused and consistent basis.

Also, Dr. Hunter at BYU recently did a study looking at the differences in stride length while running uphill. From my memory, I believe they found that runners almost automatically fall into their optimal stride length while running uphill. I'd have to find it to give you more details though. But still an interesting note since we are talking about hill running and fatique.

[Sasha Pachev]

Josse:

Thanks for the suggestions. I tried the cross fiber friction according to how you described it and it discovered some deep soreness inside the muscle, which I suppose is good. I did have a great run today both in terms of speed and biomechanical efficiency perception, not sure if it was just finally recovering from the marathon and the micro-cold, or if the cross fiber friction has something to do with it. I also did a drill yesterday to practice keeping my legs parallel with the torso while lifting up my knees.

Adam:

The pain was in a big muscle on the medial side of the quad right next to the knee. I see on the anatomy charts that only vastus medialis is big enough near the knee , and is shaped the right way to correspond to the pain. Also, the standard quad stretch (heel to the buttock) immediately alleviated the pain from not being able to squat and difficulty walking up or down the stairs to being able to run.

Interestingly enough, although probably unrelated, I do have chronic tension in some muscle or muscle group in the upper portion of the inner right thigh, though. Probably some adductor,  as I feel it when abducting the right hip. I also have a lateral bend of the lower spine which is (from X-rays taken on the same day) more pronounced when sitting down than when standing up. My friend, who teaches PT at the University of Nevada, suggested that possibly the cause of that is the asymmetry in the hip bone. I have not been motivated enough to get a test done to see if this is actually the case, but if somebody can do it for free or a low price (under $30), I would be interested.  Another detail to point in that direction - I am much more comfortable laying on my left side on a hard floor than on my right.

Probably connected with that, I do have a snap when extending the knee of what a chiropractor once identified as semi-tendonisis/semi-membranosis attachment tendon near the knee - it happens only on the right side as well. I used to have a TFL snap against the greater trochanter on hip flexion as well (on the right), but it recently disappeared.   May be correlated with the use of the inversion table for the last 4 months.

Very interesting study from Dr. Hunter - I'd be curious to see the details.

Question - assuming I do indeed have a hip bone asymmetry. Between the ages of 12 and 14 I did a lot of track work (sometimes as often as 4 times a week) on an indoor track with a very short curve that was very highly banked. Could that be the cause? I know that when you are a kid your bones are not fully fused, but once you reach maturity they are. How fully are they fused, and is there anything that can be done to reverse bone asymmetry that is developed rather than genetic?

[adam]

Sasha,

Hip asymetery can be corrected, depending on the severity. One thing that is always asked is whether or not you keep a wallet in your back pocket. Changing that habit helps alot. I'll take a look and see what else can be done. For the most part, things can be improved through exercises- I doubt you would need something drastic.

I couldn't find an abstract on that study, I believe it is still in preparation for publication, but here is a news release on it:

"Earlier studies performed at BYU have found that competitive runners fall into a natural, economical stride when running on level ground. Nasson and her research partners wanted to find out if runners take the most economical stride when running uphill-not lengthening or shortening their stride too much while maintaining adequate oxygen intake to get over the hill and have enough left over to keep running.

Nasson, Hunter and others studied the running stride of 13 female cross-country athletes, comparing their steps with the beat of a metronome and measuring their oxygen intake, among other evaluations. The women first ran on a level surface, then on a six percent upgrade.

We found that athletes do fall into their natural stride length while running uphill, says Nasson. She also notes that the experienced runners can take up a natural stride without much difficulty, saving time and breath. Novice runners, on the other hand, usually have to learn to adjust their stride and oxygen intake during ascents. A natural rhythm, she says, comes with time and experience."