Because I recently had ACL surgery and used a hamstring as my graft, strengthening the hamstrings is something that has been on my mind lately.
Just a quick primer: The hamstrings perform two main movements, hip extension and knee flexion.
Credit to TrackMom
Hip extension involves bringing the leg backwards, like while walking. Knee flexion consists of bringing the heel to the butt, like a leg curl.
A lot of people in the powerlifting / strength and conditioning community love to proclaim all you need to strengthen the hamstrings is hip extension exercises. That we do way too many leg curls, that leg curls suck, and exercises like squats, deadlifts, good mornings, etc. are all you need.
These people have clearly never had or worked with someone who had reconstructive ACL surgery with a hamstring graft.
From personal experience I can tell you my hip extension strength, i.e. movements like squatting, deadlifts, good mornings, is fine. In fact, it has been fine nearly the entire time after my surgery.
My knee flexion strength (like a leg curl) is not. It has been excruciatingly difficult and tedious to regain.
One of the issues people have doing leg curls is they have poor form. They are often performing lumbar extension during a leg curl rather than pure knee flexion.
Here are some examples:
There are a couple of issues going on here:
1) People try to use way too much weight.
2) The posterior trunk is stiffer than the anterior trunk. Specifically the lumbar extensors are stiffer than the external obliques.
Lumbar extensors. (From exrx.)
Said another way: The lumbar extensors are overpowering the external obliques. Therefore, the pelvis anteriorly tilts and the movement becomes much more a lumbar extension exercise than a knee flexion exercise.
So that’s kind of the intro into this. The next issue is something I discovered recently. I am just about fully there in the process of trying to regain my hamstring strength in movements like the videos above. However, I’ve noticed during something simple I still have issues. For example, if I try to bring my heel to butt while standing (like say I was trying to look at the bottom of my shoe), it is really hard.
This didn’t make sense to me. By all indications my hamstrings are nearly as strong as they used to be, and nearly as strong as my non-operated side. Something isn’t right.
Then the last month or so my lower back has sporadically been bothering me. Sometimes I’ll have issues due to being on my feet all day, helping load and unload weights, leaning over a ton, etc. But the past month it has become much more severe. And nearly any time something at the lower back is going on it’s almost always indicative of the lower back moving too much.
So one day I look in the mirror while I attempt a leg curl. And I notice this:
You can see I’m getting quite a bit of my leg curl by performing hip flexion. Not ideal. Next, when I keep my knees together to prevent any hip flexion, watch my lower back and pelvis:
It’s not dramatic, but you can see my lower back and pelvis moving quite a bit when I attempt a leg curl. As well as my entire upper body leaning forward.
This is not good.
When I keep my pelvis and lower back as still as possible, and prevent any hip flexion, this is how much I can move my leg:
I can barely flex my knee at all.
But during typical leg curl machines my hamstrings are nearly symmetrical in strength, and I have no issues, why is this happening?
Look at the position of the hips during a couple of typical leg curl exercises:
The hips are always flexed! Therefore, when the hips are in a flexed position my hamstring strength is good. But when the hips are in a neutral or extended position my strength is not good.
That’s one reason why my lower back and pelvis wants to move during a leg curl. My body is trying to put my hips and hamstrings in their strongest position (hips flexed). It’s just that position is not good for my lower back.
Also, I bet a lot this had to do with getting a hamstring graft. After a hamstring graft for ACL reconstruction your knee flexion strength becomes very, very weak. I’m willing to bet a lot that after my surgery I started using my back to help achieve knee flexion and hip extension due to my hamstring being so weak. (Literally a part of it was cut off.)
Either way though, this is important because of the training implications for the hamstrings. The hamstrings are rarely functionally used to curl the leg when the hip is flexed. They primarily extend the hip, and then help to curl the leg when the hip is in an extended position.
Also, you need to be wary of training the hamstrings too much in the hip flexed position due to the compensatory patterns that can occur. As I talked about, issues at the lower back can arise. Issues at the knee can arise too.
Let’s go over the proper form:
1) Before anything moves the pelvis and lower back should be in a neutral position.
This:
Not:
2) The knees should be touching one another. This provides a self-feedback tool for letting you know whether or not your hips are flexing:
This:
Not:
3) Make sure when curling the leg no rotation at the knee occurs. Lateral rotation is the most common, and results due to a tight IT Band. See The Best Damn IT Band Stretch Ever for more.
The foot should be straight and in line with the knee, maybe even rotated inwards; it should NOT be rotated outwards like this:
4) Absolutely, positively, ZERO movement occurs at the pelvis / lower back. This is much harder than you would think. Especially for people with any knee or lower back pain history. It helps to tighten your stomach to prevent lumbar movement.
Here is a video with better form:
Give it a shot with you or your clients. I think you’ll be surprised with how difficult it is.
Cathy
June 12, 2012
This is my problem also. Except i had my surgery 12 years ago. I have never regained my original hamstring strength and continue to have pain in my knee when trying to excercise hamstrings especially if i try to lift my foot to my but with a pointed toe. This is almost impossible. I can feel the connection between the weak hamstring and the acl connection. I will try to improve my form and keep my butt and hips out of it, but without them i am really weak. Thanks for the tips.
reddyb
June 18, 2012
Hey Cathy,
Sorry to hear you’ve had so much trouble regaining strength. Just wanted to confirm; you had a hamstring graft also?
Where do you get your pain during hamstring exercises?
Hope this post helps. Let me know how things go for you. I’d be interested to hear.
Alma C
July 5, 2012
My question is what type of exercises were you doing after therapy was over? Did you continue on your own? Were you in shape before the surgery? I had ACL surgery in Feb. 2012 (complete tear in ACL and torn meniscus). I also used the autograft, I am still wondering if I made the right choice. I guess it’s too late for that now. Just have to live with it, and do the best I can to regain full strength.
reddyb
July 7, 2012
Hey Alma,
If you click on the “ACL” category link on the right of this page you can see my entire rehab. From a few hours after surgery to 7 months later (now), it’s all there.
My therapists sucked. Yes, therapistS. I will write about this in the future, but I had horrible, horrible physical therapists after my surgery. I did this completely on my own, but I had planned on this before my surgery. My experience with my clients has taught me the majority of physical therapists are just not good at their job.
I was in very good shape before my surgery. My leg was very strong, I had full range of motion; hell, I was running quite a bit!
Again though, this was all planned; one of this was by accident.
A hamstring autograft IS the best choice. So feel good about that. I have a long write up on which graft is best on this site as well if you’re interested.
You’re still very close to your surgery date. The hamstring strength can take 6 months to a year to fully come back. My experience says it’s more like 9-12 months.
This is a long, long, tedious process. You just have to stick with it and take care of yourself. I’m going to post my 7 month update soon but I can tell you I’m doing very, very well.
Stay positive!
Feel free to ask me anything else. I know how hard this is!
Alex nielsen
April 19, 2013
After reading this I discovered the same lack of knee flexion in my own operated leg. I developed a very obvious way of training the leg- simply passively pull it into flexion with a rope and allow it to fall against gravity whilst activating the hamstrings. You should get some serious DOMS come morning but it works!
reddyb
April 23, 2013
Hey Alex,
I haven’t done this myself, but it seems like a great idea. Thanks for the comment.
Alex Kim
June 19, 2013
For someone with healthy legs/hamstrings, would you recommend still doing this unweighted? With the strictest form I can force myself to feel it at around the level of a good warmup for other exercises, but I want to use this/these concepts as a main part of my workout (with more resistance). Any ideas for adding resistance without compromising the mechanics of the movement? After trying these I can never do the hamstring curl machines again, the quality and focus of the movement is on a whole new level.
reddyb
June 21, 2013
Hey Alex,
The main way I load a knee flexion movement is still through a prone hamstring curl machine, making sure the person isn’t compensating at the lower back.
Often I’ll mix in the standing curls I go over in this post, or some unweighted prone curls -where the hips can be more extended- just to make sure the person maintains this ability i.e. knee flexion without lumbar extension. Video here:
Leg curls using the stability ball is another variation:
The stability ball version allows one to get the curl with concurrent hip extension. However, I’ve slowly gotten further and further away from using this version. People have the hardest time getting the form down. For instance, the form in that video is subpar. The person should lift their butt higher as their legs curl to generate hip extension. It’s not so much it’s a hard exercise to learn, it’s more people simply aren’t strong enough to do it. Now, keep in mind I deal with everyday people. Typically in the vicinity of 35 years and older. I’m not training athletes.
That said, the majority of people who think they’re doing that version correctly are not. When you look closely you’ll see their lower back extending quite a bit. 16 year old? Not normally a big deal pain wise. 55 year old with a lower back history? I’m rarely going to even attempt trying this.
Even if the 55 year old can do the exercise, there’s risk. The person has to be acutely aware of when they reach a certain fatigue point because that’s when they’re most likely to start using the lower back. And all it takes is one shitty rep for their back to be pissed all day, and not too pleased with me. While the good ol fashioned prone hamstring curl machine isn’t exactly optimal, it’s a hell of a lot less likely to piss someone’s back off.
Another knee flexion movement I’ll do is something akin to heel slides:
I don’t have a video of this, but I’ll have the person put both feet in the plate, curl the legs, then lift the butt. This way they get their knee flexion and hip extension, but there’s very little risk the lower back is going to extend too much. You can change how much weight the person is curling by what plate you put below their feet. 10lb, 25lb, etc.
I don’t really use this as a hamstring exercise though. It’s more of an abdominal exercise for my purposes. (A 10 pound plate (like in the video) isn’t really going to work the hamstrings much.) I’m trying to train the person to move their leg without their lower back coming off the ground. I suppose you could get a little creative. I’m thinking throw a 45 pound plate under the person’s feet, then maybe a big dumbbell in the plate, and you have yourself a much more loaded knee flexion exercise.
Hope that helps.
Zach Shuffield
December 12, 2013
ey I know this blog is old! I have had 3 ACL surgeries. 2 on the left one on the right. On the left I had a patella graft that failed so we used a hamstring for the second go around. I am 19 years old, 6″2 205lbs with an athletic build. I work out 5 days a week, doing squats and deadlifts for my core leg exercises 3 times a week. Heavy weight (6 sets of 275 on deadlift, 250lbs on squats).I also do a lot of quad exercises. I have had zero problems. But doing leg curls the other day (the one where your sitting in a chair position) i have a bad aching towards the left of my knee on the outside. More towards the back, but on the back left. Any reasons for this? Its not a muscular soreness feeling, more like an ache.
reddyb
December 12, 2013
Hey Zach,
3 ACL surgeries? Man, I don’t envy you! Sorry to hear about that.
Is this something you’ve only felt after this one workout? If so, probably not much to worry about. It’s common to get weird sensations after a surgery.
Unless you had an atypical graft, that location isn’t consistent with where the hamstring is cut, so I don’t believe that’d be an issue. Might just be one of those weird feelings you get from being active sometimes.
Ben Reyhanian
December 28, 2013
Hey there Reddy,
First off, let me commend you for having such an excellent & informative page for those of us who have had hamstring ACL grafts done. I really feel that this page is a must-read for anyone who has gone through a similar procedure. I was searching throughout the internet for a LONG time in hopes of finding something like this & someone like yourself.
As for my situation, I had reconstructive surgery on my right knee for a torn ACL and medial meniscus (dominant leg) just over 2 years ago. Both a hamstring graft and a menisectomy (70% cartilage removal) were performed at the same time. To be honest, I was a very naive individual at the time, and didn’t even know about the different ACL options that were out there. If I could go back, I would’ve went to a few different surgeons for consults (among doing other things differently), but what’s done is done.
Things I noticed in the right leg the first few months after the surgery that have persisted: extremely weak hamstring strength, extreme lack of ROM for flexion, significantly smaller calf muscles, overall imbalance when walking. The last point has been difficult to overcome, as even now with every step I take, I still feel all the imbalances and so I’m made consciously aware of each step I take.
I trained hard after my surgery but had a few setbacks along the way. I was unfortunately brought back to baseline strength around a month ago, as I was out of commission for several months due to surgery for a severe retinal detachment in my eye. Over the past 2 weeks I’ve been making my way back to the gym slowly (6 workouts thus far).
Because I was brought back to baseline, I didn’t have a lot of muscle mass in my legs. Thus, I was able to feel a significant difference in the amount of actual hamstring tendon when I would flex (if that makes sense) in the back of my right knee as compared to my left. I feel this is greatly hindering my ROM for flexion, but I suppose that this may be out of my hand?
In my time back at the gym, I’ve focused on a lot of unilateral exercises. I believe that training both legs equally at this point isn’t going to make much sense, and I need to build in fact, MORE muscle in my right leg to be able to better balance and also, prevent further deterioration to the cartilage in my right knee. I actually had been feeling a lot of knee pain as a result of being unable to really work out and build/maintain muscle. If you could follow up with me, I could inform you as to what exercises I’ve been doing and will attempt to begin in the near future.
I myself just turned 27 and prior to my injury, was an extremely active individual. I still am working towards the day when I can achieve as much knee flexion as possible and be able to keep up with my other leg with exercises. I would love to be able to play basketball and soccer again at full capacity, sprinting at will and stopping on a dime without a fear of pulling my hamstring. I’m aiming for a period of 6 months time/100 workouts until I can really assess myself.
Also to note, I recently underwent some x-rays and ultrasound, and am planning to get another MRI done on my leg. I want to see how my knee is doing so far in terms of how the ACL is looking, how my meniscus is holding up, and how much my hamstring tendons are differing from each other. Do you think that’s a good idea?
Once again, I really appreciate the work you’ve put into your site. I look forward to any feedback you have to offer pertaining to my situation.
Best wishes,
Ben
reddyb
December 30, 2013
Hey Ben,
Thanks for the nice words.
In regards to your flexion ROM, are you talking about active or passive? Actively could definitely be from the graft. If you’re still having limits passively, that wouldn’t be from your graft. That could be something you didn’t work on enough in the beginning, something structural (screw(s) perhaps), or something you haven’t addressed enough overall. In general, limits in passive ROM after this surgery are due to poor rehab practices. There’s rarely a reason it shouldn’t be attained. Your 70% meniscal removal could be a factor, but I’ve seen plenty of people with as much or less meniscus than that, who are considerably older, with no ROM issues.
Again, active is different than passive. Full, active knee flexion, might be something that doesn’t agree with you anymore, which is common after knee surgery.
Regarding exercises, that would take a thorough follow up. I believe I’m going to have something up on the site soon for brief consultations of this sort. Something like 30 minute (or however long) phone call. Might be something you’d be interested in.
You don’t want to hear this, but my honest opinion with all ACL people is if you can get yourself to be active, not in pain, with a good working leg, you should be happy. You’re better than many others. Playing basketball, soccer, sprinting at will, and stopping on a dime are going to be incredibly hard to attain. Physically you could even be great, but psychologically this is a daunting task. Jamaal Charles, a running back for the KC Chiefs, had ACL surgery a couple years ago. He came back great last year, yet still said he thinks about his knee all the time and believes he always will. Comparing him, a professional athlete, to the weekend warrior type, and you can see the difficulty of what you’re describing.
Plus, a 70% meniscal removal at your age is drastic. If I were you, my priority would be to have a healthy knee for 60 more years that doesn’t need any more operations.
I shy away from the MRI idea. You need to ask yourself, “Am I willing to have another surgery?” If that answer is yes, getting an MRI is the first step down that road. With your knee history, it’s easily conceivable they find something worth operating on. If your answer is no, I don’t see a reason to get an MRI. You’re pretty much guaranteed to get a report back which doesn’t look good. If nothing else you have 70% of your meniscus gone, which never looks good on a radiology report.
You can have a shitty MRI yet have little pain, good function, etc. (Notice I’m not saying play sports with no issues. That’s different.) All a shitty MRI does in my mind is make you worrisome. I talk about this a bit here: http://b-reddy.org/2013/12/13/feeling-perfect-is-not-the-goal/
What you likely need is a good, thorough exercise program. After one of those, done for a considerable amount of time, if you’re still having basic issues, an MRI might be worth it.
Ben Reyhanian
January 4, 2014
Hi Reddy,
First off, thank you for your quick and informative response! I’m very grateful for it, and honestly can’t believe so many more people don’t post to you for advice or insight.
The problem I have is referring to active flexion. Passively, I can pull my shin in so that my foot touches my butt no problem and without any pain. Actively, I can flex my left leg to about 110 degrees or so from a standing position. However, I cannot for the life of me flex my right leg a little more than 90 degrees. It just feels like something is blocking my hamstring from flexing, although I highly suspect it’s a result of a major loss of tendon. In fact, I’m always feeling my hamstring tendons underneath both knees and comparing them. To be honest, it feels like there’s a whole lot of hamstring tendon missing in my right leg. Do you think the surgeon could have potentially over-harvested? With that said, I am really leaning towards an MRI just to see what exactly is going on in terms of my anatomy right now. I think it would be important to know if I do have a lot of my tendon missing as it could provide better insight into formulating different exercise plans.
One thing that I am just getting very frustrated with is trying to build my hamstring strength back. The issue is (and I’ll try to explain this as clearly as possible) that it is so much harder for me to build actual muscle when I have a limited range of flexion. With my left leg, I have full flexion so I’m able to “hit” all the muscles and work them. With the right leg, I can’t essentially “hit” all the hamstring muscles I need to work in order to strengthen the overall area. As a result, I find that different hamstring muscles are actually being activated in opposing legs during curls.In fact, hamstring curls without any weight at all are extremely challenging for my right leg. I focus on hitting both the positive and negative in my curls, but the leg just tires out way too quickly.
It was also hard for me to read what you said here: “Playing basketball, soccer, sprinting at will, and stopping on a dime are going to be incredibly hard to attain.” Now, I have to say that I’m not very concerned about my meniscus situation because the reality is, they are making huge advances in cartilage restoration, preservation, and treatment each and every day. With that said, I’m very confident that by the time it becomes an issue for me (ranging anywhere from 5-20 years) there will be some very good solutions available. With that said, I really haven’t been doing much to cause any further cartilage deterioration anyways.
I can gladly upload some videos if you have difficulty visualizing anything that I’ve said.
Thanks Reddy!
Sincerely,
Ben
reddyb
January 5, 2014
-Surgeon potentially over harvesting
Possible? Sure. Likely? I have no idea. I’ve never looked into the “mistake rate of graft harvesting” of ACL surgery. This type of information is notoriously hard to get. It might not even exist.
What I do know is: You can’t expect your hamstring to return to normal. It doesn’t happen. You can get close, but not normal. There’s good data on this. Same goes for patellar grafts. You can get the quad back close to normal, but not normal. We have some lizard like ability to regrow body parts, but not to the point we can completely regrow things like they’re new.
The only way you’re going to be hitting different hamstring muscles in a curl is through the alignment of your foot. I briefly cover this in the post, but foot turns out = more biceps femoris; foot turned in more medial hamstrings. They’re all still working as flexors, but you can change how they work in terms of lower leg rotators. Might be something to consider.
If hamstring curls without any weight are very challenging for you right now, there’s no need to use weight. Once you add weight you’re going to compensate, such as using your lower back. You may be trying to do too much right now.
-I’m not sure knowing how much tendon you’re missing can change what plan you have. I just don’t see how that changes things. Your function, how you feel, how you move, is what’s important. But feel free to clarify what you’re thinking.
I’m sorry man, this isn’t true. Arthroscopy, which is how these surgeries are done, became mainstream ~35 years ago. In that timespan our idea of meniscal surgery has moved from “Take it all out” (menisectomy) to “Take as little out as possible” (partial menisectomy). We haven’t come far, and there’s no indication we’re getting anywhere.
ACL surgery decades ago revolved around patellar grafts. The gold standard is still patellar grafts. This is what all the high level athletes have done. They don’t have any of the new age stuff done. IT band grafts, hamstring, achilles, robotic surgery, etc. They have what was being done 3 decades ago as it’s still what’s considered best.
Even if we do come up with some great meniscal remedy, by the time it’s mainstream, we know it’s safe, it’s approved, would almost assuredly be at least 10 years from now.
Next, chances are it will be using foreign substances. Which in the body is never better than your own body. And we are nowhere near making surgery a “routine procedure.” No surgery, any time, especially orthopedic surgery, is routine or noninvasive. Not until they stop making people sign the, “You could die during this,” amongst other factors.
The only possibility I’m aware of that seems like a panacea is nanotechnology. This is Star Trek type shit. Something like where we are able to build microscopic robots, insert them into your knee, they go around cleaning up stuff, repairing things, then we take them out and you’re good as new. Lord knows how far away that is.
Lastly, what if it takes 20 years (or whatever) for some great remedy to come about? What if 10 years from now is when you end up really needing it? 10 years of your life is a lot of time to have significant issues. You’re making a risky gamble.
Sorry for the rant, but betting on the future in this context is ill advised in my mind. Taking the best care of your knee right now FOR the future is a much better approach. Then, if something comes along, great. But how much better would it be to not need something to come along because you’ve taken great care of the leg in the meantime? Hell, if you take good care of your leg, you could have bone on bone and still have great function! Playing sports at a high level? No. Great daily function? Absolutely.
The goal after surgery of this fashion, in my opinion, is very simple: To not need another surgery. Of course, to each their own. But keep in mind my opinion is based on research, not just how I feel.
As a tangent, where we’ve actually come very far in all this stuff is not the surgical procedures, but the physical therapy. We used to cast people up for months after a knee surgery. Now we make them move the day of surgery!
Remember how I said we’ve gone from “Take it all out” to “Take very little out?” We’ve even found physical therapy after something like a meniscal tear is just as effective as meniscal surgery. Further illustrating how far we haven’t come: No surgery for a meniscus issue is often better than surgery! We’ve gone from “Take it all out” to “Take very little out” to “Don’t even open the knee because our surgical procedure is worthless.”
Ignore the media on this topic and take a hard look at the data. Even if you want to compare yourself to an athlete, the likelihood of a professional athlete returning to form after this surgery is no better than a coin toss. The guy who did Adrian Peterson’s surgery, Dr. James Andrews, is actually the doctor who has performed found this out!
Again, sorry for the rant. I’ve spent a lot of time thinking about this topic.
Ben Reyhanian
January 25, 2014
Hi Reddy,
Thank you for your response. You make good points regarding the progress they’ve made so far with regards to cartilage. In fact, the one positive I’ve taken from my surgery is that it’s prevented me from really playing any kind of team sport and I suppose as a consequence…any further injury or damage. I looked up Dr. James Andrews and I have to say, after reading all the testimonials, I WISH he was my surgeon.
Regarding whether or not to get an MRI, I read your page on that and it was quite interesting to see your thoughts it. For myself, I think that getting an MRI will at least help me better understand, and eventually really accept what’s happened to me. You know I’ll be honest, I had no idea how serious and life-changing an ACL surgery could potentially be (connects with your other page which I read as well). I never in my wildest dreams thought that my athletic days would pretty much be over at the age of 25…but that’s what it’s been like the last 2.5 years.
Elaborating further on what I just said re: “life-changing”. You know Reddy, ever since the surgery I’ve felt that something was very off. Ever since then, walking has been different (I often still wobble when I walk and fall over to my left “strong” side). Standing is still different (one leg is usually more flexed than the other). Turning, squatting, lifting my leg to put on my pants…etc. And so, with every movement I take, I’m thinking about this. It’s like having a fly in your face 24/7…
I’ve been doing A LOT of research the last few weeks regarding recent studies, advancements, comparisons between graft types, etc. I’m pretty sure (will find out soon) that my surgeon harvest both my gracilis and semitendinosus in the procedure. It makes sense because one of the tendons is pretty much missing there and has been replaced by muscle. It also makes sense as to why I have enormous difficulties achieving deeper flexion in my leg. I had always thought that it was just due to lack of muscle strength (in addition to what other trainers and PTs were telling me). I think that, now that the tendons are gone, it’s just not possible to achieve proper flexion. I also feel that, now with the lack of support from these tendons, it may actually accelerate my cartilage deterioration.
It’s funny how before the surgery and even 1 year after, I had no idea about all of these things. I suppose it’s because everyone was telling me the same “don’t worry, it’ll come with time”. Well, I think that 2.5 years has been enough time to get a good assessment as to what’s going on. With that said, I do have to start a proper exercise routine.
Thanks for listening Reddy,
Ben
reddyb
January 26, 2014
I wouldn’t feel too bad. Average NFL player’s career is over at 25.
-Harvesting both tendons is very common, I believe it’s the norm now. This wouldn’t impact your progress in the way you’re thinking.
-One thing an MRI may be useful for is finding out how much of your tendons have come back. I have seen some reports where something like the semitendinosus doesn’t regenerate. This is the unusual instance, but it’s not crazy unusual.
Regarding your other issues, I would be much more on the side of “I need to figure this movement and exercise stuff out” than the “I need to find a new surgical procedure” side.
There is no reason to give up hope. To give you some context:
-I had no ACL for 7 months and my knee was completely fine in everyday life. My rationale for getting surgery was not “I need an ACL for the everyday health of my knee.” It was for other reasons.
-I have a guy right now, 25 years old, who has had something like 9 surgeries between both of his knees. His health history would make you feel like the luckiest person alive. Is he a normal person where you would never think anything ever happened? No. But for everyday life, his knees are more than adequate. He also Leg Presses, Squats, Lunges, etc.
-I’ve worked with plenty of people with bone on bone knees and had no issues. Were they playing sports? No. Were they exercising a bunch, hiking, playing with their kids, their dogs, etc? Yes. And they still are.
Point being don’t obsess over structural changes in your knee. They are not “knee death sentences” (for lack of a better phrase).
Sandya
March 24, 2015
Hey Reddy
It was good reading what you have written. I had both a lateral meniscus tear and a complete ACL tear. They first did the surgery for the meniscus and I was asked not to put weight on the right knee (operated knee) after two weeks they did the surgery on the same knee for the ACL. Well I then did not have much of an idea about this. Its nearly 4 months now after the surgery my knee is still not straight. Add to it I have initial stages of Arthritis. If I sit for a little longer time I find it difficult to get up and walk my knee hurts. If I keep my knee straight for too long I struggle to bend the same. I started physio a bit late
reddyb
March 24, 2015
Hey Sandya,
Wow. Two separate surgeries? Not sure I ever heard of this situation before. Do you know what the rationale was behind this? Tough for me to imagine this is ever optimal.
Get working on your knee extension! It’s crucial! I write about this a ton with all my ACL content.
sandyarod
March 25, 2015
Thanks for the response yes working on knee extension it is a painful process. Really not sure why they did two surgeries and not one
reddyb
March 25, 2015
Working on knee extension may be uncomfortable at times, but it should be minimally painful, if at all.
Chisom Okolie
May 29, 2015
Hello,
I’ve had snapping pes syndrome (snapping hamstrings) for three years. On my left left leg the gracilis and semitendinosus tendon are snapping on my medial side and on the back of my knee. On my right side, the gracilis and semitendinosus tendons snap, but the gracilis is more present than the semitendinosus. Also on this side, the bicep femoris is snapping on the lateral side. The pain is becoming progressively worse. Symptoms include acute pain, numbness, tenderness, stiffness, and inflammation. As a result I have a lot of scar tissue accumulating in my knees. I’ve tried countless treatments from physical therapy to a cortisone injection, and so far nothing has worked. I’ve seen countless doctors and they’ve either said nothing is wrong or they simply won’t do surgery. This injury has led to me tearing my Achilles in football because of my inability to fully push off and extend my leg. My stride in running is restricted as well as my hair when I walk. I’ve tried dealing with the pain, but I’m desperate for a solution. Can you please help me in anyway.
Thanks,
Chisom C. Okolie
reddyb
June 1, 2015
Hey Chisom,
Out of curiosity, how have you been able to differentiate between those muscles? That’s pretty tough to do.
Have you had imaging done? Such as to rule out a meniscal issue?
This just randomly started on you? Or do you have some history which this started afterwards? (For instance, this is a post about ACL reconstruction and a hamstring graft.)
Chisom Okolie
June 1, 2015
Yea I’ve able to differentiate the pea anserine tendons and yes I’ve gotten an ultrasound to confirm my condition. My question to you is the chances of my recovery if I decide to get my semitendinosus and gracilis tendon excised? And I’ve never tore ACL.
reddyb
June 1, 2015
That depends on what you mean by recovery. Chances the symptoms go away? I’m not sure. Chances your leg gets back to normal after excision? Minimal, if any.
Excision is a drastic measure. It’s not a fun thing to attempt to come back from.
I’d look at other factors first. Such as how you’re extending your leg. More here for instance: http://b-reddy.org/2013/07/29/better-exercises-to-stretch-the-hamstrings/
I’d be interested to see if there were differences in how you felt based on how you straighten your leg, what your hamstring flexibility is like, etc.
Chisom Okolie
June 1, 2015
Lol I’be been on that link in the past and tried all the exercises and it hasn’t really done much. The solution I read up on is to harvest the tendons. Look up snapping pea syndrome on google and it’ll show you some articles. This is a very rare condition
reddyb
June 2, 2015
There are many other potential solutions besides harvesting tendons.
Edit: Meant to say “potential solutions”
Dean
September 25, 2015
Hi,
First off: Thanks for posting this article. I’ve felt for a long time that I was the only person in the world with this problem.
I had an ACL reconstruction (Hamstring Graft) along with a lateral meniscus repair on my left knee (From a bucket handle tear). This was back in May 2010.
Now with a combination of a lack of education, poor discipline at times, therapists that didn’t adequately guide me and poor functional form….I’m still struggling to bring my heel to my bottom without any weight. It’s utterly demoralising. I spent a lot of time extending and building up my quads in the year after my surgery.
I recently twisted my knee again (whilst rotating and stretching in May 2015). I had a MRI, which showed my ACL is fine and intact. But my lateral meniscus is torn again.!!!!!! I also had a consultation with a surgeon (knee specialist) who told me that I should have surgery and therapy would not help. I also discussed my hamstring problem and he said that my gracilis tendon is ‘shot’ and that I’ll never get that sensation of deep knee flexion back when standing. He was quite arrogant in my opinion and I really didn’t enjoy spending £200 for a 15 dismissive chat.
My Hamstring feels as though there is knot trapped, something is missing. It’s like I always need to stretch it. I cycle every day and this has not changed the feeling. Psychologically my body feels out of balance. Not properly aligned. Even when I cycle I’ve noticed I’m leaning over to the right. I ride fixed wheel, which has revealed that my mental confidence on my left side is weak. For example: When I balance on my bike (stopping at traffic lights for instance without dismounting) I have to turn my wheel to the right as i can’t execute the action with my wheel turned left. Apologies if this is way too much personal info. But hey….If I never fix my issue but can help someone else who is considering a hamstring graft. Then it’s worth it.
After reading this article I tried the standing leg curl with proper form and I can only manage 3 or 4 before the struggle starts. But I have definitely been training incorrectly, which has contributed to my problem.
After 5 years of wondering down many roads, several consultations, searching the web, in the gym trying. I’ve come to some realisation that I really would like to avoid another surgery and that if I can build a ‘proper’ programme that is focussed around this acute issue I will see some results.
I’m not on a quest to feel as I did before surgery. However, I’m adamant that I can get some balance back and where I can raise my left leg and lean on a wall without needing my arm to pull my leg up to be comfortable!!
It’s like I have bulk and mass but no core stability or strength to do the basic leg curl. I’m embarrassed but determined to improve. (Like a really big balloon – but filled with air)
I’d love to know if anyone here who has had a hamstring graft could share a training program that I could use??? Or share your best exercises for tackling this issue. I’d like to commit to a 6-12month program and chart my progress.
I’d be most greatful.
Best,
D
reddyb
September 28, 2015
Hey D,
I recently wrote something about a meniscus repair failing: http://b-reddy.org/2015/09/21/your-knee-just-locked-on-you-what-do-you-do-the-fickleness-of-the-meniscus/
How someone can do with a meniscus tear depends on a lot of factors, but surgery is not always necessary. It’s usually not necessary. Sometimes it’s true though, that the only thing left to help things is surgery. (Discussed in the link above.)
For regaining hamstring strength, after ACL surgery, most will not recover full strength from wherever the graft was taken. If it was a patellar graft, full quad strength (knee extension) likely won’t return. If it’s a hamstring, full hamstring strength (mainly knee flexion) likely won’t return. One can usually get very close, but getting to the point where both sides feel the same doesn’t usually happen. A huge chunk of tendon has been cut from the body, and the body remembers that.
In terms of your hamstring stiffness, I wouldn’t expect cycling to do anything for that. If anything, cycling may stiffen things up even more, depending on how bent your legs are. (Other things can factor in here, but it’s a bit technical for a comment.)
You may want to take a look at this article on loosening the hamstrings: http://b-reddy.org/2013/07/29/better-exercises-to-stretch-the-hamstrings/
You probably want to start out working on the hamstring curls in prone first, as it will be easier: https://www.youtube.com/watch?v=mUQRuyVoNYQ
Then you can progress your way to standing, once something like a few sets of 15-20 reps are fairly easy.
If you want more on reps and sets: http://b-reddy.org/2013/06/20/how-many-reps-and-sets-to-correct-muscular-imbalances/
I likely wouldn’t be using some generic hamstring strengthening program either. You need to individualize whatever you do to yourself, and more than likely need to be working on more than just hamstring strength. If you feel that out of balance, some other stuff is probably going on. (I offer remote work. More here if you want to take a look: http://b-reddy.org/2013/06/20/the-remote-client-process/ )
Chisom Okolie
September 28, 2015
If your snapping hamstring tendons aren’t painful, it’s best to manage it. Otherwise, surgery is the best option to relieve pain and future structural damage.
*This condition is so rare that many assume is not a serious matter. For the longest, I thought similarly. However, as time went on the pain got increasingly worse to the point where I would have to avoid doing certain activities just so I won’t feel any pain or discomfort. If you’re not going through this condition don’t assume what’s the best option because you don’t know what it feels like.
reddyb
October 1, 2015
Hey Chisom,
Was wondering what route you ended up taking? Did you have an excision done?
Chisom
October 2, 2015
I’m about to have the excision. Doctor says that’s the best option especially if I’m dealing with pain and discomfort. Trust me I don’t want to have surgery, but if that can help alleviate my problem, I must comply.
reddyb
October 4, 2015
Gotcha. What’s being excised exactly?
When are you having it done? If you don’t mind, would love for you to update me (and everyone else). Would be interested to hear how things go for you.
If the excision is soon here, best of luck!
Chisom
October 4, 2015
My gracilis and semitendinosus tendons on both legs are being excised. However, on my right leg my bicep femoris tendon is snapping over the fibular head, so the doctor will suture that back to its rightful site. My surgery is scheduled for December 18th.
reddyb
October 6, 2015
Gotcha. Has your surgeon found anything particular about you they think is causing these issues? Like abnormal knee structure?
Chisom
October 7, 2015
No knee abnormalities were discovered. From what they gathered it’s heredity.
reddyb
October 8, 2015
Was curious was some of those hereditary factors could be.
Found this, if you haven’t seen it, or others are interested: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014471/
Chisom
October 8, 2015
I’ve read that article already. I’ve done extensive research on my condition for over three years.
Chisom
May 28, 2016
I’m 5 months post op. I still have one tendon snapping behind my left knee. Overall the surgery was a success and my hamstrings aren’t too weak.
reddyb
May 28, 2016
Good to hear!