bicept femoris tendonitis

[Michelle Barker]

hello new to the site just signed in,
i have had a knee problem for 2 years 7 months can you believe it and i am no closer to a solution, where to start February 2006 i went for a cycle on my mountain bike with my husband and slipped on a pipe and fell my feet were still stuck in the cleats and he had to pull them out. No problem yet a week later i saw a for doctor for my headaches and she said my one hip was slightly misaligned and she put a wedge in my shoe all was fine that weekend i went out for a 110km cycle route with 5 guys on my mountain bike on the road for distance training and had to push quite hard to keep up with the guys but keep in mind i train with them all the time so it was not new, the route had lots of hills, when i got home i mentioned to my husband my knee was a bit sore but though nothing of it normally by the next day all my aches and pains are gone well the next day it did not subside (NOT SURE IF IT WAS THE FALL OR THE WEDGE THAT CAUSED THE PROBLEM IN THE FIRST PLACE) so deciced to rest for a week and not cycle, threw the wedge away, after a week pain gone so tried to cycle again pain returned this went on for 3 weeks eventually was fed up went to a doctor who sent me for physio for 3 weeks of therapy 3 times a week and acupunture and nothing helped. Same pain whenever i cycled again rest, ice, anti inflammatories, massage, topical creams, knee guard nothing helped so waited a month to see a knee specialist as he was fully booked. He touched my knee sent me for a x-rays nothing showed up then an MRI diognosed biceps femoris tendonitis said rest and carry on with physio give it 6 weeks come back went back no changes same so he said i should have cortisone injections, had 3 did absouloutley nothing said nothing he can do for me just rest and it will pass, 2 months later nothing so decided to see another knee specialist who did a sonar said inflammed in the area and diagnosed the same thing rest stretch and be patient,i did various treatments of ultra sound and infra red lamp for 8 weeks nothing helped as soon as i started training again low milage no hills the pain came back, very frustrated i took a year off cycling did weight training every now and them i would try riding after 2-3 rides pain back so did nothing, got frustrated again heard of this wonderful new knee specialist who promised to help me said he will find a solution went had another sonar, active inflamation cells in the area another MRI said the same thing biceps femoris tendonitis but could not under stand why the inflammation is not going away after so long a period it should of healed said he was going to speak to his collegues in America and would come back to me they all said rest stretch and it will heal, i even sent my MRI to a friend in the States who said he would pass it on to a friend doctor who worked with knees and he never came back to me so frustrated after spending so much on treatments scans, sonars, MRI ect i got fed up and said i am just leave it. I walked on treadmill a bit gets sore if i over train did weight training again, for the last10 months +-did nothing with cycling now this week tried to cycle again been out 3 times 18km a time and i am in agony the pain is just as bad as the week after it happend I am so frustrated i can hit my head against the wall no one can tell me why the pain wont go away i am miserable i can't cycle anymore it used to be a HUGE part of my life now i can do nothing please can anyone help me???????????????????? PLEASE any suggestions???????????
thanks Michelle

[Adam Reyer]

Hi Michelle, welcome to the Modern Athlete Network and sorry to hear about your physical frustrations. My local (washington, dc area) sports injury guru is Andy Smith, an amazing chiropractor who also practices Active Release Techniques and Graston Technique - both relatively new manual therapies aimed at breaking up the adhesions/fibrosis that accumulate in our soft tissue from injuries, repetitive movements and inactivity. I am pretty confident that Andy could fix your Biceps Fermoris problem and there are good A.R.T./Graston practitioners in most major US cities (don't know about South Africa - isn't that where you live?). Either way, get in touch with Andy through M.A.N. or his email ([e-mail]). Also check out Andy's website. Good luck and keep us posted.

Adam,
Modern Athlete Network

[Michelle Barker]

Thanks for the advise will go check out the website and try to get in contact with him.
There might be help after all thanks again.
I do live in South Africa the Doctors here are not very helpful like i said but will follow your lead up.
I will keep you posted
Michelle Barker

[Michelle Barker]

Hello Adam,
I have emailed Andy Smith on Monday i am waiting for a reply so i will keep you informed when i have heard back from him.
All the information you gave me to read up on A.R.T. and Graston technique scar tissue wow it sounds exactly like what could be the problem and it gives me hope that it could cure me. I phoned around South Africa and no one had heard of these TWO TECHNIQUES, we are so far behind here it is scary, anyway i will wait to hear from Andy and i asked him if he knew of anyone closer to S.A, that could do the treatment that he could reccomend or if i fly to Washington could he treat me in a week or two as i could not stay longer because of work so i wait for his relpy.
Thank-you for your information you wont believe how you helped me.

Kind Regards
Michelle Barker

[Adam Reyer]

Michelle, I will follow-up with Andy but I'm pretty sure he could effectively treat you within two weeks here in DC. You might want to call his office (703-444-1182). Good luck!

[Michelle Barker]

Hello Adam,
I have had correspondence form Andy what an amazing man who has taken time out of his busy schedule To help me. He speaks VERY HIGHLY of you Adam.
Here is our correspondence for you to read.

Hello Andy Smith,
I got your details from Adam Reyer,
I sent a email to Modern Athlete Network and Andy gave me all your information, Below is the email I posted

Hey Michelle! Sorry I hadn't seen your email. I can help...or at least ART and possibly Graston can help. I will write later today to let you know what I think about things, out today, but will write tonight.
Andy Smith DC

OK Michelle!
I read it again and my gut diagnosis is rotational injury from the "cleats-stayed-locked-in" fall...even if it was a subtle rotation within the joint (which is common with this injury) the POPLITEUS muscle, which is responsible for rotational stabilizing the knee may have been injured (strained). As this heals it lays down fibrosis loses its ability to hold the knee in proper position during flexion and extension. This allows the meniscus to become under greater pressure and the altered biomechanics create a cascade of guarding and aberrant movement that lays down even more fibrosis. Use will make it worse and worse even though it may feel looser during the event. Does it swell at all? The popliteus helps unlock the knee from the fully extended position also, so one can develope a "trick" knee that locks in position nor "gives" under pressure...you probably don't have that...yet. So, does it swell?? Please respond to [e-mail] that's my personal email, I'll get it quicker. Peace, Andy Smith, DC

-----Original Message-----
From: SFI
To: [e-mail]
Sent: Mon, 15 Sep 2008 10:45 am
Subject: PLEASE HELP!!!!!!!! KNEE INJURY

Hello Andy,
Thank-you for your reply most appreciated!!!!!!!!!!!
Been reading up about POPLITEUS muscle.
To respond to your question NO i do not have swelling at all.
I do not have trick knee yet either.
If it is this diagnosis is it easy to treat?????
Would it help if i sent you a copy of the M.R.I. on disk i think i still have it, and doctors reports?????
It is a public holiday for us tomorrow (yipeeeee) so i will only be able to respond on Thursday.
Thanks again for all your trouble i am very greatful.
Kind Regards
Michelle Barker.


Wonderful. And no, I don't need to see the films, but if you'd scan the reports or fax [phone]) them, it would help with the transglobal diagnosis! Great news with the No Swelling, it does sound like a fairly easy fix, but I don't ever know the truth until I have the tissue in my hands. Enjoy your day off, Fall is arriving here and it's beautiful out. Peace, A


-----Original Message-----
From: Michelle
To: andy smith
Cc: andy smith
Sent: Tue, 23 Sep 2008 1:04 pm
Subject: PLEASE HELP!!!!!!!!!!KNEE INJURY

Hello Michelle!
I received the faxes and I've formed an opinion...a clinical impression is what we call it, because it's not a dx (diagnosis) until it's in my hands.....but here's my two cents:
First, if it IS the popliteus as a primary problem (that it was strained, and while healing has become fibrotic and therefore weak and unable to rotationally stabilize the knee) the overload of this job will be picked up by the surrounding musculature (like the Biceps Fem long head).....and if we review the anatomy, the popliteus' job is to keep the tibia from externally rotating as the knee goes into extension and is planted on the ground or a pedal. If this job isn't done by the popliteus, it is common that the biceps fem long head would "pick up the slack", and after months would become thickened from overload (and tendonopathy). Note that the insertion of the BF is on the ANTERIOR side of the fibular head. Treating this structure is fine (the BF tendon) but it isn't the problem...it's the symptom..and granted it DOES need to be treated to fully resolve this situation. Treatment with Platelet Rich Plasma injecTreatment with P

[Michelle Barker]

Did not all fit it so i have added on

Treatment with Platelet Rich Plasma injection may be needed to resolve the BF, but ART and possible Graston is required for the "mild ITB", ham, posterior knee musculature (popliteus and plantaris...as well as others) and lumbopelvic issues also, which may also require specific manipulation.

Following? I'm guessing you're pretty well-read on this stuff, so I gave it to you straight.

Let me know how you want to proceed, since you're coming through Adam, you have an open-door with me, he's helped me in so many ways...thank him. Have a great Friday, Peace, Andy Smith DC

THANK-YOU SOOOOOOOO much for putting me in contact with Andy Most appreciated
i am extremly greatful, Nice to know there are still good people in the world
Kind regards
Michelle Barker
Will keep you posted

[fouad]

Dear michelle,
iam DR. fouad from lebanon ,iam an orthopedic surgeon . your case is really strange .first i advice you to discuss with your orthopedic surgeon the diagnosis ,bec a lot of structures here could overlappp e.g popliteius tendinitis .anyway if he is sure of diagnosis i advice surgery. take care

[Michelle Barker]

Dr Fouad,
Thank-you for responding to my discussion most appreciated, i will go look up Popliteius tendinitis and if the symptoms sounds the same i will consult my orthopedic surgeon again, he has been very reluctant to perform surgery in the past but i will bring up the subject again.
Thanking you i will keep you posted of any news
Michelle Barker