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.
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)
Ventura City Impact Half Marathon- June 18, 2011
Santa Barbara Semana Nautica 15K- July 4, 2011
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.
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
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)...
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.
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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