Category: Hamstring

 

This post delivers the third installment in my earlier promise to share my hamstring avulsion ( third grade hamstring tear) conservative treatment recovery journey.

See previous posts here

My third grade hamstring injury – a right pain in the butt 

My third grade hamstring tear – ham off the bone update

Third grade hamstring tears are classified as both ‘rare and serious’. Dr Google was an invaluable source of information and advice  when I found myself both  ‘rare and serious’ and potentially looking at a very nasty operation. It gives me great pleasure to bring you up to date at the almost 12 months post injury date

In my case conservative treatment appears to be a resounding success. I put this down to getting the best medical advice and rehabilitation specialists and being bloody determined

Bloody determined currently involves

1. Four hours walking per week
2. Six to eight hours of fully supervised Gym classes per week which include
   1. Weights
   2. Functional training
   3. Fitball with weights
   4. Balance classes
   5. Pilates stretch
   6. Pilates – my goodness you can even do Pilates with weights
3. Regular Dr visits
4. Power of Positive Thinking
5. Rest and Relaxation

I have gone from being unfit to overexercising without advice ( leading to hamstring avulsion) to being fit and able to do almost anything (if I master the technique and that is one of the reasons you need supervision). Balance remains my one sticking point –  Its about one leg learning to trust the other can hold me up – its a mental thing I am working on

Mental as well as physical health also plays a big part in your ability to stay resilient.

I found the whole experience pretty unnerving from living in a house unsuitable for people with partial disabilities, the severe restriction on activities you can undertake and the isolation of living in the country.

I have renovated my house, grown my network of genuine friends and found other ways to do the things I love. For example I have a beautiful garden but was restricted with what I can actually achieve in it since I had a quad bike accident in 2008.

When I decided to renovate my house to accommodate a short term disabled person I also revisited how I could garden with a dodgy back.

When my original fern house was blown over in a storm the opportunity to build ‘The Orchid Palace’ was born. Its amazing what you can do with re-purposed doors and windows

   My orchids are flourishing in their new home and they are giving me great joy 

The Orchid Palace upgrade also allowed me to remodel the Poultry Palace

These little cuties know how to make me smile 

I have learnt the hard way like physical fitness, mental toughness is the result of a long-term conditioning programme – you can never be too prepared.

 

 

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

 

Its now four months since my right leg hamstrings and the bone they were attached to decided they would like to divorce and get some distance between each other. Now in a way I don’t blame the hamstrings, fancy been attached to something called a ischial tuberosity.

Third grade hamstring tears are classified as both ‘rare and serious’. Dr Google was an invaluable source of information and advice  when I found myself both  ‘rare and serious’

Grade 3 Hamstring Tear

A grade 3 hamstring tear is a severe injury involving a tear to half or all of the hamstring muscle. You may need crutches to walk and will feel severe pain and weakness in the muscle. Swelling will be noticeable immediately and bruising will usually appear within 24 hours.

Diagnostic MRI may also be used to specifically identify the grade of hamstring tear and its exact location. Source 

You can imagine I wasn’t too thrilled when Dr Google kept assuring me major surgery was on the horizon. This type of injury normally happens to people who enjoy extreme sports like Mick Fanning or Alberto Tomba  or Alisa Camplin and these people do need surgery if they have any hope of getting back to the sport they love.

 

Hamstring happily married to Ischial Tuberosity  

Hamstring and Ischial Tuberosity Divorced aka Ham off the Bone aka Proximal Hamstring Avulsion 

Having a proximal hamstring avulsion with more that 2 mm of displacement the literature wasn’t very positive for me

If a proximal hamstring avulsion has more than 2 mm of displacement, a surgical consultation for reattachment is recommended. Early surgical repair can yield superior results over both conservative treatment and delayed surgical repair of proximal hamstring avulsions.

The recovery process following surgical repair can take from 6 to 12 months or longer, depending on the severity of the initial injury and required surgical intervention.

As I said it’s a rare injury and not too many orthopaedic surgeons touch it. So I was very grateful to the bloggers who directed me to OrthoSport Victoria where I saw the adorable Brian Devitt and very lucky to have sports physician Dr Paul Bloomfield (who works with David Wood) visiting a town near me fairly regularly.

Because of my “age” (I so hate it when I get classified as elderly. Don’t they know 60 is the new 40) both the surgeon and the physician recommended conservative treatment (that’s the medical term for wait and see)

The reason being

‘The surgery involves an incision that is either vertical or horizontal under the gluteal fold.  After identification and neurolysis of the sciatic nerve, transosseous tendon reinsertion to the pelvis is performed with three or four metal or resorbable suture anchors.’

All this means they cut you open under your bum cheek and apparently healing is dodgy in this area for “elderly” people and they are not crazy about surgery so close to the sciatic nerve .

However there is almost no information available for people like me on what the road to recovery looks like with conservative treatment and as its rare not too many medical professionals have been involved in the rehab process. I have been very lucky to have have wonderful medical support and conservative treatment may just work for me.

So this is Part One of my story to share my road to recovery journey with other “elderly” people and the not so elderly who choose the road less travelled.

and the road to recovery is one plank at a time