T Nation

Repeated Muscle Tears

So, in 2016 i got a grade 1 (small) tear in my left quad and right glute, but with rest and rehab i was able to return in about 4 months. Anyways, in october i was forced to 6 weeks of my training because of covid and when i returned i was a fool and didn’t gradually work my way back in to it, so in early december i tore both of these again and since then i haven’t been able to train my legs because they have gone up twice since, so a total of 4 times since 2016, and not from training, but normal daily movements.

So is my training career over? I mean, everytime that they get reinjured the risk for it happening again greatly increases, and both these muscles are impossible to completely rest/deload since i can’t lie home in bed for 3-4 weeks and then not being able to pick things up from the ground, sit down etc for another 6-8 weeks, because those are the movements that drags out the recovery time and prevents them for healing/staying whole, so i don’t even get to the rehabilitation training before they go up again.

So i’m curious, have anyone else here had a small strain/tear that has gone up 2+ times and been able to return? This sucks so much, 9 years of gains going away because of two ****ty grade 1 tears…

Do you mean this literally, ie, as in ‘There are no leg-training movements I can do in a manner that would generate a training response’? Or do you really mean 'I haven’t been able to train my legs using the exercises and in the manner I am accustomed to doing’?

Well i have been able to do leg extensions for my right quad, leg curls, calves and adductions, but i can’t do anything else because of the lef quad and right glute tear. So my left quad is about 50% gone, same with the gluteus…

Why did you have such a long lay-off? Standard return from a Gr1 muscle pull is 2-4 weeks.

Were the other pulls Gr1 or higher?

The first month it didn’t get enough rest because of my daily life, so i went to a physio and we rehabilitated it for 10 weeks, which is a normal time for grade 1 tears. Heck, as you can see in the paper below from Järvinen et al. 2005 it takes 3 weeks just for the interlacing myofibers to be fused with the intervening connective tissue. So if a person goes back to lifting in 2-4 weeks that will without a doubt rerupture (talking from ALOT of experience with grade 1 tears here).

I think we might be miscommunicating here.

By most models I’ve seen:

  • Gr 1: No muscular damage, no loss of strength. RTP 1-4 weeks
  • Gr 2: Mild to moderate muscular damage, loss of strength. RTP 3-6 weeks
  • Gr 3: Complete muscular tear, severe loss of strength. RTP 6-12 weeks

Do you think what I’m referring to as a grade 3 is what you’re referring to as grade 1? In which case, I apologise for the miscommunication.

The answer is definitely no. What has your rehab plan looked like post-injury?

I’ve torn my R hamstring twice and my R hip flexor once, plus various strains and pains etc associated with playing rugby. While I don’t play any more (not due to injury, because I’m not a very good athlete :laughing:) I still lift, run, jump and sprint every week without injury.

I currently work as a rehabilitation coordinator for a rugby team and regularly return athletes with muscle strains/tears (mostly hamstrings and quads) to function. As such, I can assure you that it is possible to return, if you can take the right steps.

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No muscular damage in a grade 1 tear? A grade 1 tear is when <5% of the muscle fibers are damaged, so it’s very much a tear. And those models are way wrong. If you get a grade 3 tear it’s surgery and 6+ months of rehab, it’s not even certain that one can return to lifting after that, or not at the same level. I’ve had more grade 1 tears than i dare to admit, and it’s always taken atleast 10-12 weeks with rest and rehab before being able to train with moderate loads and volume. But it’s different with other sports that doesn’t load the muscles as much. But lifting weights is a whole other thing that requires a longer rehab before being able to train as before the injury.

I’m not here to argue with you mate, I’m just trying to make sure we’re on the same page.

The timelines I posted above are correct, as any sports medicine textbook would attest. May I ask who told you about those rehab time frames?

Yeah, me neither mate, and i appreciate you taking the time to answer, i just got a bit chocked by those numbers, because with my body they’re far from accurate. It’s like a 99% chance that i will reinjure it if i try going back to weights as light as 12-15 RM before 10 weeks with initial rest and then rehab training were the form of resistance (isometric, dynamic etc) and load is gradually and slowly increased. The times i haven’t done this it’s always resulted in a retear.

This is also the regime that my physiotherapist is using (met him a couple of days before making tgis thread), and he has 28 years in the field and have worked with many elite athletes here in Sweden.

And as you see in the paper i posted the scar tissue isn’t attached with the surrounding tissue before 3 weeks, and at that point it’s still very weak and making it strong enough to withstand loads above 60% and beeing able to take sets close to failure isn’t done in a few weeks. Heck, the remodelling phase is ongoing for 6+ months, and during this the risk of reinjury is pretty high. Also, a grade 3 tear is when the entire muscle is off, there’s no coming back from that in 3 months. A mate of mine got a grade 2 in his groin last year, and with the help of a pt it took him 5 months to be able to squat at 80% weights again.

I’m curious though, say that you got a grade 1 tear in your triceps long head that hurt when stretched or loaded, how would that rehab regimen look like to be able to return to lifting in only 5-6 weeks (step by step with exercises, load etc)?

This is all completely correct, but doesn’t actually mean you can’t be at near full function more quickly than you may expect.

If we’re talking about grade 1 tears, we’ve got to remember that there is still 90-99% of the muscle tissue still remaining, which can easily manage tensile loads around the injury site. This is called stress shielding. I’m also not saying that you should return to full training straight away, but there are progression strategies I’ll write down below that explain how to do this.

You are, however, absolutely correct that injury risk is elevated for about 24 weeks following a muscle injury, and risk increases with every prior injury.

Moreover, muscle tissue has more cells and less matrix than other structures such as bone and ligament, and because it is highly vascularised. Therefore, muscle’s repair rates are far faster than other tissues. The time frames you’ve mentioned would be more appropriate for ligament injuries such as the ACL or UCL.

In addition, it is extremely important to load a muscle early. A healthy muscle’s collagen has a high degree of alignment, whereas an unhealthy muscle’s collagen is disarranged. If the injury site is allowed to repair in the absence of mechanical loading, the new collagen will not be nicely aligned, leaving the injury site more prone to injury. Additionally, prolonged deloading of the muscle will lead to collagen throughout the muscle to becoming increasingly disorganised. Furthermore, early loading promotes vascularisation of the muscle tissue, which supports the repair process.

Other reasons to load the muscle early include faster time to return, faster reclamation of strength and better ROM due to reduced muscle shortening following injury.

I’m not going to write it out with load and sets/reps because that is highly dependent on the individual I’m working with, but there are phases.

Phase 1: Modify other training as necessary, light direct loading for triceps.

  • For the triceps, use an exercise that does not bring the muscle to a full stretch and is not most challenging in the lengthened position. Rope pushdowns or kickbacks would work well here. Hit them 2-3 times per week with 5-10 sets total per week, using relatively light loads (15-25RM). RPE 7 or less, unless pain free. If very irritable, use 30-45s isometrics as opposed to normal reps
  • Modifications to other training would probably involve minimising vertical push/pulls and reducing absolute load on compound pushing. To get around the load reduction, utilise pre-exhausts and slow Tempo training to make light weights more challenging.
  • Once pain is less than 2/10 during training progress to phase 2. Should be about one week

Phase 2: begin loading into a more stretched position.

  • Elbows-out triceps extensions or decline skullcrushers would be good here. Similar loading parameters as before
  • Begin moving into more overhead range with pushes and pulls, for example using incline Bench. Begin loading slightly heavier, perhaps sticking to sets 8-12
  • From here, just increase load over 2-4 sessions.

Phase 3: more or less normal

  • return to loading the triceps at end ranges. Skull crushers and PJR pullovers work well. Start with lighter loads of around 15-20RM, then move to work 8-12RM over 2-6 sessions.
  • return to vertical push and pulls, return to normal loading for compounds.

So the main principles when dealing with muscle injuries are:

  • load early, but do not load the stretch
  • load early, but do not load maximally
  • Maintain load in non-injured muscles by whatever means necessary
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Thank you very much for taking the time to write that! is it ok to feel some pain and stiffness? Even when not loading it? Because i did 3x30 partial band pushdowns (like a 60-70 RM resistence) a couple of days ago and since then i got the tight and uncomfortable feeling in the area back that i had the first 4-5 days after the injury 3 weeks ago. It barely hurt during the pushdowns though, just a very vague pain the first reps. Now i’m to scared to continue because this feeling must be a warning sign, or that’s how i interpret it, it feels like it’s on the edge of breaking up. So i really don’t see how one can start using 15-25 RM weights with an RPE 7 so early on without messing it up even more, tbh i’ve never heard of it before and it doesn’t seem to work with my body =(

But do you have some time estimations on the phases? Like phase one 3 weeks, phase 2 3 weeks etc? And during the first week i should completely rest it right? And shouldn’t i do like a couple of weeks with very light loads (circulation training) before going on 20-25 rm concentric loads?

And yes, the mistake i’ve done is to rest too long, which probably is why they keep getting reinjured, but i can’t do it as fast as you say either, so i quess i will have to find a middle ground. Anyways, do you believe that i can come back from the ones that has gone up 3 times if i’m real careful with the progression and staying away from high volumes and loads (<8RM) in the future or am i bound to regularly reinjure these for the rest of my life (chronic)?