Report from rehab - II : HSR training

We shall overcome...

I have not been running since April 22. You'd think that I would be going mad at this point, but actually it is going surprisingly well. The first four weeks, where I was not allowed to do any kind of activity with my legs, no strength training or biking or even extensive walking, were pretty hard. I almost lost my motivation to recover and ever start running again. These first weeks were necessary to give the injury a complete rest so that the swelling and the irritation could calm down. After that the active rehabilitation phase started, with heavy slow resistance (HSR) training three times a week, in addition to regular strength training twice a week, and gradually increasing hiking/walking activity. Still no running for quite a while yet, but you can imagine how much I enjoy and cherish my uphill walks to Stoltzekleiven and Ulriken these days!

The injury that I have been struggling with for a long while is an irritation around the upper hamstrings tendons. At the back of our thighs we have three muscles stretching from the knee to the hip. These muscles each have their separate names, but they are altogether referred to as the hamstrings muscles. These muscles are attached to our knees and our hips with tendons. The tendons around the hip and the butt are called the upper or origin hamstrings tendons. My current injury is at and around the tendon attahed to the sitting bone and the surrounding bursa (small fluid filled bags that we have many of in our body, usually around the joints). The condition is probably a variant of so-called proximal hamstrings tendinopathy combined with pain from the ischiogluteal bursa. According to recent research, the most commonly accepted best way to deal with any kind of tendinopathy seems to be HSR training.

Unfortunately nobody told me this until I met my current physiotherapist Ane. I had an MRI examination already in May 2014, and the findings there should clearly be interpreted as an early stage of the injury that I am describing there. Although I showed the MRI results to every therapist I have been to, as my condition worsened, nobody was able to suggest the correct cure. My previous therapists were all into treating me with their various methods, whereas with HSR training I have to do the job myself. Ane examined my hamstrings with ultrasound, and combined with the old MRI result, she concluded tendinopathy and immediately and very firmly put me on the described rehab scheme.

 

So what is HSR training? It is a series of strength exercises for the legs and the butt, performed on various weight machines at the gym, with so heavy weights that you can barely manage 8 repetitions. These 8 repetitions are done on each leg separately, and then the whole set is repeated 3 times. Strength training on machines is not necessary for normal functional training, but in therapy the machines make sure that you put the effort on exactly the right spot and the right muscle. The idea of HSR training is that the muscle uses its own strength around the tendon both to contract and to stretch, all very slowly. I am doing a series of nine strength exercises three times a week, increasing the weights whenever I can. In addition I have a series of two active stretch exercises which I do twice a day. I do leg press, toe press, leg curl, leg extension, hip abduction, etc etc. The exercise that really goes right into the heart of my injury is the leg curl:

It is important to do it without flexing your foot. The foot should be completely relaxed, and then you pull the weight with your leg until your lower leg has a 90 degree angle with your thigh. When you don't flex your foot, you are not at all using your lower leg muscles and the hamstrings are doing all the job. My goodness was this painful the first time I tried it! I had no chance of doing it even with the lightest weight, even if I flexed my foot and helped with my other foot. In fact, even without a weight I could not lift my leg without flexing my foot! Remember that the first time I tried it was after four weeks of no running or leg training, so the fact that it was so painful at that point was really depressing. However, you cannot imagine how fast it has become how much better when I started the HSR training! Now I can lift the lightest weight completely correctly with my injured leg, no flexing of the foot and no help from the other leg. Next week I plan to move to a higher weight! It is still painful, but it is a kind of pain I can work through, as opposed to in the beginning when it felt like a sharp knife was being inserted into my tendon. I think, when I am able to do this exercise completely pain free, I will be able to start running.

Here is another test that I have to take before starting to run: single foot back plank. Lie on your back. Raise yourself on your elbows with your body straight, so that you are touching the ground on elbows and heels only. Then lift one foot off the ground. It may be hard, but it should not involve any pain. If you cannot do it because of pain in either thigh, then you should not run until the pain is gone. I am determined not to start running too soon, and I am also very careful in not getting carried away with my uphill hikes. I am allowed to do them fast and hard, but if something does not feel right, I slow down and take one or two days' break before the next uphill adventure. I also make sure to do at most two fast ones a week, and the others in moderate pace. Next step is to do longer hikes in the mountains avoiding the temptation to run. Wow, I feel so patient and wise! :-)

The nice thing about being in this phase of my rehab period, which I called determination,  is that I can do increasingly heavy activities and all the time I notice improvement. My injury is healing and activity feels better and better, albeit extremely slowly. I suppose the first four weeks of inactivity were necessary, but interestingly I felt no improvement whatsoever in the injury. As soon as I started HSR training, I could very quickly notice improvement. It is small, it is slow, but it happens all the time! It is so rewarding. If you are avoiding running due to an injury, please check the HSR training exercises that are recommended for your injury. For knees, ankles, heels, there are targeted exercises, and the healing will be much faster than just avoiding activity.

In my regular strength training I can now resume almost all my regular exercises, except those that target explosiveness of the legs. Ketil continues to add fun to my days with various games during our PT sessions. It feels so great when he tries new ideas on me and I can do them! He escalates the excitement by setting up the game from the start of the session so that I know that some new experiment will happen but I don't know what it will be. You might remember the push ups on the balls; they have by now become a regular weekly exercise. This week, we played building blocks. While holding an exercise ball in the air all the time with both legs. The important part is that you have to take every block with both hands and place it in the other pile also with both hands (it is much easier if you take with one hand and pass it to the other hand - yes I tried to cheat).

(There is a video here, but I am afraid it does not play on some mobile phones and tablets.)

Yesterday one piece of news made me very optimistic and gave me new inspiration. My friends Hege and Elisabeth, who both had long periods of not being able to run due to injuries, are back stronger and faster than ever. This weekend they both became number 2 in each their class in an uphill (from 0 to 1500 m) half marathon! As Elisabeth recited from a well known quote: 

What defines us is how well we rise after falling.