More knee questions

[grrrr]

So when I tore my knee up several seasons ago, I tore my hamstring partially. Yesterday's great conditions meant that I pushed myself, and had more hamstring pain than I've had since rehab on the original injury. I kept getting back to relieve the tension on the hamstring, which menat I was flailing around by the end of the day.

I quit doing hamstring curls about six months ago, because of the disconcerting "pop" everytime I tried to curl more than 40 lbs.

So, do I ignore the pop and strengthen my hamstring, ignore the pain when I ski, go back to see the ortho, or just go waah waah wahh?

[Vinman]

Not sure what could be causing the pop in your ham when doing curls. Strengthening is very important though. If the pop in the ham keeps up or is painful get it checked.

[L7]

You could try what I do using a physio ball. On your back put the back of your ankles on the ball and then bridge the pelvis up and pull the heels and ball towards you. I find it works the hams in an even full range and offers less strain than the ball (you can do both legs at once or one at a time about for lots more effort). The best part is the ball stays handy and it takes nothing to do a few on a regular basis without a trip to the gym.

[Stikki]

Well, you have a weakness and eventually you need to deal with it or it will plague you for the rest of your life. A doctor will give you typical doctor advice, “Doc it hurts when I do this” “Then don’t do that”. Most likely they will tell you to cease skiing and any other activity that results in pain. After the pain subsides you’ll get the green light to begin rehab. If I were in your situation, being the fool I am, I would start rehab now and continue skiing as long as it didn’t further the injury. Here would be my plan of attack:

RICE- Rest, Ice, Compression, Elevation, and toss in some anti-inflammatory drugs. This is for the acute injury. After that it’s rehab time.

Massage and heat- Either a vibrating massage tool or hand massage can do wonders to relax the muscle. Heat pads or even a hot and damp towel further relaxes muscles. Combine the best of both worlds and get a massage in a hot tub (“Baby, it’s for my hamstring rehab”).

Streeeeeetch- Healthy muscles are flexible muscles. Hamstring injuries are often related to low range of motion. With haste start stretching. Pick a couple of stretches and go for it, aim for three times a day at minimum. Static stretching, i.e. holding an even gentle stretch for anywhere from 15 seconds to 15 minutes, is the old standby. Dynamic stretching, i.e. controlled leg swings and kicks, should be saved for a later time when the muscle is healthier although very, very gentle, low range of motion leg swings could be included if they are pain free. Contrast-relax stretching would also be good to include. This technique begins by getting into a static stretch and then slowly and lightly flexing the stretched muscle for 5-7 seconds. Increase the flex to the point of tension up to light pain then release the flex and relax the muscle, exhaling works well with this. A greater range of motion should occur so go ahead and stretch a little further. This cycle usually continues until a limit of motion is reached.

Strength work- Hamstrings flex both the knee and hip joint so you need to do both motions for thorough strengthening. Knee flexion brings the foot closer to the butt like in a hamstring curl exercise. Leg curl machines do this but there are alternatives. A replication of the hamstring curl machine can be made by attaching surgical to the heel and anchoring to something else. Lie prone and bring the heel to the butt. Physio ball curls (described above) also work. Another option is sitting on a towel on a smooth floor and placing feet flat on the floor as far away as possible. Bring the feet to the body and scoot across the floor. Hip flexion is when the hip tilts backward like when the belly button is aimed toward the floor while standing then brought upward and aiming at the horizon. Some exercises that use the hamstrings in this fashion include stiff leg dead lifts, Romanian dead lifts, good mornings, and step-ups. See here for descriptions, pictures, and other options.

Again, stretching should occur all the time. Strength work for rehab may occur 3-6 times a week and possibly daily as long as the muscle can recover between workouts. The more intense the strength work the longer the recovery period. Start at a pain free and attainable level and slowly increase variables (reps, sets, resistance, weight, etc).

Added: Don’t forget to stretch the hip flexors (the muscles above the quads that cross over the hips, right where front pockets on pants are). If the hip flexors are tight they rotate the pelvis forward, think pulling your belly button downward, thus stretching the hamstrings. So by lengthening the hip flexors tension can be released from the hamstrings. A simple stretch for this would be to get into a lunge position with the back knee on the floor. Concentrate on pushing your hips forward, the stretch should be felt right above the quad of the rear leg.