I have recently moved from San Francisco to Basel for a treatment of a hamstring pull. Or more specifically, a pull of my right semimembranosus muscle that is part of a hamstring group of muscles. I wrote the move in my previous post.
To recap: semimembranosus injuries are rare and my pull is in the lower part of the muscle which is even more rare. I’m 2 years into this injury and I haven’t recovered despite a really dedicated commitment to physical therapy. Normally, muscle pulls take 2–3 months of physical therapy to treat but my injury wants to stand out.
I couldn’t find much of information on chronic semimembronosus pull on the internet so I decided to chronicle my latest attempt at physical therapy. I’m taking fairly detailed daily notes on everything recovery related: therapy sessions, training and “pain logs”. I’m three weeks into physical therapy at Rennbahnklinik and I’m planning to publish my notes weekly. I’m playing the catchup game now.
Convincing myself to publish notes weekly was a bit of a drag. I would rather write about something else than struggles with a recovery. But sometimes there’s no other way than to play the hand one is dealt.
The first week had a theme of planning and bootstrapping the treatment.
On Monday (May 28th) I learned my schedule: physical therapy everyday plus training almost every other day. I will have two physical therapist taking care of me: Fabienne and Tanya. Fabienne is my main therapist and Tanya is a supporting one. Tanya specializes in dry needling that I will have done once per week on Wednesdays. The prospect of having needles inserted into my muscles every week doesn’t excite me.
Tuesday was the day full of diagnostics. We used Vicon motion capture system of 8 cameras for high-precision biomechanical analysis of my running and biking. I brought my bike from California for both testing and training. The the motion capture looked like this:
The treadmill I was running on was monitoring my stride and weight distribution throughout my both feet via surprisingly accurate pressure-sensing. Viacon provides software that combines readings from motion capture and from the treadmill to produce an unified image of one’s biomechanics. I learned that this is one of the most precise and best systems in the world.
The same day we performed biking analysis that looked like this:
We were interested in recording the motion/position of my pelvic, hips, quads, knees, ankles, foot and spine. You can see the points of interest in the picture by spotting where markers are placed.
Overall, we spent almost four hours preparing me for the analysis and on the actual recording. During recording, we spotted that my pelvic position is not great on the bike. I’ll need to wait for the detailed results of analysis until early next week, though.
I was really fascinated by the technology aspect of my biomechanical testing so I asked a ton of questions. Including, “how much all of this equipment cost”. “A lot, even for Swiss standard” — I’ve heard. And I kept thinking if modern computer vision could make high-precision biomechanical testing cheaper.
On Wednesday, I have met with Tanya for the first dry needling session. Did I mention that I was not excited about inserting needles into my leg? On a way to the clinic I recited to myself my past experiences: the nearly fatal accident, several surgeries, trips on drugs in a hospital and over 250 physical therapy sessions and several dozen dentist visits. And right that minute, needles sounded like a great way to start my day.
It was the first time I had dry needling therapy done and it worked for me really well. The basic idea is to insert needles at strategic points in muscles and trigger them to release their tension. The sensation you get once you hit the right spot is a swift muscle contraction followed by a release. It feels almost like a local electric shock.
As a form of distraction, we chatted with Tanya about my injury. “It’s a fascinating puzzle for us, you know” — I’ve heard at some point during our conversation. And I thought to myself that this is the best thing I could hear that day. It was a direct confirmation that I’m in hands of inquisitive sports medicine nerds.
The same day I found a local biking club called VC Peleton and I decided to join them for the afternoon “easy” ride they do on Wednesdays. We met by sports stadium and set off in the direction of Gempen — a locally well-known hill outside of Basel. As we approached it, I realized I will get to see the view from the top another time. The climb we were headed to normally would be a piece of cake but dry needling is incompatible with anything more muscle-demanding than riding flat at an easy pace. At the beginning of ascent, I waved at twenty-something group of bikers and turned around.
On Thursday, I briefly chatted with Fabienne about my muscle tension after dry needling (it was better) and we did a lot of manual therapy (massage). We also chatted about my previous physical therapy and my struggles with muscle pain and tigthness I experienced over the last couple of months. Overall, it was an easy session and I felt relaxed enough to go for a exploratory/warmup ride in the afternoon. I cycled to a little town called Liestal and back to Basel, covering an easy 43km loop.
On Friday, we did more of manual therapy and tension release. Fabienne told me that I will need to work on core/pelvic stability and we went on to core muscle strength training. We also discussed my “exponential ramp-up” training plan that I used in my previous recovery. We decided to come back to it next week. I had a break from biking that day.
On Saturday, I felt ready for a longer training. I did 74km loop with 1500m of elevation gain. I did claim Gempen and it was offered a great view:
The feeling you get from a climb up celebrated with a view like that is why I moved across the world to fix my injury. Doing even occasional rides like this is how I recharge.
Somewhere deep in the country side, I spotted a barn covered with solar panels.
A perfect reminder I was crossing Swiss countryside.
Sunday was a day of rest and optimism for the second week of physical therapy; the plan is to be much more intense.