Sports Medicine/Back knee tendonitis

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QUESTION: Hi Dr Arthur,

    Thank you for being so generous with your time in helping people like myself on here, much appreciated.  I am a 35yo male with a history of hamstring muscle weakness/ pain in both legs.  Probably more caused by being out of shape and then trying vigorous activities.  Most of the pain is gone in the muscles thanks to electro acupuncture.  But I've tried using the elliptical and I have gotten tendonitis pain behind my knee.  I have a history of other tendonitis pains throughout my body. I am not currently in pain now, but I want to strengthen it to prevent it from re-injuring again. I have read that eccentric strengthening exercises is the best for tendonitis.  Could you please tell me names of eccentric strengthening exercises to strengthen back of the knee tendonitis?  I have been trying to some squats, lunges.  And don't know the name of the exercise, but laying on my stomach and pulling a exercise band with my heal towards my butt.    

Thank you so much!

Jim

ANSWER: Hello Jim!

Thank you for your note, and from reading what you are saying, it seems to contradict what you would like to do!

Firstly, let's address the pain in the back of the knee.  Not everything you have is "tendonitis".  This is a general term for irritation of the muscle attachment to the bone, used to move the bone (tendon).  To have your body afflicted with so much tendonitis, is pretty uncommon.  It could very well be the loaded and vigorous exercise you are doing........too much, too soon, too little warm-ups, and way too heavy.  If this sounds anything like you are doing to get in shape fast, I guess we will have to talk about re-directing your thoughts!

Tendonitis is the result of over-stretching your muscles with which the tendons are attached to move the bone joint.  So, as an example, you mentioned your calf muscles in both the lower legs.  Because  the joints are held together with ligaments.........bone-to-bone.........and the tendons then hold the muscle-to-bone.  Therefore, if you pull too much weight, the muscle fibers start to tear, the tendons are now trying to pick up the slack, and they stretch too far, and finally the joint pulls the ligamentous fibers so they tear also.  The brain can feel only one pain at a time, and in your case it was the worst one with the calf weakness.  Those muscles were used to their max, and could no longer fire nerves innervating the muscles.  This is a simplistic model of how the muscles, tendons, and ligaments work throughout the body.

There are no exercises to divide the body up into one area to strengthen it, and you cannot "strengthen" just one tendon, without affecting the other parts of the joint it is attached to.

I am concerned with the knee pain that has developed in back of the knee.  This could have happened when lifting a heavy weight, and the knee could have been weak from another injury.  This particular injury could very well be a Baker's Cyst.  This type of injury should be seen by an Orthopedist Knee Specialist as soon as possible.

You asked for Eccentric Exercises, and I would suggest to you that instead of trying to lift weights, SWIM!  Yes, this is the very best weight training program you can do, as swimming uses every muscle in your body.  You need to to get off the heavy, joint-wrenching, machines and bars you are using now, and get into something that equalizes the muscle workload, as in swimming.

I guess I haven't given you very good news, but you are quickly ruining your body, and to continue with your own routine will produce massive osteoarthritis in every joint you have injured at your young age.  At 40, and certainly by 50, you will have more arthritic pain than you could possibly tolerate without using powerful drugs to dull the pain.  So, the answer is swim, and see the specialist about your knee.

Thank you again for your note, and I wish you good luck.  Please let me know how you are doing, because I care what happens to your body.

Dr. Patricia Arthur




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

QUESTION: Thank you for your wisdom and thoughts Dr Arthur,

  I also have come to the conclusion in the past couple days that swimming might be best for me.  My body can't do any other cardio right now.  It isn't my calves that I had issues with, but my hamstrings over the years.  I let me body go by not staying in shape at all.  No stretching or working out.  I had gotten my hamstrings healed with electro acupuncture 6 months ago but I wasn't diligent at stretching or strengthening my legs after.  And I think that is what caused me to hurt my knee area.  

You are right about me trying to do too much too soon.  The other night I tried squats and lunges, and it caused some new pain on the inside of my knee yesterday.  I almost certain that was some tendonitis.  I was feeling the point of the pain, when the tendon connected to the muscle.  And then the pain wrapped along the inside of my knee.  Just doing reading and looking at pics, maybe pes anserine tendonitis?  The back of the knee hurt at the band leading from the knee to the muscle.  

I went to see an acupuncturist again yesterday to see if it would help.  And I was icing as well.  I will go and see my Dr next week about possibly seeing someone.   But its with the VA, so that might take months.  I will absolutely start swimming, I'll be looking for pools in my area today.  

Say it is tendonitis, what would be any exercises for it that I could get started on besides swimming and stretching?  

Thanks again for your kindness in helping people in your spare time.  :)

Answer
Hello Jim!

As I mentioned in my previous correspondence, there is no specific exercise which will tone your tendons up.......only exercises that encourages MUSCLE tone, which will then toughen the tendons up.  I know it's hard to understand, but the concept is  purely anatomical, with a bit of physiology and pathology thrown in.  Remember this one thing:  when you  work with one thing in your body........whether big or small......you will always get an opposing reaction.

So, if you decide to use the strength machine of some type, the legs or arms, will cause the opposing side to try to balance the workout.  As in the case of your knee, you had an injury to the knee prior to the workout.....whether you knew it or not........and  then working the legs, the injured knee could not balance the opposing side, and you re-injured the knee.

I will stick with my original premise of swimming as the all-around appropriate exercise for you.  You mentioned stretching, and if you decide to do some simple, light stretching prior to swimming, that is fine.....BUT, please remember to do the same simple, light stretching activity as you did prior to swimming, doing it after the swim, is very important!

If you can find a local Y, or a club, or a school with a pool, that would be ideal.  I applaud you for deciding to use swimming as your main exercise extension, but if the knee should continue to bother you, please see your Orthopedic Specialist.  If you could do laps for three times a week for an hour each time, within a month you will not realize how much weight you have lost, and how well conformed your muscles will be!

Good luck, Jim, and please drop me a line to let me know how and what you are doing.  Thank you.

Dr. Patricia Arthur

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Dr. Patricia B. Arthur, DC, MRC, CST

Expertise

As a 30-year practicing Chiropractic Physician, my specialty was Sports Medicine. For 8 years I had the distinct pleasure of working with the USOC, and traveled the world to care for the athletes in the Pre-Olympic venues for the Summer Games. When I wasn't traveling, I had a private practice, and a hospital practice, in Kamuela, Hawai'i. Questions I couldn't answer usually dealt with pharmeceuticals. This was not my expertise, but the simple questions pertaining to familiar drugs I was able to digress, or refer to someone that was knowledgable in that field. Most Sports Medicine field injuries were familiar to me, but I always aired on the side of caution. In my office practice, I would tend to see more patients with the weekend injuries who would try to self-treat, only making the injury worse than it should have been! Nevertheless, I never took anything for granted, and so it was my conservative approach to the "cause-and-effect" mechanisms that were vitally important to the healing process.

Experience

Following my competitive nature, I knew Sports Medicine would always be a part of my life. After graduation from Palmer University in Iowa, the old adage taught at the school dealt only with the spinal column......anything connected to the spine was outside our scope of practice. To me, this was too simplistic, because the complex body also had arms and legs! From this point, I developed specific technigues which would encorporate the body as a whole rather than haphazard segments. There is nothing traumatic that happens to a single ligament, tendon or joint that doesn't effect a secondary, or possibly a tertiary element in that area. In order for that space to heal, all the factors must be addressed. Volunteering my time teaching referrees, coaches, and interested parents about the realities of probable sports injuries was worth a thousand words!j

Organizations
American Chiropractic Association; Local Emergency Response Committee; Hazardous Materials Response Team; Urban Search and Rescue Team - Operations and Planning; Federal Corps of Engineers Committee; Earthquake Advisory Board; Big Island Wildfire Committee

Publications
Papers published focusing on the importance of proper care of sports injuries; Authored medical columns for the syndicated magazine "The People's Doctor "; Published papers in professional journals on Head Injuries in Sports; Published papers on Drug Abuse in Sports.

Education/Credentials
Robert Packer Hospital - Certified Surgical Technician - CST; Palmer University - Doctor of Chiropractic - D.C.; Wright State University - Masters in Counseling/Psychology; Wright State University - Masters In Couseling of the Severely Disabled.

Awards and Honors
Selected US Olympic Physician -1988; Graduated Wright State University with a 3.75 GPA; Graduated Palmer University with a 3.5 GPA; Faculty Appointment - Palmer University Post Graduate Education; Faculty Appointment- Hawai'i/Kapiolani Community College - Skills Team Tester;

Past/Present Clients
Cincinnati Bengals Football Team pre-season training; Summer Olympic Athletes worldwide; Kona Ironman Triathletes - Finish - line physician

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