biceps femoris tendonitis treatment

Discussion in 'Ask the Docs' started by Santi, May 6, 2014.

  1. Santi

    Santi Barefooters

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    This past thanks giving I went on a climbing trip and ended up hiking 3 days in a row on very steep terrain with a heavy pack. There was some pain on the lateral side of my right knee on the last day.

    A couple days later on my walk home from work I felt so much pain that I had to limp home with my knee locked straight. The pain only started as I was lifting my foot off the ground to start a new step.

    I rested a couple weeks and the pain left very quickly, but then came back as soon as I resumed my normal activities. I reduced my activity again and started an itbs rehab routine that I did every day for a month. Again I had no pain 99% of the time and any pain I did feel was very minor. After that month I tried a couple short hikes (8 miles over two days). The pain came back on the second hike.

    After looking into knee structure more I realized that the pain seems to be in the tendon of my biceps femoris. I found a lot less info about this online. But I did read that it can heal in a few weeks. Does that sound like a likely source of my pain?

    Why is it sticking with me? How inactive should i be? Is it ok to walk to work if i feel no pain? Should I stretch my biceps femoris? Should I strengthen any particular muscles? I'm hoping to hike the AT in 6 weeks is that reasonable?

    Thank you so much in advance for any one with advice!
     
  2. Dr. Mark

    Dr. Mark Barefooters
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    Santi,

    I think hiking 2000 miles may be out. the body is a series of fascial planes (see Thomas Myers "Anatomy Trains"). where the pain appears is most often not the issue. there is a weakness or tightness somewhere in the chain leading to continued dysfunction here. you cannot push through pain. never a good idea. do not stretch the area, tends to weaken it more.

    this is honest answer as it is impossible to give any specific advice without an assessment.

    find someone close to you who can help you figure it out

    Mark
     
  3. Backfixer

    Backfixer Barefooters

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    Dr. Cucuzzella gave a great answer. I too am a fan of Anatomy Trains, and while we do not find all the problems by using his book, it is a good way to understand why the body does certain things such as locking up the knee.

    On the other hand, in my experience, when something seems that tight, it is usually straining and the problem is likely on the opposite side of where you are feeling the problem. When you treat the pain, it may often get worse which tells you to look elsewhere. I have seen upper body issues shut down the lower body as well which seems to fall in line with the Anatomy Trains idea. I referenced this in my book Cheating Mother Nature, what you need to know to beat chronic pain which may be a useful reference since it is designed to be read and understood by the general public.

    My suggestion is to find a good sports certified chiropractor who specializes in myofascial release or graston and understands the gait process. I hope that helps.
     
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  4. Santi

    Santi Barefooters

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    Thanks for the advice. I will look into local chiropractors. I have an appointment with a physical therapist tomorrow. I will ask all the questions I did in my original post. Does any one have other questions that I should ask?
     
  5. Santi

    Santi Barefooters

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    I went to a sports certified chiropractor this morning. When he heard I had two surgeries on my right lateral meniscus he said I should go back to an orthopod for advice on treatment.

    I didn't imagine this had much to do with my surgery because the last one was two years ago. And I've done hiking between then and now without pain. He said it could be scar tissue or another tear.

    I'm about to go to my appointment with a physical therapist. I'm hoping she can at least help me identify the parts of my knee where the pain is. And give me an idea of the cause. Tendonitis, ITBS, scar tissue, whatever.
     
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  6. Bare Lee

    Bare Lee Chapter Presidents
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    May sound counterintuitive
    but I had ITBS and a frequently sore MCL
    and then I started doing more deadlifts and squats
    and stretching and massaging more
    and now I'm fine
    I can run half-marathonish distances no problem
    and my form and foot landing feel solid and smooth.
    It might take a while however,
    for this to take affect and help.
     
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  7. Santi

    Santi Barefooters

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    Went to the PT and she said it's probably ITBS, maybe meniscus flaring up. Either way strengthening muscles around the knee is a good idea. It was a reassuring visit. Good to get advice on how to do exercises properly and to make sure I wasn't doing anything that would make my situation worse.
     
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  8. Santi

    Santi Barefooters

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    Thanks Lee, I will stick with the exercises and massage until I get better. How long did it take you to notice an improvement?

    I have been doing the following for a month:

    Clamshells with exercise band
    Iron cross
    Single leg squats
    Side steps with exercise band
    Lateral leg raises
    Hip hikes
    Hip thrusts
    Donkey kicks
     
  9. migangelo

    migangelo Chapter Presidents
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    itbs is a symptom, not a problem. you may be suffering weak/inactive glutes. lots of people do from sitting too much.
     

  10. Bare Lee

    Bare Lee Chapter Presidents
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    Those are all good exercises, I like leg swings and mountain climbers--front, side and crossing--too. I do them all as the 'mobility' component of my fitness routine, with 10-lb ankle weights for extra resistance. Still, there's really no substitute for old school barbell training for general strengthening. Having a strong upper body helps posture and arm swing too, so I would recommend bench press, overhead press, chin-ups or pull-downs, and some rows, in addition to squats and deadlifts for the lower body. If all this is new to you, start light and get a good book like Mark Rippetoe's "Starting Strength" or go to ExRx.com to learn proper technique. I've become convinced that basic strength is more fundamental than cardio, because it's hard to do cardio properly--injury-free with good form--without a strong body. Box jumps and power cleans are also excellent for building up power in the posterior chain.

    For time, this will depend on a lot of factors, but for me, the improvements came pretty quick. I think I killed off the ITBS ogre within a few months. I would also stop to stretch in the middle of a run at the first sign of tightness, and stop to walk at the first sign of soreness. A lot of people are against stretching these days, but I think stretching out the hammies, ITB, and piriformis in particular helped in my rehab, but also massaging everything involved in running, before and after the run, also helps enormously, from using a wooden roller under the arch of the foot, rolling the shin and calf muscles, using an electric massager on both my lower and upper leg muscles (especially up and down the ITB in our cases), and sitting on a baseball to massage the glutes.

    Also, some people have found that running faster helps relieve ITBS. So you might consider interval training as part of your rehab. Running fast is also a great way to strength your running muscles, as it recruits more muscle mass overall and tends to force one to adopt good running economy/form.
     
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