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1175 Views 3 Replies Latest reply: Apr 12, 2011 5:00 AM by Damien Howell
Finnatic Amateur 11 posts since
Mar 20, 2011
Currently Being Moderated

Apr 9, 2011 10:28 PM

Who should I call?

I seem to have a hamstring injury that is not being healed with conventional RICE method. I've been dealing with this now for about 3 weeks, besides the fact that it was almost healed then I ran a half marathon.

 

I don't really want to call my primary family doctor because I feel like my doc would just give me muscle relaxers or pain med.

 

I want to know if I should see a sports MD or orthopedic MD? What would be the difference between them?

 

I'm sick of this injury and dying to go out and run!!!

 

BTW, I think it's one of the hamstring tendons at the medial aspect of my knee, kind of side/back of knee. I cannot sit on the floor with my leg extended straight, it feels REALLY tight. I can't properly lift up my knee/leg to climb up stairs either.





Completed:

San Luis Obispo Triathlon- July 24, 2005 (2:12)

Oxnard's Santa to the Sea Half Marathon (first running race)-  Dec. 12, 2010 (2:38)

Great Race of Agoura Hills, Pacific Half Marathon-  March 26, 2011 (2:33)

Upcoming:

Ventura City Impact Half Marathon- June 18, 2011

Santa Barbara Semana Nautica 15K- July 4, 2011

  • nikkicarr1 Legend 314 posts since
    Apr 28, 2009
    Currently Being Moderated
    1. Apr 9, 2011 11:12 PM (in response to Finnatic)
    Re: Who should I call?

    I would go with sports medicine md if at all possible they specialize in injuries pertaining to an active lifestyle vs an ortho who may or may not be familiar with proper treatment and road to recovery.  Sports med MD may even be more proactive in modified training to decrease training set backs and PT reccomendations would not only be focused on injury recovery but getting back to running and injury PREVENTION.  Here in Pittsburgh, this time of year up until october, we actually have a sports medicine injury clinic run by the UPMC Sports Med people that treat the Steelers and Pens, look into a program like that with your local hospitals.





    http://www.active.com/donate/PawsoverPittsburgh/nikkicarr

    COMPLETED

    2009: Opperation Troop Appreciation 5k oct 29:44 (first race), Greensburg Turkey Trot 5k nove 31:09

    2010: On Deck for the Cure sprint 1mi 1-4 9:00, Race for Grace 5k 3-20 32:11, Yough River Council 1/2 marathon 4-10 2:16:39 (goal for 1st 1/2 2:25) 3rd in AG, Pittsburgh Komen Race for the Cure 5k 5-9 30:08, Jerry Mahar Jr Parkinsons Awareness 5k 6-5-10 29:28 6th in AG

    Las Vegas Rock N Roll Marathon 12-5 5:01:?? FIRST FULL MARATHON (with calf tear)

    2011: Race for Grace 5k 3-19 30:56, Alpha Fitness 5k 4-9 28:57 8th in AG, Pittsburgh Half Marathon 5-14 2:17:52, 9/11 Heroes Run 5k 9-11 27:34 (PR) 5th in AG, Pittsburgh ZooZilla 5k 10-2 28:03, Greenburg 5k Turkey Trot 11-24 28:35

    NEXT PLANNED EVENT: Race for Grace 5k 3-31-2012, Pittsburgh Marathon 5-6-2012, Great Race 10K 9-30-2012

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    2. Apr 11, 2011 3:03 AM (in response to Finnatic)
    Re: Who should I call?

    Before you spend any money, please check a few more places that can  cause mystery pain where you seem to have it. While some of my posts are  long and exhausting to read, I'm trying in this case to introduce  concepts a little at a time, to make it less overwhelming so it is  easier for you to digest, which may encourage you to troubleshoot your  pain. It's something you'll need to do anyway as you discover setbacks  and injuries through running like the rest of us, lol.

     

    It's  important to think of your muscles grouped into systems. The system we  are looking at here is knee flexion, because it hurts when you stretch  it by straightening your leg. Pain can also be produced in a muscle when  you contract it, but this symptom appears to be more of the passive  kind. Here's a tool again, set for the knee flexors of the lower leg,  also implicated during back-of-knee pain...http://www.getbodysmart.com/ap/muscularsystem/legmuscles/gastrocnemius/tutorial.html Click on stop#14 to view the superimposed muscles.

     

    A faster look without the action (from Gray's via Bartleby.com and Yahoo! Education)...

    http://l.yimg.com/a/i/edu/ref/ga/s/438.jpg

    This  is a rare graphic showing everything involved with knee flexion, and  what is being stretched when you straighten your leg.  As you view the  Semi-tendinosis tendon, upper left, note its proximity to both the  medial upper head of the Gastroc (in cutaway) and the Popliteus muscle  underneath.  Along with the hamstrings, these are the top three muscles  involved with back-of-knee pain (top six if you count the hammies  individually). Let's isolate them to see which ones of this important  muscle group can be responsible for your discomfort.

     

    Bear  in mind that such pain is often mislabeled "tendonitis," even when the  operating muscle is causing the pain and tension. The tension is the  giveaway, since tendons don't flex or stretch as easily as muscles do.  Stretch a tense muscle, and it will usually produce pain somewhere along  its path, including the tendon, and often much further. Additionally, a  chronically tense muscle will eventually lead to tendon, joint, and  ligament problems by placing additional stress on them. In the event  these latter structures fail, they will not be safe until the muscle  stressing them can be relaxed.

     

    Let's examine your  stretch. If you stand with heels to the floor and have difficulty  straightening your knee, you are attempting to partially stretch the  Gastroc. If you stand on your heels while straightening the knee, you  are completely stretching it. As you can see from the graphic above, the  Gastroc crosses the knee onto the femur bone with its two upper heads  anchoring there. Therefor, the muscle is most active with knee straight  and foot flat or dorsiflexed. When you bend your knee or plantarflex  your foot -especially when dojng both, you take away its leverage and  essentially take it out of play. This is an important point for  troubleshooting the Gastroc.

     

    Deep to the Gastroc in the  cutaway, you can see the small muscles Popliteus, running side-to-side  between Femur and Tibia, just under the back of your knee. Over top of  that, and between your powerful plantarflexor Soleus and the Gastroc,  runs the skinny muscle Plantaris, another plantarflexor. This muscle is  not present in everyone, and in many only in vestigial form, almost  nerve-like. While that muscle is also stretched with the Gastroc under  the same circumstances, I would consider it last on our list of  suspects. Popliteus, on the other hand, serves to initiate knee flexion  and tibial rotation to invert the foot (see tool above). That means its  maximum stretch would be with knee straight and foot pointed out,  regardless of dorsiflexion.. another important clue to isolate the  muscles and differentiate their pain.

     

    The hamstrings,  on the other hand, are not going to care much about Tibial rotation, but  they CAN be isolated by rotating the Femur, using your hip rotator  muscles. If you are sitting on the floor, and it is easier to straighten  the knee when your Femur is rotated outward (foot pointing out), than  inward, it shows the outer hamstring (B. Femoris) is less of a problem  than the inner hamstrings (Semis), which are stretched more when the  Femur is rotated inward.

     

    When you isolate the pain by  isolating the muscle, it can pare down your treatment and save time.  Chances are, there is more than one muscle of this knee-flexion system  involved, because they tend to fall into dysfunction in a domino effect.  Remember also that tight quads make knee flexion more difficult and  will lead to tight knee flexors, and vice-versa. All of these muscles  may need treatment, but it helps to isolate the worst ones first.

     

    You  can treat them yourself with your thumbs or a tennis ball, and the  hamstrings respond especially well to foam-rolling upward toward the  glutes, or by sliding on them over the edge of a chair. This can also be  done with the outer/upper Gastroc. For Popliteus and Plantaris, work  them with your thumbs while seated, with knees at 90 degrees, probing  just inside the Semitendinosis tendon toward the back of the Tibia.  Avoid the nerves and blood vessels in the vulnerable area in the center  of the back of your knee.

     

    Try releasing the tension in  these muscles before throwing in the towel on your injury. As I  mentioned earlier, unless you are a well-paid elite athlete, you  probably need to learn these interventions anyway.

     

    Meanwhile,  you ran your Half at a competitive speed against advice, and did not  allow yourself enough time to fully heal. Of course your condition  worsened after. You just have to start over, realizing that the  competitive life often requires equal attention to recovery, not just  strengthening. You can do it.

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    3. Apr 12, 2011 5:00 AM (in response to Finnatic)
    Re: Who should I call?

    Take a look at the short article Who you going to call? Choosing a Healthcare Professional.  If you decide to see a Physical Therapist this web site Find a PT can help.  Be bareful about when you begin stretching exercises, take a look at Should you stretch it out: Pain from too loose Pain from too striff. Sometimes injuries are painful because it is "too stretch out".

    Damien Howell PT, DPT, OCS - www.damienhowellpt.com 

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