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Hi All
I have been contacted by an interested party regarding a race walker that has a knee problem. Some walkers have a leg action that is referred to as hyper-extension, where the knee appears to be bent further forward than the normal straight action when in the extended position at heel plant, and during the motion where the knee passes under the hip (with the leg in its support phase) and the body moves over this supporting leg.
The walker is experiencing pain (and swelling) behind the knee and has had a number of tests to find the cause of discomfort.
Attached below, please find some details of the treatments used.
If anyone has any ideas on the topic, please let me know. At this stage I have suggested calf strengthening (for foot flexibility) for better toe-off and a possibility of using heel inserts to ease the tension when the foot is in its final stage of heel/ground contact before the foot rises at toe-off.
I have also suggested a visit to the ADIDAS Sports Medicine Clinic in Auckland (NZL) where there are specialists who deal with knee problems.
Comments passed on to me are as follows;
DOB: 13/12/88
Chronology
Date Event/Action
Chronology
Date Event/Action
January 2003
Strained inside of left knee during a race walk training session (road).
Physio determined a strained (or possible slight tear) of the cruciate ligament*.
Physio administered ultrasound; prescribed exercises, and checked injury weekly.
Injured area pain and symptom free within 6 weeks
Strained inside of left knee during a race walk training session (road).
Physio determined a strained (or possible slight tear) of the cruciate ligament*.
Physio administered ultrasound; prescribed exercises, and checked injury weekly.
Injured area pain and symptom free within 6 weeks
March – July 2003
Occasional race walking only.
Cross country running.
(pain free)
August /September 2003
Injured same knee during a 5 km race walk in early August (road).
Extreme pain experienced during race at back inside knee (pes anserinus region*).
Physio determined that the injury XXXX sustained to the cruciate ligament in the same knee
back in January had left her with more knee extension when locking the knee and this
hyperextension had lead to a strain of her unaccustomed winter hamstring while race walking.
Injured same knee during a 5 km race walk in early August (road).
Extreme pain experienced during race at back inside knee (pes anserinus region*).
Physio determined that the injury XXXX sustained to the cruciate ligament in the same knee
back in January had left her with more knee extension when locking the knee and this
hyperextension had lead to a strain of her unaccustomed winter hamstring while race walking.
Prescribed ice and message and anti-inflammatories to reduce initial pain (which worked, albeit
slowly); and then hamstring strengthening exercises to strengthen the area.
slowly); and then hamstring strengthening exercises to strengthen the area.
October – December 2003
Commenced 2003/2004 athletics season and raced (3km on track) comfortably until close to Xmas
before return of symptoms – a noticeable ‘tugging’ initially, but slowly building up to
eventual searing pain. Painkillers/anti-inflammitories (tablet or topical) do not work to
‘prevent’ pain – they don’t even mask it.
Same diagnosis, and same (and some extra) hamstring strengthening exercises prescribed.
January – March 2004
Remainder of season interrupted with pain, and eventual withdrawal from race walk training and
competition.
April – June 2004
No race walking of any kind.
Cross country running and a bit of light weight training. (pain free)
July 2004
Recurrence of pain when deciding to tackle a 6km race walk (road). Had to pull out after 3km
(first and only time XXXX put stubbornness to one side and actually pulled out of a race).
Informed physio that this problem had been put on the back-burner for too long while XXXX concentrated on other things, and it was time to seek further advice.
August 2004
Met with XXXXX at XXXXX Sports Med.
The 'blind' prognosis was tendril-like scarring and a possible cist resulting from the original
injury, and/or pes anserinus tendonitis/ bursitis*.
Physical tests also confirmed increased hyperextension in the knee joint, and a marked overall
weakness in that leg in comparison to the unaffected leg.
weakness in that leg in comparison to the unaffected leg.
XXXX confirmed the importance of keeping up with the hamstring strengthening exercises.
XXXX provided XXXX with some Synflex (550mg) tablets to try during a ‘test’ race the following
weekend – just to see if that sort of medication would mask the pain – it did absolutely
nothing.
weekend – just to see if that sort of medication would mask the pain – it did absolutely
nothing.
X-rays and ultrasound ordered, both of which showed no tendon, hamstring or joint damage.
The area (very specific, and no bigger than a 10 cent piece)* sometimes showed a slight
puffiness which could indicate a collection of fluid in the bursa, but nothing showed up on
X-ray or ultrasound.
The area (very specific, and no bigger than a 10 cent piece)* sometimes showed a slight
puffiness which could indicate a collection of fluid in the bursa, but nothing showed up on
X-ray or ultrasound.
September / October 2004
2 MRI scans undertaken – neither of which showed up any abnormality.
Web research regarding injuries/pain in the pes anserinus region indicated pes anserinus
tendonitis or bursitis and mimicked XXXX's symptoms, and some sections could have been taken
direct from XXXX's medical notes.
Up until this point, XXXX had only ever experienced pain as a result of the specific event
of race walking*. However, during this phase XXXX was starting to experience discomfort
during prolonged activity other than race walking, and the problem seemed to be getting worse.
The concern then was that the gradual worsening of the symptoms was not only prolonging recovery,
but was starting to affect her equally important event of javelin.
but was starting to affect her equally important event of javelin.
November 2004
XXXX administered a cortizone injection, which was followed with 5 days clear rest from physical
activity, following which XXXX was able to train and race at speed completely pain free through
until January. Exceptional improvement over 3km, and she took nearly a minute off her PB during
this time.
January 2005
When the ‘niggle’ started to appear again, a second cortizone injection was administered,
which lasted exactly 4 weeks.
March / April 2005
The third and final cortizone injection was administered, but this one did not work at all.
Season finale was a non-event, as the pain was so bad by then that XXXX couldn’t seriously
compete at the javelin either.
April 2005
Follow-up with the physio suggested more rest away from race walking, although physical test
showed a marked improvement in general left leg strength.
Reminded physio that the area had enjoyed frequent bouts of rest, but that the benefits of rest
didn’t last and as soon, or shortly after, XXXX resumes race walking, the screaming pain
returns. The longer the rest period, the more races she could squeeze in before the pain
resumed, but of course that means no training either, which means improving race walking fitness
is a case of one step forward and two steps back.
didn’t last and as soon, or shortly after, XXXX resumes race walking, the screaming pain
returns. The longer the rest period, the more races she could squeeze in before the pain
resumed, but of course that means no training either, which means improving race walking fitness
is a case of one step forward and two steps back.
The first two cortizone injections administered by XXXX worked well, and offered excellent
short-term pain relief which allowed for some good racing, but it was not a permanent remedy,
and not one she wished to rely on in future.
short-term pain relief which allowed for some good racing, but it was not a permanent remedy,
and not one she wished to rely on in future.
May 2005 to the present
Returned to netball.
No race walk training or competition.
Regular hamstring exercises.
Intermittent sessions at the gym.(pain free)
Did a mountain walk in July, and race-walked the flat portion of the course (approx 600m)
before commencing the hill climb and although no pain, the familiar ‘tugging’ sensation was
present.
before commencing the hill climb and although no pain, the familiar ‘tugging’ sensation was
present.
I did notice during a couple of XXXX’s last races in February/March that the left knee’s
increased hyperextension seems to be affecting her general style too – she’s not as ‘straight’
as she used to be and has lost the ability to ‘glide’. As well as the knee in question locking
further than the other, it also appears to twist outward. It’s difficult to know what came
first – the pain and discomfort of the condition affecting her style, or the loss of style
exacerbating the condition?
The pain XXXX experiences is unpleasant, but the see-saw effect of having a couple of good
races following a period of rest, and then everything turning to custard at crucial times is
just mental torture.
increased hyperextension seems to be affecting her general style too – she’s not as ‘straight’
as she used to be and has lost the ability to ‘glide’. As well as the knee in question locking
further than the other, it also appears to twist outward. It’s difficult to know what came
first – the pain and discomfort of the condition affecting her style, or the loss of style
exacerbating the condition?
The pain XXXX experiences is unpleasant, but the see-saw effect of having a couple of good
races following a period of rest, and then everything turning to custard at crucial times is
just mental torture.
* important points
I look forward to your knowledgeable responses.
Cheers
Gary
************************************************************************************
Gary Little & Asta Wistrand
Ph/Fax 64 9 846 6671
Check the details of running and walking training programs and free newsletter at
www.profitness.net.nz AN INTERNATIONAL WAY TO WIN.
Take a look at the famous MailWasher anti-virus protection program.
You will find a link at the bottom of the Program Fitness webpage
*********************************************************************************
Gary Little & Asta Wistrand
Ph/Fax 64 9 846 6671
Check the details of running and walking training programs and free newsletter at
www.profitness.net.nz AN INTERNATIONAL WAY TO WIN.
Take a look at the famous MailWasher anti-virus protection program.
You will find a link at the bottom of the Program Fitness webpage
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