Hey Beth,

I had ACL replacement surgery in February, and am almost ready to be released, but cannot sit on my heels without excruciating pain. This means no knee-paddling!

Can you suggest guidelines to break up these adhesions? I currently cycle daily, and will begin roller skiing and inline skating next month. I’m also a competitive x-c skier.

Thanks!
Jerry

ANSWER:

Hi Jerry,

Below is the info from Lance, the kick ass surfer/PT master. Very helpful info. My input is to just make sure that your muscles surrounding that joint stay super strong and you are not compensating once you get back into your regular activities. You are going to have to be on top of this injury for awhile even when you start to feel better. Especially in keeping everything nice and open.

Best of luck. I agree with the knee-paddling….No big deal as long as you are able to surf!!

Hasta,
Beth

Hello Jerry,

Breaking up scar tissue can be difficult, you have to keep on it. I’m assuming that “almost ready to be released” means that you are working with a physical therapist, so you most likely have a program for working on the end range flexion. If not, then find a PT who will work with you to show you a program and do some manual therapy. There are no magical techniques, it just takes time and persistence. Sitting on your knees is one of the last things to return after this type of surgery. You have to keep stretching, slow and gentle. If you push too hard, you are going to irritate the tissue and cause further inflammation, possibly leading to more scar tissue. Hopefully, the limit is anteriorly and superficial secondary to adhesions from the incisions or patella tendon (patella tendon repair). This type of limitation will stretch out easier than limitations deep in the joint.

For now, you will have to paddle prone, this is better than not surfing. Make sure you are ready for a return to surfing by asking your rehab team because you are only six months out. At six months you feel strong and ready, but you have to be careful because the graft is still gaining stability. The other sports you are doing do not require deep knee flexion like knee-paddling. You should be okay there. Good luck!

Lance Harriman, MSPT
Potrero Physical Therapy
415-701-1000
www.potreropt.com

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I just had ACL reconstruction surgery (hamstring graft) after an injury I sustained at Salmon Creek about two months ago. I know I’m looking at a long recovery, and a long time out of the water, but are there specific exercises I can be doing to increase my rate of recovery? How about surf-specific exercises? Should I pursue wearing a brace for my return to the water? Anyway, any information about this bummer of an injury you could pass my way would be great.

Mahalo,

Jamie

ANSWER:

Hey Jamie,

Sounds like you are doing the right thing with a good PT. Keep strengthening those muscles surrounding the knee but do it carefully! The problem I used to see in PT with eager athletes was they were super eager and pushed it too far. This resulted in unnecessary pains and inflammations. As for when you can surf, I have to say that you need to listen to your PT and doc. They know best and know the integrity of the joint, the new graft, and the strength of your “borrowed” hamstring. YOU may feel physically ready but the whole joint may say no way!

As for now, you can definitely keep your upper body and trunk in shape by lifting weights and doing sit-ups. It may get boring but it is better than nothing and a great way to keep your surfing muscles strong. Not to mention a great time to work on strengthening muscles, which get ignored while surfing. Take some time to stretch out the whole body while you are at it. It will definitely help your recovery.

Get in the pool as soon as the doc or PT gives you the a-okay. Swimming is not only great fitness for surfing but water also helps with the swelling in the knee. Water running is also a great alternative for conditioning and helps increase flexibility of the joint. (That is, of course, once you are allowed to add some leg exercises).

As for a brace, it’s not a bad idea when the time comes for you to surf. A brace gives some stability- but more important- it reminds you that you are injured and need to be careful. It is not just the act of surfing that could hurt your knee. It is also walking out, duck diving, unknown hazards (much of surfing!), cutbacks, etc.

Be safe, smart, and remember that it is better to let the knee heal 100% and avoid any setbacks. You don’t want to have to go through this again!

Hasta,

Beth

(Posted 6/21/04)

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Scott J.

ANSWER:

Hey Scott,

There are definitely some stretches to do for the IT band, but you want to be careful not to overstretch that area as it is probably inflamed a bit. You will also want to spend some time stretching the whole lower body as other tight muscles contribute to the IT problem.

Are you doing a self-diagnosis or have you been to a doctor yet? It may be a good idea to go to a doc, get a diagnosis, and then get a prescription for some physical therapy (preferably a PT who understands athletes). Then you could get the whole breakdown on why this is happening, what you need to strengthen to prevent this from continuing, and a great stretching program that is safe for your injury. It is hard for me to give you specific stretches/exercises over the Internet.

Once you get a proper diagnosis, you may want to try some acupuncture to help with the inflammation. It has definitely helped many an athlete with IT band issues. Also, ice helps a ton. IT bands like “ice massages” which can be done with some Dixie cups. Fill up a bunch of Dixie cups about 2/3 the way and then freeze them. Once frozen, grab a towel and start massaging the area with the ice in the Dixie cup. (Tear away the paper so you can access the ice). The reason for the towel is to catch the drip! As the ice melts, continue peeling the Dixie cup away. 8-12 minutes should suffice.

Again, have a doctor check out this injury, so: A) You know what you are dealing with, and B) You fix it for good so it doesn’t bother you again mid season.

Good luck and happy training!

Hasta,

Beth (Posted 10-02-03)

Editor’s note: Check out Surf Flex for a thorough guide to surf-specific stretches.

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Beth – I’m 38 and an avid surfer who started to run several years ago to help out with my cardio conditioning for surf trips to Hawaii, Indo etc…just couldn’t keep in shape from just surfing like I used to when I was younger. Well, now it looks like I’m going to run the San Diego Rock n’ Roll marathon in June. My question is actually about running. I usually run 5 days a week with an average of 30 miles a week, including a weekend long run of 10 miles. No consistent speed work, but I’ll throw in a 3 to 4 mile tempo run at a 7 minutes per mile pace every now and then. A few months ago I started to increase my long run every other week and now have it up to 15 or 16 miles. I run this distance at a slow pace, between 8.5 and 9 minutes per mile. However, it seems that about half the time I run over 10 miles, I developed a focused type of discomfort behind my right knee area. I can keep running without altering my pace or stride, but once finished it tightens up on me. The discomfort almost feels like a mild stretch type of injury. It will stay around for a day or two and then it might not come back until another long run. I really don’t know any “runners” or triathletes, so I was wondering if you have any impressions on what this injury might be and any suggestions. Thank you, Sean Q.

ANSWER:

Hey Sean,

This sounds so familiar! I used to work in a rehab clinic where we saw many marathon runners who came in with the “odd” injury. No real rhyme or reason and the pains aren’t enough to stop them from running. Same with many of my triathletes. Problem is, there IS something going on and if it isn’t taken care of, it could get you later. Sounds like you gave yourself a decent base before ramping up the miles. Hopefully, you did not jump from 10 to 16 miles in a 1 to 2 week period. As you get into the longer days, you definitely want to take a rest day and maybe not do another long day for 1 1/2 to 2 weeks, especially if you have a nagging injury. I would check out some of the training books that are available which give great guidelines for safe marathon training.

For your injury, I would get it checked out ASAP. If you live around SF, I would call Presidio Sport and Medicine (415-674-9530) and make an appt for a 1-time evaluation. They will try to assess the problem and figure out WHY it is happening rather than just making the acute pain go away. Better to get rid of the pain before it gets unbearable and you are unable to run your race! The Physical Therapists at Presidio Sport and Medicine deal with TONS of runners and triathletes and their goal is to keep you in your sport. Not to mention, it is a great place to meet potential training partners. Good luck in your race. It is a fun one!

Hasta, Beth

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Dear Beth,

I’m hoping (praying) that you might be able to shed a little light on a long-term condition I’ve had with my knee. About ten years ago I began noticing some minor “popping” whenever I’d ride my bike. This seemed to occur immediately under the kneecap. It would occur about once or twice a week; as the knee bent and extended, there would be a few ‘clicks’ and then one big ‘pop’. After that it would be quiet again. Lately, however, the same knee has been much worse; noisier than ever and feeling like it’s not snugly jointed. I’ve been noticing that the tendons behind the knee are much more present when I’m sitting on my board waiting for waves. Nothing seems to be tender or painful, however I’m constantly stiffening and tightening the muscles around the knee when I walk to help snug-up the area.

Any advice on what I can do to help improve the situation would be appreciated. Am I looking at surgery? Heard anything about glucosamine sulfate?Thanks, Michael

ANSWER:

Hey Michael,

Sorry for the delayed response. I have not been in the mood for dealing with responsibilities since the horrific crisis hit last week. But I am back….

Your condition sounds awfully familiar to many of “us” who have been heavy recreationalists our whole lives. And in the past the old adage would be applied, “If it doesn’t hurt, don’t fix it.” It is common to have noisy joints and as long as pain is not affiliated with it, it is typically okay to let it go. But now you sound as if stiffness is getting in the way of things. Did you have any major trauma to that knee in the past? Is it your dominant leg? I have a few recommendations for you.

First off, I would DEFINITELY start to stretch the muscles surrounding that knee joint along with your hip and lower back muscles. Tight muscles can do a number on your joints. As long as you are at it, you may as well stretch the other side as well. A good stretch is held for at least 30 sec and you should stretch each muscle group 2 times. Next, it sounds to me like you have a bit of internal swelling in your knee joint. You may not be able to see the swelling but based on your complaints, the joint may be swollen. I suggest taking an anti inflammatory for at least 1 week consistently. So if you take Advil, take the recommended dosage for seven straight days unless you have stomach issues. Ice helps as well. I would also consider making an appointment with your orthopoedic surgeon in order to rule out any major problems. Glucosamine has been helpful to people in most cases. Again, it may cause stomach issues and it depends upon what is going on in your knee as to whether or not it would help. Thus the need for a doctor’s visit.

If you can afford a massage, I would seek out a good sports massage therapist with a background in rehab. This will help loosen up your muscles and it promotes healing due to an increase in blood flow and circulation to the area. Let me know if you need more info. Good luck to you and let’s hope for world peace and off shore winds! Hasta, Beth

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