Gracilis and Semis knee insertion

Hiya,

I have a nagging issue that keeps returning and I'm not entirely sure why.

The shared insertion point of the Gracilis, semi membranosis and semi tendonosis seems to get agrivated during any straight legged stretching, mobility or strength work. Movements such as stiff legged windmill, cossack squats or any straddle work seem to be the cause.

I have seen a physio who has recommended using only stretches which allow a bent leg. This has worked, in that I can get the work done, but still when I go back to straight legged work (4weeks), it flares up the next day.

I am strengthening my legs and glutes without pain or flare ups.

What causes this and is there anything else I can do to get rid of it for good

Hi Christopher, 

Sounds like something may be compensating for the knee. I would get a second opinion and maybe check with an adhesion specificist. 

Send in videos as it may be a form check. 

Best Wishes, Tanya 

Hi Cristhoper, what exercises are you doing specifically for gracilis?

I am doing side lying leg lifts for gracilis. 3x10 but they're quite easy.

9 hours ago, Christopher Hancox said:

What causes this and is there anything else I can do to get rid of it for good

Are you talking about the Gracilis, Semitendinosis, Sartorius Tendon insertion area?

Often, if the trunk, pelvis, and proximal attachments are not warmed up, then the insertion area you are referring to takes the brunt of the straight leg stretch. (I know from over zealous experience)

Many times an adequate warm up of the QL, pelvis, and bent leg weighted pulses and isometric adductor holds of 3 x 60 s allows a more uniform straight leg stretch reducing risk of injury at that location.

It may be an enthesopathy, or the tissue around the pes anserinus, as Mark's diagram shows.

If you tap the area with your fingertips, does it feel as if the bone is sore?

Is this on both legs or just one?

As to the cause, have you had any issues with your hip/knee/ankle on that leg before?

@Ryan Bailey, Thanks and yes that's the area I meant. I will add some more warm up exercises when attempting straight leg work.

@Nick MurrayNo soreness on the bone, but the tendon and interior point very close to the bone are sore for a couple of days after. It is currently worse in my right leg (years ago I partially dislocated it) but I have felt it in both.

Thanks guys.

22 hours ago, Christopher Hancox said:

I am doing side lying leg lifts for gracilis. 3x10 but they're quite easy.

Gracilis is FIRST a postural muscle so with 3x10 you are doing a wrong work. repetition should range from 800-10 up to 2 hundred.

Wow.. Ok, thanks Alessandro.

Is that in one go or should that be broken into 3-5sets.

17 minutes ago, Christopher Hancox said:

Wow.. Ok, thanks Alessandro.

Is that in one go or should that be broken into 3-5sets.

I'd see it as in one shot (or build up to doing it all in one shot). I'd start with 60. If you have the front split stretch series, I think it's similar to the calf raises in there, as calves are also postural muscles...

Hope you find a way to get rid of the annoying nagging pain.

36 minutes ago, Jin Liu said:

I'd see it as in one shot (or build up to doing it all in one shot). I'd start with 60. If you have the front split stretch series, I think it's similar to the calf raises in there, as calves are also postural muscles...

Hope you find a way to get rid of the annoying nagging pain.

Thanks. I will have a go at and see how many reps I can get in one go with this afternoons workout.

21 hours ago, Christopher Hancox said:

I am doing side lying leg lifts for gracilis. 3x10 but they're quite easy.

Holy moly, 80–200 times! My left gracilis is always tight, messing up all my kinetic chain on the left side. I am going to do this too… It is probably tight because it's weak, so I will start strengthening it too… with the lying down leg lift, you mean lifting the bottom leg, aka doing adduction with that leg, right? 

@Suzanna McGeeYeah that's right. I just tried some and got to 60, and it was a struggle to say the least.

Would every day be the recommendation on these @Alessandro Mainente

33 minutes ago, Christopher Hancox said:

@Suzanna McGeeYeah that's right. I just tried some and got to 60, and it was a struggle to say the least.

Would every day be the recommendation on these @Alessandro Mainente

I will jump on it soon too… I suspect that the high repetition will be very horrible :-)  Alessandro is vicious, ha ha  :-) 

4 hours ago, Christopher Hancox said:

I just tried some and got to 60, and it was a struggle to say the least.

Well, I did 100 on my left (bad leg), 100 on my right, and one more 100 on the left… It was not the most pleasant experience, haha… And if Alessandro didn't say 100, I would never get the idea it's possible. I think I would be done by 30…  I must say I felt almost immediate relief (a little bit) and my internal rotation was less stiff… I will give these a chance regularly. Curious if Alessandro suggests daily or not… 

Nope, begin with 1-2 days a week. only when you can manage 200 reps you can consider 2 times a week.

Hi everybody, in the side Lying leg lifts,do you mean like slspe1->im? 

Hi Jonas,

Its the same side lying position, only you raise the bottom leg up toward the ceiling. The top leg is bent in front of you resting on the floor or on a block.

I find it is quite a small range of movement but it definately works the adductors. Also a bit of padding under the hip help make it more comfortable.

Thanks Christopher. Should we keep the foot IR/ER/natural? And pointed toes or not? @Alessandro Mainente

So, a quick update. I have been able to complete 200 reps on each leg for the last few weeks. The Gracilis pain has pretty much disappeared.

The issue is now more on the hamstring area of the same insertion. Is the same rep range/intensity now needed to rehab the hamstring. Interestingly, I went climbing the other day and used my leg for lots of heel hooks (gripping with heels by squeezing adductors and hamstrings). The next day I had serious DOMS which lasted two days. After that, I had no pain in the usual place on straight leg stretches. What is happening with this?

Muscles begin to be stronger than before and now the stress due to muscles fatigue is no longer a connective tissue problem. in your case, there still exists the necessity to work all life long these muscles. I can say that everyone has it nemesis, for me, for example, are bicep. they tend to be my weak point.

Sorry to steal the thread alittle bit, would get stronger in this adductor exercise help improving hip Internal rotation? 

I feel my IR have made some small progress since adding this exercise. This despite only managing fifty reps in one set.

You cannot improve directly the internal rotation by this exercise, you improve the adduction.

Hope the issue is resolved for you now. I know I used to get the same type of aching years ago from sports. For me at that time it was always, just a lack of warm up and tight musculature around the knee. The quad and adductor specifically. The moment those relax the tenderness would go away entirely.

HI Dominik , one of the most important things is that lacrosse and foam roller should not include tendon manipulation. for this reason, I do not include gracilis and semi tend in the muscles I can eventually work with roll therapy.

From your words seems that a normal pattern you described is still painful, you can for sure work the high rep exercise but limiting the range of motion.