T Nation

Knee Pain and Hamstring Injury

Hi all,

In 2007 I started a strength building and sprinting program. At the end of 2007, I mildly strained both my left and right hamstring tendons while doing leg curls. I wasn’t able to do leg curls again without pain, even after resting for a while, so I stopped doing them. I kept on doing squats, deadlifts and sprinting and they were ok.

Around April of 2008, I started to notice some pain in my knees when turning sharply. Then one night I sat down in a couch, got up and I couldn’t walk without pain. So I saw some physios who didn’t help, and eventually one that said I have a patellofemoral dysfunction and I need to stretch my hamstrings, ITB and calves. I did my stretches every day but my flexibility never improved, and my knee problem was pretty much the same. Eventually, in 2009, I strained my hamstring tendons again doing explosive movements in the gym. I lost a lot more flexibility and my knee pain became worse. As a result, I lost a lot of strength as well.

Now my knee pain is very bad; I can’t fully straighten my leg when lying down or standing. I had an MRI of the knee and an ultrasound of my hamstrings: both looked normal, with no sign of a tear or damage. I’m pretty sure my inflexibility is the cause of the knee pain. I can barely get my hands past my knees in a forward bend. But no matter how much stretching I do, I can’t increase my hamstring flexibility. I’ve tried stretches and yoga for at least 6 months now. It might improve for a few hours or a day, but it always goes back to the same level.

Does anyone know of possible reasons for this and what to do about it?

Thanks,

David

Virking,
Where is the knee pain located?
Which hamstring tendons did you strain, the upper ones (where the ham meets the glute) or the lower ones? (back of the knee just below the hamstrings).

I strained the lower medial tendons, and the knee pain is mostly medial but can be lateral as well.

Knee flexion exercises can really irritate your hams and soft tissue if you are doing a decent volume of speed work so I would suggest to drop all leg curls/GHRs for now. I’ve had the same tendon issue as you but not the knee pain, what helped to get rid of it was to avoid all hamstring stretching and to work from the calf muscle. I would stretch my calf as like that shown in the video for about 45 seconds 4-5 times throughout the day:
http://www.youtube.com/watch?v=IIxfZd2eSFY

I would also self massage my lower hamstrings and calves while watching TV or something. Finally I would roll my feet on a tennis ball to release the fascia. All this kept the muscle tone very low throughout the day and released the pull on the tendon. For me direct hamstring stretching would only aggrivate the hell out of it.
Like you, I still have terrible hamstring flexibility and can barely get my hands past my knees, despite strecthing the hams my whole life! What does this tell us? - the hamstrings have a poor response to stretching.
I would love to hear some other opinions on how to relieve tight hamstrings as they are a bastard of a muscle to loosen out.

Hope this helps.

Thanks Supa. I’ve actually started doing that calf stretch and using a tennis ball to work on my feet already. It hasn’t made a difference to my hamstring flexibility or my knee pain yet, but I’ll see how it goes.

I thought I was the only one with such stubborn hamstrings. There has to be a reason for it, because I used to be very flexible, so I’m trying everything.

I found one thing that helps temporarily - a massage of the PSIS, the bony knobs at the back of the pelvis, the space in between them and the lower back. It’s like an acupuncture point that relaxes the hamstrings, only for me it doesn’t last very long.

Yes keep at the stretching and tennis ball work. My tendon was killing me and I could hardly walk, however after several weeks of pain it seemed to suddenly improve, now it’s 100% and hasn’t bothered me since.
Some other things you could add to your regime:

  1. Foam rolling the entire posterior chain from traps to achilles tendon.
  2. You may have some sciatic nerve issues as you say you were flexible before this problem so you could try Massaging your piriformis muscle with a tennis ball and then stretch it out afterwards as shown below:
  1. Make sure you are supplementing with plenty of fish oil and glucosamine if you are not doing so already.
  2. I personally can’t massage my hams hard enough when using a foam roller, so what I find incredible is to roll them around on a shot putt, you can really get a deep self massage on the hams doing this. You prob don’t have a shot putt, but just throwing it out there incase you happen to.

The PSIS massage is something I havn’t tried, cool thanks I will give it a go, you can never have too many therapy methods!

Good luck.

I haven’t been doing a piriformis stretch, and I’m inflexible in that area as well. So I’ll keep stretching, get a foam roller and see how it goes. Thanks again, Supa.

Shirley Sahrmann - If you have a chronically tight or chronically injured muscle, look for a weak or inhibited synergist.

. . . Or something like that.

Turn some attention towards your glutes for a bit, as they could be the source of the problem.
They should help with your hip extension, but if they are inhibited, your hamstrings work overtime, then you get the strains and pulls. Do you get cramps as well?
Stretch out the hip flexors, then do some glute activation techniques, followed by some isolated glute strengthening exercises.

Try that a few times per week and see if that’s where you are lacking.

Edit - The reason of the knee pain could be weak hip stabilizers as well. Do some glute med work for a few weeks to boot.

I had a similar problem with my knee. Though it was not related to any hamstring injury…but a skiing injury when I was 15. I had issues off and on for years and recently it had just been hurting ALL of the time, sometimes to the point of immobility. Like you the doctors could not help and the MRIs showed all good.

Then one day about a year ago I read about dog crap training…and thought I would try the leg pump-stretch for 90 seconds of the quads. Not for any knee rehab or anything but to get bigger muscles (as is the claim of dog crap training). So I did my normal Cross-Fit workout, then 150 air squats to get my legs pumped full of blood.

I then did the quad stretch they recommended…careful not to cause severe pain to my knee (though there was some) but to make sure the pain from the stretch was in my quads. I finished the 90 seconds and I noticed right away - VERY little pain in my knee. So over the next few weeks I continued to do it and I have no pain at all in my knee now.

I am not sure why that worked…but something was bound up which was released by that stretch. It helped me, and so I mention it here to you for what it is worth.

My condition has gotten worse since I posted this, but at least I was able to confirm the cause of my knee pain when I saw a neurologist. Basically, I didn’t know how to treat injuries when I first strained my hamstrings, I repeatedly aggravated the problem and it became chronic and affected my walking pattern. Now my hamstrings are so tight that I walk with bent legs, at around 8-10 degrees flexion. This causes the knee pain. It’s hard to do any activity with my leg because of the knee pain, so I struggle to maintain my strength. And it’s hard to relieve the knee pain because my hamstring tendons have become so sensitive and are easily aggravated.

The last rehab program I tried with a physio didn’t work out. I’m looking for others but it’s hard to find someone who can help, and to know whether I can trust them.

I’m really confused about how to treat the problem. Right now I’m just going by what relieves the pain and what aggravates it.

Currently I’m foam rolling my legs, doing some basic isometric hamstring and quad exercises, seated calf raises and stretches and glute activation. I think maybe I should foam roll my whole back as well, but tight hamstrings have caused my back to become flatter rather than having healthy curves, so I’m not sure if it will be ok.

I’d appreciate any advice…

David