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I saw an RMT and ended up in the ER
Not how these things usually go... Here is what happened late March and my recovery since.
But before I share all the details, we can’t forget the bike of the week feature, so lets start with that, and then get back to my injury story.
Enve Mellee - DNA Pro Cycling
Bike of the Week - 5th Edition - MAKE IT SPICY 🌶️🔥. This week, we have an Enve Melee for a DNA pro cycling women’s team rider 🩷.
Hit the button for all the details and photos, then don’t forget to come back here.
Went to see an RMT, ended up in the ER
Registered Massage Therapists (RMT’s) are great. I used to see one for treatment weekly when I was racing, I still get treatment when needed and recommend the athletes I work with get treatment from RMT’s regularly, and/or as needed. I just want that here right off the bat before I get into this, because this is not about RMT’s, it’s about a specific experience I had recently, which is thankfully uncommon.
Why am I sharing this here?
When I left the hospital, I posted a quick story on Instagram sharing the basics of what happened and I was surprised (and disappointed) by the number of messages I got from people with similar stories. I am mostly sharing for a very simple reason - A lot of people have been asking what happened, how I am managing and how I am recovering and it is a lot easier to simply share the link to this post with them. Also, injuries suck and recovering from an injury can feel a bit lonely… So if that is you reading this, know that regardless of the severity of your injury, you’re not alone and things get better with time.
Before
On Thursday, March 21st I noticed a bit of tightness around my hip (right side) during the day. I think it was tightness after a strength workout the day before. It was nothing serious, my right hip does get a bit tight from time to time (usually comes from my right foot. It’s a long story) and I just do my little self care rolling routine and it goes away within a day or two. I went on a short and easy 35km ride that evening, which felt completely fine (other than the annoying annual flat on Marine drive) and of note, my power was my typical 50/50 left/right, so the tightness didn’t seem to affect how I was riding.
I decided to schedule an appointment with an RMT. You know, to be proactive and stuff. My regular RMT moved to the island a while back and I haven’t found anyone else, so I thought it could be a great opportunity to find someone new. I am also always on the lookout for other professionals I can refer the athletes I work with to, and what better way to see if someone is worth sending referrals to than scheduling an appointment with them myself. There is a relatively new clinic close by and one of their therapists had an opening the following evening so I booked it.
During
The treatment itself wasn’t bad at all. The therapist was nice and we chatted most of the time. Nothing seemed out of the ordinary, although he did apply quite a lot of pressure (For better or worse, I have a very high pain tolerance). I asked him to go lighter on my right leg, but he did dig pretty deep into my hip flexors. He also did traction at the end of the session (pulling my legs while they were crossed). I felt fine afterwards and went on my way.
After
I went home, made some dinner and curled on the couch to watch a movie. After a while, when I got up, my right leg felt weird, almost weak, which was a bit unsettling. I went to work as usual on Saturday and my leg soreness got progressively worse, and there was swelling, to the point that I was concerned enough to drive by the emergency room on my way home. They mostly dismissed me without proper examination after giving me pain meds and said to come back in a week if it stayed the same. At that point, I had a noticeable limp and my leg felt both weak and sore at the same time.
On Sunday morning, I woke up and basically fell to the floor when I tried standing up - My right leg felt like it had nothing in it, the pain was excruciating and all I could do was crawl with 10/10 pain levels. I called 911 and a few hours later I got wheeled out of my apartment building in a stretcher and taken to the ER, where I sat in a wheelchair waiting to be seen for about 4 hours. Luckily my friend Heather came by (with coffee) and stayed with me until I was discharged after a total of 7+ hours.
They did x-rays to rule out an evulsion fracture and gave me 4 trigger point injections with lidocaine (a local anesthetic) - two in the rectus femoris and two in my glute. It was very painful, but not as painful as the pain I was already in as it is. Either way, 0/10 do not recommend. I was semi lying on the bed (I couldn’t straighten my leg while lying down) and my right leg was basically useless. I couldn’t lift it even a tiny bit off the bed without using my hands to do so. The lidocaine injections did help a bit, as well as the pain meds, so I managed to limp out of the hospital very, very slowly.
The following day, everything was worse than the previous evening, but not as bad as the previous morning. I had to call my 9am appointment to postpone because I wasn’t sure how I will be able to get to my office and then move around my office… I was pretty determined to work as usual, so a friend got me a stool with wheels, then picked me up and dropped me (and my stool) at my office, and came back that evening to take me home. I was in pain, and I had to stay seated the entire time, but I managed to wheel myself around and get the job done.
I used my stool to wheel myself around my studio and the office building, as well the rotating platform the trainer and bike are on to make sure nothing was missed during appointments and the riders who came in helped get their bikes on and off the trainer (it was great practice for some of them). Having someone in front of me helped a lot with the pain, so I was okay while I was in the studio, but when I was home or when I had to do any work that did not involve direct communication with someone in front of me, the pain was too much and I could not focus on anything (which is why I am now playing catch up on a lot of things).
I was sort of okay when seated, so I could drive and then sit while working, with the biggest challenge getting myself to and from my car from my condo. Thankfully grocery delivery is a thing, and I hired help for cleaning, laundry, etc, because I couldn’t do much. I managed to cook while sitting on a bar stool.
Sleep was affected for over two weeks and actually got progressively worse. At one point, I had to sleep on my couch - I could only tolerate being on my back leaning against a big pillow, with my legs at a 90 degree angle with a stack of pillows underneath. I tired recreating that in my bed, but the couch worked better because it did not allow me to move, so that is where I slept for about 4 nights. You gotta do what you gotta do.
After 4 days or so, I started noticing numbness around the medial side of my knee, which lasted for close to 3 weeks. For ~3 weeks, I also couldn’t walk - I was limping with my back basically at a 90 degree angle, leaning against a wall or anything I could grab on for support. I had to get off my feet within a few minutes - I just could not keep my leg straight, even when there was no load on it. Things started getting a bit better and after 3.5 weeks - I was still limping, but could get around a bit better and I could stand up a bit straighter. It took 4 weeks to be able to stand straight, 5 weeks for my limp to go away, and at almost 6 weeks later, I still have trouble going up and down stairs.
So, what actually happened?
The whole thing had me worried, but when I started noticing numbness at the medial side (inside) of my right knee, I emailed a sports doctor I’ve known for years and she assessed me a week after my ER visit. Luckily, I know the right people!
There was no reflex response in my right knee and I could not complete some of the assessment due to pain and lack of ability to move. I got a referral for an EMG, which was done 2 weeks after the assessment (3 weeks post injury). By that point, I was able to stand up a little bit straighter and while the numbness was not completely gone, it was a lot better. The results showed no damage from the nerve root (the spine) and the neurologist suspected a nerve stretch injury or something similar that affected the femoral nerve, as all the signs and symptoms point to a nerve injury, as well as substantial issues with the hip flexor muscles (psoas, iliacus, rectus femoris and sartorius).
I started physio treatment 10 days after the RMT session and at that point, lifting my leg a tiny bit off the ground was a huge, painful and very frustrating task.
The initial swelling subsided after a few weeks, at which point I measured my legs - I lost 2 cm in diameter on my right leg compared with my left in 3.5 weeks (yes, they were the same size before). Almost 6 weeks later, the pain is mostly gone, but there is still some discomfort and my right leg still feels weak and tight. My rectus femoris has been feeling like it is a rod in the middle of my leg and the whole leg just feels different in general, and not in a good way.
My return to play plan
I am sharing this because as a coach, I helped a lot f athletes get back to it after injury and now it is time for me to practice what I preach, so I am sharing in the hope that it might help someone else in one way or another. I am also sharing all my little rides and rehab exercises on Strava, as a way to lead by example, or something like that (if your physio gives you exercises to do, do them, okay?).
Physiotherapy
I started basic rehab exercises during my first physiotherapy treatment after 10 days and have been consistent with doing everything as prescribed, 3-5 times a week. The duration varies between 10 to 30 minutes to this point. It started with very basic things (like lifting my leg off the ground, which was very challenging) and I have now progressed to slightly more advanced exercises, including what I call ‘baby plyometrics’, because I am only able to do very small hops (two legs) and can not hop on my right leg at all (yet). The leg is still sore to the touch and I can only tolerate minor manual work on that leg, but I hope that will change soon.
Walking / Stairs
For several weeks, I could only ‘walk’ completely bent over, basically dragging my right leg and 50m was a huge task. 2 weeks in I limped to a nearby coffee shop and it took me over 6 minutes to walk 200m (I timed it because I was curious). After 5 weeks, my limp went away and now at almost 6 weeks, I am okay walking, but can still feel mild discomfort in my right leg and I still have trouble going up and down stairs. I can not walk as fast as I used to because if feels like my leg is giving in a bit when I do. I am forcing myself to go up and down stairs more often without using the railing for balance and I am trying to get my leg to be able to push off properly going up and have a bit more control going down. It feels ridiculous having to think this through, but here we are.
On the bike
I got back on the bike after 2 weeks, on a Saturday. I started with 10 minutes, using flat pedals on the Kickr bike in my office (so I could modify the position a bit).
The following week (lets call it week One) I rode three times for a total time of 42 minutes, all at very low watts.
On week two, I rode 4 times a week, for a total time of 86 minutes at low watts. Started looking at left and right balance on the power meter and it was mostly 56/44 L/R, which is not horrible (I'm usually at 50/50 or 51/49).
On week three, I rode 5 times a week, for a total of 2 hours and 43 minutes. Still low watts for the most part, but added short durations with slightly higher watts (still well within my aerobic zone).
On week Four, which is this week, I rode once so far (on Tuesday) and this time, I ventured outside. I rode for 55 minutes and it was slow, keeping the watts low and the route as flat as it gets for Vancouver without just riding the seawall (iykyk). Left and right power was still 54/56 L/R. It was more balanced on slightly higher watts and I felt okay, but that right leg fatigued fairly fast. I plan on riding outside today (Thursday), Friday and Sunday, keeping the rides to 40-60 minutes and the watts low.
I don’t feel the need to modify my bike fit other than adding a small 2mm leg length lift under my right cleat, as a temporary measure while that leg learns how to be a leg again.
I plan on building slowly, frequency first, then gradually adding time, keeping the intensity low until my leg is stronger and less tight.
The mental component
Probably the thing that affected me the most. In the grand scheme of things, I know that this is not a major injury and it could have been far worse if the nerve root was affected. Also, this is obviously not life threatening and it is just a bump on the road. That said, for someone who is fiercely independent, not being able to do basic things like stand for long enough to shower (not to mention wash my hair), get groceries or walk down the hall for weeks was not fun and even less fun when you live alone and kind of need to do things for yourself.
The part that I have been struggling with the most is that I didn’t get injured in a bike crash or accident nor was it an overuse injury. It happened when I tried doing something positive for my health and prevent an injury, so I guess that makes me feel upset and betrayed in a way.
My first ride outside in 5.5 weeks earlier this week felt very sad, to be completely honest. It was great to be outside in the sunshine, but there was a disconnect between my brain saying ‘lets do this’ and my right leg saying ‘nope’. It was also challenging getting on the saddle again after stop signs and traffic lights because I clip out of my left leg, and I almost fell when I first got started and pressed on the right pedal to get on the saddle - I couldn't put the pressure needed on it, which was unsettling. I had to be careful and take it slow getting started again after every stop, which made me a bit nervous (very much out of character for me when I ride), and a bit annoyed overall.
I think it is okay to acknowledge a shitty situation and be a bit grumpy about it, but at the same time know that it is temporary and this too shall pass. Easier said than done, but Im working on it. Today's ride will be a bit better. The ride after that will be a bit better still. I'll probably have setbacks and that is okay because progress is not linear.
The clinic’s response
I won’t get into it too much, but lets just say I was not impressed and felt like they just wanted it to go away. Their response was that I must have had lower back weakness (I never had back issues) and that I didn’t respond well to treatment (No kidding. You think?). Even if that was the case, I would assume a trained professional should have taken that into account and tailor the treatment to suit the situation and individual instead of digging too deep (repeat after me - context is king and nuance is queen).
Their solution was to offer me one physio assessment, which I declined because 1) I don’t know their physio, 2) bias and 3) I need far more than one initial assessment - I had three sessions so far (with a physio of my choice, at a different clinic, obviously) and will need to continue with rehab for a while, so one assessment with a physio I don’t know is not much help, especially if I do not plan on working with that physio for the rest of my rehab. Of note, I have not heard anything from the RMT himself, just from one the clinic owners. I also suggested I come to the clinic and chat with them about all of this, which was ignored.
I have chosen not to share the name of the clinic, at least for now (I might change my mind down the road).
Anyways, we will be back to more fun topics next week! Comments? Questions? Shared experiences? Feel free to comment below.
Noa
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This is a condition called neurapraxia of which there are two types: axonotmesis and neurotmesis.
You really only learn which is which by the rate of recovery; neurotmesis takes about 12 weeks to recover while axonotmesis can recover much quicker, sometimes in days to weeks.
Excessive lengthening of the connective tissue, which you see with overstretching, especially of the sciatic nerve, can also occur.
Massage therapists have been known to tear the long thoracic nerve with vigorous or aggressive scapular mobilization.
The long thoracic nerve is a pure motor nerve and, since there is no or only mild pain, the serratus anterior muscle will go flaccid with minimal symptoms.
Another injury that occurs in massage therapy clinics, especially with “deep massage” (which is, IMO, dangerous, unnecessary and traumatic) is damage to the deep venous structures of the soleus and gastrocnemius soft tissues.
This can result in Deep Vein Thrombosis, embolus formation, pulmonary edema and death.
These events can happen in a physical therapy clinic.
The incidence is rare, but it does happen.
I'm sorry to hear about your experience, Noa. It sounds like you went through a really tough time. I hope you're feeling better now and that your recovery continues smoothly. It's frustrating when a positive step like seeking preventative treatment ends up causing more harm than good. Your story serves as a reminder that sometimes things don't go as planned, but it's important to stay resilient and keep moving forward. Thank you for sharing your journey with us, and I wish you all the best as you continue your recovery.