Joe A Shaw PA-C - 8/16/2008

Question
QUESTION: I am a very active person. Most every day, I will get in 2 to 4 hours of physical activity. It will include walking, bicycling,rollerblading, martial arts, and light weight training. One day a week, I usually will participate in a group activity such as soccer or other physically active game.I stretch a lot.

Problem.....I keep injuring left hamstring. It will audibly "snap", and sometimes it will almost make me fall down. I am not sure if it is because of the sharp pain or if the muscle just gives out. I can usually catch myself with my right leg before actually hitting the ground, and I
will keep going because I'm stubborn, but I wont be able to put weight on it without severe pain. I usually have to skip on my right for a few steps until my speed is slowed down and I can walk it out. It has been a problem since February of 2006, even with physical therapy, but the
last few months it has been A LOT worse. Sometimes when I'm in a situation where I have to continue to be on it, it will swell all the way into the knee and then the knee doesnt want to bend, but usually the pain is mostly in the buttocks area. Working out is a stress reliever for
me and I really need to be able to continue to be physically active, but the pain is getting extra annoying. Do you have any advice on what I can do?


ANSWER: Vicki,
Hamstring injuries are one of the most frustrating injuries to get over. I get tired just looking at your regimen, so I think you are obviuosly over training or not allowing this to heal. You night have a chronic tear,scar adhesions, hematoma or cyst w/i the muscle belly of the hamstring or at the tendon insertion area (where the tendon turns to muscle and attaches to bone). Surgery is usually not needed, but it is done from time to time. You need an MRI to see whats going on. Sometimes they will give cortisone injections in the specific area via ultrasound guidance (not in the tendon).
I have attached the best article I know of and is a fairly easy read even for a nonmedical person.
You could still do upper body workouts and what not to relieve stress, but you are going to have to give that area a rest regardless of what you find.

  http://www.physsportsmed.com/issues/2005/0505/fredericson.htm

---------- FOLLOW-UP ----------

QUESTION: the article you provided describes my problem completely. Because I tend to mask pain and have trouble verbally communicating with doctors, I have a hard time getting them to comprehend when something hurts and i need help. You seemed to figure it out in one email. Any chance the office you work for is in AZ, Southern CA or NV and is accepting patients? Thank you again for the article. Also, do you know how much if any that an auto immune / undifferentiated mixed connective tissue disorder would factor in to the problem and healing or lack of healing process? ..glad you dont answer queastions on the weekends. It is great to know someone still spends time with family =).

Answer
Vicki,
I'm glad it helped. No I am in TN. You did a good job of describing what is going on and it was all written down so I had to read through the whole thing, unfortunatley in real life in a clinic you would have probably gotten 1 or 2 sentences out and would have been interupted with a question and that would have thrown your train of thought off and put you in the position of just answering yes or no. Now sometimes pt's do ramble and we have to keep them on track but often we try to get to the question w/o really listening to the whole story.
I do recommend that you write down your questions and/or a good summary of what makes it worse better etc..what you have tried and not tried etc.. on index cards and take them with you in the exam room..it will at least give the provider pause and you can have your questions answered so you don't forget or get distracted. I would also print off that article, it is from a reputable source..you don't have to wave it in front of him/her but I would let them know that you have read it and it seems to fit your situation. Try and find a sports med ortho. You can see if orthofind on my site has one in your area.
I do think that these nonspecific mixed conn. tissue findings cause delayed in healing, I don't know of any studies, but just from exp. it seems to be the case, but I still think you have something going on w your hamstring.
good luck, let me know what you find out