Posting because this might help someone else down the road. July 20th sustained a bad VMO strain on the final climb of a 10K vertical day. Mis-dx by numerous “professionals” as meniscus, plica, nerve entrapment, PFS, the list goes on. 10 days of no bike, unable to go upstairs without knee collapsing in pain. MRI and ultrasound revealed nothing - all clear. Somehow got back on the bike and sorta kept training and finished LOTOJA. A modern miracle. Post race totally unable to climb stairs without dropping to the floor in pain. Post-race started regular PT, Graston, foam roller, etc. Doing tons of leg lifts, bands, wall sits and balancing exercises. Months of this and no real results, still climbing stairs like grandpa.
Pain would come and go daily over past several months and never really go away. Sometimes VMO was very sore to touch. Last week, I got fed up and decided to throw out the PT work and go brute force and use weights in the gym, step-ups, etc. With my limited knowledge of physiology I figured that mimicking the exact movement pattern of a pedal stroke or climbing stairs would be worth a try. So I started started doing two things - Step-Ups and Leg Extensions. First few sets were a little uncomfortable, but I pressed on and literally used the “no pain no gain” approach. Just 3 days of doing Step-Ups and Leg Extensions went from a 7 down to a 1 on the pain scale. I’ve never experienced a turn around like this with an injury. And 10 days later I can say that about all I feel now is a little tightness in the quads.
Theory #1 - There was a ton of scar tissue bound up in the VMO that could only be released by working it real hard. The hard work and weight stress released the muscle fibers from the scar tissue.
Theory #2 - The PT exercises (while seemingly hard) were way too easy and lacked the real functional movement or strengthening to rehab the tissue.
Probably a combo of both. I write this to hopefully help others who might be dealing with these issues.