My third grade hamstring tear – ham off the bone update

Kiama Harbour #lovewhereIive – the perfect place to inspire rehabilitation 

In my Third Grade Hamstring Tear Blog Part One found here I promised to blog the progress of my conservative treatment post the divorce of my right leg hamstrings and the bone (ischial tuberosity) they are attached to. As the literature shows there is little documented about conservative treatment for third grade hamstrings tears with most authors preferring and recommending operative treatment in both acute and chronic cases so I am doing my best to help rectify this.

There is almost no evidence in the literature about non-operative treatment of complete proximal hamstring ruptures in elderly patients. Source 

Bit of background

The hamstring group comprises three muscles – biceps femoris, semi-tendonosus and semimembranosus. The muscles function as movers and stabilizers of the hip and knee The action of these muscles is to bend the knee and extend the hip, especially on faster running.  They also  help to get from a crouched position to an erect position. This refers to movements like getting up from a chair or in sprinting, where the front leg in starting position has to bear the effect or the start. This makes the hamstrings extremely important muscles if it comes to walking and running.

Hamstring tears are divided into the following categories

• First degree strain is damage to a few muscle fibres
• Second degree strain is damage to a more extensive number of muscle fibres
• Third degree strain is a complete rupture of the muscle itself

A Grade 3  is deemed to be rare and serious and ranges from more than half of the fibres ruptured to complete rupture of the muscle.  It causes massive swelling and pain. The function of the hamstring muscle can’t be performed anymore and the muscle shows great weakness. 

OK so mine is a complete rupture embarrassingly caused by falling over in Pitt St in Sydney.

 

The scene of “ham off the bone” event 

I have a very high pain threshold and I think what happened next was I went into shock. I just sort of lay there. I was in gym gear ( I was going for a run but hadn’t started ) Onlookers assumed I was dehydrated and everyone was running around trying find water. This nice man asked me if I would like a hand to get up and I said Yes Please in this tiny little voice.  It wasn’t that painful I just felt weird so I decided I would continue. I walked a block and realised I was living in fantasy world to think I was going to start jogging. It was a bit painful behind the knee, so I iced there which was a waste of time as the injury was under my buttock. I went to an all day workshop the next day which required going up and down steps for meals.  I can assure you I was taking baby steps. The next day I had a heap of things to do in Sydney and baby stepped my way through and then drove two hours home.

It wasn’t getting any better and I decided to consult Dr Google. Even though I wasn’t in a lot of pain and there was no bruising my self diagnosis was either a second or third grade hamstring tear.The doctor agreed and when the radiographer rushed out and got the radiologist to come in and look at what was on her screen I knew it was serious.

This is a snapshot from my MRI – all that white stuff is not good

Surgery repair is usually very successful for athletes but conservative treatment is preferable  for those of us who fall into the “aged” category  

Conservative treatment means I will always have a third grade hamstring tear. So if conservative treatment was the healing of choice I said enough is enough I am going to this properly. It had been one thing after another with my health in the previous six months. First there was the ocular ulcer ( now that’s painful)  and cellulitis in my leg. I wont bore you with the rest. One thing about third grade hamstring tears their rarity excites specialists. Despite having a distal retraction of more than 2 cm ( how far the hamstring had moved from the bone) it was decided for people my “age” conservative treatment was the first choice of action.

What have I done and how am I tracking 

I have done all the right things and I am star patient ( even if I do say so myself).

First I consulted a sport physician and orthopaedic specialist whose area of expertise include hamstrings. I have seen an osteopath and a podiatrist to check my gait. I am   currently seeing a physiotherapist one day a week who is doing dry needling  which I can assure you doesn’t hurt but when a nerve accidentally comes in the equation wow is that a funny feeling. I visit a gym and see a rehabilitation specialist personal trainer. I have been doing this four times a week for four months. My routine includes weights, recumbent bike, functional trainer, fit ball exercises, balance exercises, planks and bridges (specialist loves these). I now have my own program under supervision.

Today I walked ( baby steps, no steep hills and no pathways or roads with a cambre)  for an hour, did weight training and balance exercises for one hour and a one hour Chillax* class.

My biggest setback has been the onset of neurpoathic pain. It was really nasty for a while. The pain was bad enough without the ants walking all over you sensation. The specialist prescribed Lyrica. It aint side-effect free but it appears to be helping so I am putting up with the side-effects. I still have trouble sitting for extended periods of time and the dry needling seems to be helping with that. If I hit a roadblock the next step will be Platelet-Rich Plasma (PRP) treatment

Diet

Diet has played an important role in my recovery. I have an ‘all or nothing’ attitude to supplying my body with the nutrients needed to maintain optimal health and recover from my injury. I am eating a high protein diet to ensure my body gets the essential amino acids to help my satellite cells and new muscle fibers create the protein needed for repair and rebuilding. The experts say the best sources of protein are meat (beef, lamb, fish, chicken et al), dairy products and eggs; second to those are legumes, nuts and high protein vegetables like peas, broccoli and spinach. On a regime like mine it is hard to get all the protein I need from whole foods so I have added whey protein powder to my diet

  Adding whey protein powder to my diet ensures my body gets the essential amino acids to help my satellite cells and new muscle fibers create the protein needed for repair and rebuilding 

Taking in sufficient dietary amino acids, including essential amino acids, ensures your satellite cells and new muscle fibers can create the protein needed for repair and rebuilding. In addition, the branched-chain amino acids – isoleucine, leucine and valine – found in milk products can play a role in making the process more efficient. These amino acids can enhance protein synthesis within your muscles, particularly when you consume them with a carbohydrate.    

A typical breakfast pre-exercise would be cottage cheese and fruit and 20 grams of protein powder dissolved in a glass of water, another 20 grams of protein powder drink post the gym and just before I go to bed. I love cottage cheese which features heavily in my diet as do vegetables, eggs, other dairy products and salmon  .

Often after my walk I will drop into the Hungry Monkey

 Adore the Veggie Juice

Scrambled Eggs and Avocado and Haloumi – wonder woman food 

Once in a while I treat myself to the Blueberry Pancakes  

As mentioned above without surgery I will always have a third grade hamstring tear but if my rehabilitation continues at this level I should be able to walk and hike without hamstring pain.  Whether the neuropathic pain  continues is anyone’s guess at this stage

The road to recovery is one plank at a time 

Footnote*

A Chillax class is designed to help you chill out and relax using stretch, relaxation and breathing techniques.  It is designed to de-stress and unwind