Recovery from hamstring pull: week 5

I’m writing and publishing my (rather raw) notes on hamstring pull recovery. I hope by taking detailed notes I can swing my own recovery towards success. And I hope the techniques, thinking patterns and simply the story might inspire others battling against chronic physical injuries.

Notes from previous weeks: week 1, week 2, week 3, week 4.

I’d like to take a moment and reflect on the broader picture of my recovery. It’s not looking good. At the beginning of the fifth week of my recovery, an unsettling realization sunk in: I need to throw my ambitious recovery plan of the window. I moved to Basel with a believable ambition to fix my semimembranosus muscle pull and up my bike training regime. In week 2 I discussed this chart with Fabienne:

The idea was: I wanted to get to the level of being able to bike 200km a day. The starting point for my training would be 100km, and we would bump the intensity (distance in this case) of my training by 7.1% a week. Over the course of three months, the compounding growth would get me to 200km. Why this goal? I secretly dreamed of participating in Heute Route, one of the toughest endurance races in the world and a breath-taking experience. This bike race has been on my mind for four years now. It was when I could barely walk after knee surgery, and I had a “walking budget” of 1km per day. The thought of participating in this race has served as a North Star throughout all of my recovery. It would be a mark of an undeniable win over a devastating injury if I ever participated.

Fixing my semimembranosus muscle problem this summer was practicality; Heute Route was why I was willing to sustain any amount of pain or training fatigue. Getting me trained for that race was how I convinced people at Rennbahnklinik that I’m serious about my recovery and worthy of a world-class sports clinic. Sadly, I’m ready to talk about this secret goal because it’s getting shelved. The chart I drew will remain an inspiration, long passed by pages of physical therapy notes in my Moleskine notebook.

The fifth week into my recovery, it’s fair to say that my problem is far more baffling than originally anticipated, and it already had a high score on the difficulty scale. Only once I started doing physical therapy full-time and had enough spare room in my day to dive into my issues, I appreciated the full complexity of the injury. The most puzzling problem is my muscle tension that spreads across the whole thigh and is not limited to my original semimembranosus pull. An analysis of how my body learned to compensate for muscle misalignments and an attempt at fixing them revealed how fragile my condition is. My recent trip to Zurich showed that I plummeted from biking 100km to pretty much zero due to muscle tension kicking in the very first few kilometers of a ride.

We don’t understand how and why the tension builds up. There’s no regularity or pattern to the phenomena. That’s why I decided to look for more ideas and followed my friend Mathieu Spencer’s recommendation to reach out to JP Meersseman. Meersseman is a notable chiropractor that has been deeply involved in sports medicine for soccer players as a cofounder of Milan Lab. He is known for unorthodox methods and unconventional results.

Week 5

Monday (June 25th, 2018). I started off the week by taking a train to Como, a small Italian city known for its beautiful scenery: a pleasing blend of Lake Como view and surrounding hills. That’s where Meersseman has its office. My visit consisted of three parts: a general admission interview, a posture and gait examination, and an appointment with JP Meersseman.

The posture examination was done with video raster stereography. I had a series of photographs taken of my back with strips of light projected over my body serving as reference lines. The photographs are then processed on a computer using a technique inspired by photogrammetry, a science of making contour maps. It’s pretty cool to see a transfer from topography to the body’s posture measurements, and if you think about it, it makes sense!

One of the pages of the report produced looks like this:

The key findings are highlighted in the report, and one is the most striking: I have a notable pelvic rotation. Pelvic rotation means rotation along the axis parallel to the spine. Imagine grabbing someone from behind by their hips and then pushing one side to the front and pulling another side to the back. You would get the pelvic rotation that I have, except for me, it emerges without any external force: I was standing in a relaxed, straight position, or that’s what I thought.

When Meersseman saw the results and looked at my posture, he instantly ruled out one possibility: my legs are of different length, hence causing the rotation. More strikingly, and to my skepticism, he claimed that muscle imbalances causing pelvic rotation have the source in my jaw. Meersseman’s theory: my broken Temporomandibular joint (the jaw joint) from my ski accident five years ago is causing problems with my hamstring by inducing muscle tension, resulting in a rotated pelvic. What’s even more fascinating is this: the rotated pelvic causes other body parts to compensate, e.g., back muscles are compensating, causing mild scoliosis. In turn, it puts more pressure on my neck and eventually jaw muscles. So we get this closed feedback loop spanning a large section of my body.

I was rather skeptical of Meersseman’s claim of jaw/hamstring connection because we just met for the first time and maybe spent 5 minutes talking to each other. Meersseman put pieces of something that looked like simple earplugs into various spots in my mouth and asked me to bite them. It was an experiment in repositioning my jaw and changing the muscle forces’ structure applied in this area. We then reexamined my posture and found an improvement in my pelvic’s position, and my scoliosis was less marked. It wasn’t a dramatic change, but it was a visible change. I was genuinely astonished by this.

We then talked more about my history of injuries and ran out of the thirty minutes we had scheduled. Meersseman said my case is complicated, and he has to think about whether he can help me. We’re supposed to talk in a week.

I got on a train back to Basel with a new clue: jaw/neck tension and position contribute to my pelvic position and might be messing up any attempt at recovery of my muscles in the leg. It was a bit of a stretch of a theory, but the finding of pelvic rotation was undeniable and somewhat surprising on its own. At Rennbahn, we looked for pelvic misalignment but only during dynamic exercises.

There’s one more thing to mention: while researching Meersseman’s background, I found via Google Books a mention of his name in Play On: The New Science of Elite Performance at Any Age by Jeff Bercovici (based in Oakland, CA). Conveniently, it came out this May, so I ordered it on the spot. While on a train to Como, I started reading this book to understand better the latest advancements in how elite athletes are treated and borrow some ideas. I also wrote Jeff a short note that I’m going to see Meersseman and asked some questions that I felt the book itself might not have answers to. He responded the same day, which I found really cool! A note to myself: email book authors more often.

Tuesday, we discussed with Fabienne the results of my trip to Como. She was intrigued. We discussed the connection between the jaw and pelvic position, and she didn’t find it flat-out implausible. Quite contrary, she said she has heard of this phenomenon before. For PT, Fabienne did massage my back to release muscle tension, focusing on the trapezius muscle. It was extremely tight, so the massage was difficult. I was sore the whole day afterward.

Wednesday. Started off with a 500m swim and went for 2h PT. We focused with Fabienne on neck/jaw muscles massage, and she showed me some home exercises for “small” neck muscles. I learned a bit of neck anatomy as a side effect, and I was amazed at how complex the muscular structure is around the jaw and throat.

We did “sinking into fingers” during neck massage, which triggered an unexpected reaction: the skin over my right quad became numb. I discovered this by accident and got spooked due to numbness being strong. It went away after a few minutes, but Fabienne took a note. It is significant.

Thursday, I had the first physical therapy session with Luca, who specializes more in the intersection of physical therapy and dealing with neurological issues. Our first session discussed three systems: physical (muscular), visual, and inner ear. We briefly covered how they work together and moved onto diagnostics. We discovered that my tactile sense is uneven between the two sides of my back, with the spine being the dividing line. We concluded with some pelvic position adjustments.

Later that day, my right side of the back was stiff and hurting. The whole right thigh was tight — tightness level: 6/10.

I started rereading Ben Horowitz’s book The Hard Thing About Hard Things. Despite being a business book, it has many excellent ideas on structuring your thoughts on complex recovery if you look at it from the right angle (long-running march against the odds).

Friday. I had to drag myself off the bed due to muscle tension and pain. For PT, Tanya did jaw muscle massage and hamstring massage. I felt better. After PT, I went for a 500m swim that felt good, and I had a good time (19:16).

Saturday. I woke up with tension around my leg, above the knee. I had less adductor tension/pain. I went for a 500m swim, but overall I was low on energy.

Sunday. It is the day off from training for me. I picked up Why We Sleep by Matthew Walker and found it interesting. I haven’t done much research/reading on sleep before.

Proponent of dense representations. Previously: @stripe , hobo, #scala at @lightbend .