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High Hamstring Tendinopathy Rehab Protocol
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I have posted here serveral times over the last year regarding a hip/hamstring/glute problem that has now been definitively diagnosed as tendinopathy at the hamstring/adductors insertion (diagnosis by injecting the area with a deadening agent and then seeing if I had pain - I had zero). I have had a few ups and many downs with this injury over the last 18 months and have experienced nothing remotely so difficult to get over in my athletic life. If there is one lession I have learned and would tell others on ST it is that it just takes forever to improve and if you do just a little too much too one day you can set yourself back months. Trying to train even lightly with this is just too much of a balancing act. At this stage I am trying the last option I am aware of, platelet rich plasma injections, having had my first shot a couple weeks back and going for my next one next week. My doctor, who seems like a good one and says he has successfully treated this condition with PRP, says that my injury is one he sees more often in cyclists than runners because it is very medial and includes the abductors as well as the inner hamstring. He also said the most optimistic recovery time is 4-6 months. No noticeable improvement yet but I have not really tried to do much either. And this bring me to my question: rehabilitation protocol. My doctor has told me no ice, no nsaids, no strength training of the hamstring for now (too weak) minimal stretching (needs to heal), weekly massage and accupucture is ok as is light activity that gets the blood flowing but does not aggravate it. Problem is I can do a light ride of an hour some days and be fine but other days I will be fine but then it will be achy later in the day.

I would be incredibly appreciative to hear from anyone who has come back from this condition and what you did to do so, particularly in the early stage of rehab + what did you use as a guide for your activity level so as not to reinjure it.
thanks,
Jack
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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I dealt with hamstring tendinopathy and trabecular edema for a little over two years. PT made my hamstrings strong but did nothing for the condition itself. Shockwave therapy (similar to that used to break up kidney stones) did nothing. Finally got PRP (platelet rich plasma) therapy and that really made a huge difference. It is now about 90% back to normal.

Good luck,
Jim
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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Sounds similar to what I have been struggling with for over a year now. One doctor has called it ischeal tuberosity. Most of the pain is out at the upper part of the hamstring and then in where the hamstring tendons attach to the ischeal bone. I finally had a injection two weeks ago (so at least I could get through the IM without too much pain in that area) and it definitely feels better. I am going to PT, but have really never seen much result from that. I don't know if I should just stop training both the bike and run for an extended period or to continue with the madness of trying to train but always hurting some. I think just sitting keeps it somewhat aggravated. Messed up my A races the last two years, really don't want to make it three. Please let me know how the PRP goes.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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Jsmith, I talked to you before about this injury. And yes, it was fixed :P

Here's the outline of what happened:

-Get the injury and see a lot of bad doctors and get no where. I rested the injury for 6 months with no improvement.

-Finally after 6 months of rest I go to a doctor for a PRP injection. He ends up NOT giving me the injection. He said he could fix it with a rehab protocol in only 3 months, and if I still had pain I could come back for the PRP. I decided to do the program (honestly I didnt believe it would work at first).

-1 month after following the program I am 85% better and able to bike without a problem.

-3 months after following the program I am 99%

-No PRP injection needed :)

Rehab protocol (Everyone is different, but this is what they had me do)

No cycling, elliptical, pooling until I had pain free range of motion.
No running for 3 months

Weeks 1-2:
-wobble board
-Thera band speed skaters (This is a glute medius exercise)
-Double then single legged bridges
-Lateral band walks with thera band (for hip abductors)
-Front planks
-Side planks
-Hamstring curl with ball (Picture in the article I linked at the bottom)
-Good mornings with NO weight. Should feel only a light stretch

Later Weeks (Now for the good stuff, the eccentric exercises)
All of those exercises made more difficult by stronger bands / more reps

-They then added what I like to call the face plant exercise (http://www.youtube.com/watch?v=GBfHwWX6lak) However I did NOT do the concentric portion. When I got to the floor they had me push myself up, not use the hamstrings on the way up.

-The good mornings were changed to single stiff legged deadlift.


Interestingly enough, these exercises were done every other day. I did not do the eccentrics twice a day nor did I do it everyday. I know that most programs say to do the eccentrics 2x a day 7 days a week, but that was not the case for me.

Also:

-The doctor prescribed dry needling once a week
-I had ART done each week and used the foam roller
-Had a chiropracter align more hips

This article was phenominal, it was how I diagnosed myself before even visiting the doctor http://www.agilept.com/...pathy-in-runners.pdf

The female runner in the articles case study had the hamstring problem for nearly 2 years and after 3 months of the rehab program she returned to running and by 6 months elite racing.

She did the exact same treatment I outlined:

1)Proper hip alignment (most people with this injury have an anterior pelvic tilt causing extra strain on the hamstring)
2) Cross frictional massage / ART
3) Core strengthening, especially working on the glute medius
4) Eccentric Hamstring Exercises

If you have anymore questions feel free to ask.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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Wow, this is just uperhelpful. I really, really appreciate it.

My questions
-My main question is about pain free range of motion. Can you explain a little more what you mean? For instance, right now I have no pain walking or sitting but can feel it tugging at the insertion point if I do any sort of light standing hamstring stretch or a good morning rep (though the actual range of motion/stretch is the same as the uninjured leg). When I try to ride in fact, it is usually fine for the first 30-1:00 then I notice tightness/twinges/spasms at various points along each of the hamstring muscles that increase with time but the hamstring insertion itself usually does not really hurt when actually riding if I don't go too long (though if I stop riding and try to stretch after about an hour or more I can feel it has tightened up at the insertion, also it will be sore there later in the day). I guess what I am trying to figure is how much total rest from activity should I give it given its current condition/strength before engaging in the week 1-2 protocol that you have listed? Do I have to wait to begin the rehabbing until I can do a light hamstring stretch or good morning and not feel it?

-What are the speed skaters? I have done the lateral walks with a band but not speed skaters.
-What do you do on the wobble board and for how long?
-The doctor you saw who put this plan together - I couldn't be so lucky that he is somewhere near Washington DC?

THANKS AGAIN,
Jack
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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My hamstring tendinopathy is on the lateral side of my knee at the top of the tibia. I did the 8 months of rehab between mis-diagnosis of ITB and have been suggested PRP. My insurance doesn't cover it so I am a grand out of pocket for each injection. I have delayed having it done in hopes of a miracle. Do you think your training protocol will work given that this is a different area but still related to the hamstring?

Swim, Forrest, Swim. Bike, Forrest, Bike. Run, Forrest, Run.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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@Jsmith

If you look at page 8 of the article I sent you it says that if you can do this test: http://www.physsportsmed.com/...figures=89?figure=75 pain free then you can start cycling and elliptical.

However, when my doctor allowed me start cycling it was only for 30 to 45 min easy to moderate (Only on the trainer). He said to wait until I was 95+% to start actually training on the bike.

When I tried to bike (before rehabbing / getting a dx) what would happen is that around 25 to 30 min I would get this really tight knot in the middle of my glute that would cause pain everytime I pressed down on the peddel stroke.

You should be able to start the first week of rehabbing. But as the article I sent you states, if you cant perform that ROM test pain-free then your only activity should be upper body erg / swimming with a pull buoy.

No running for 3 months at least. Once you can do the linked test pain free I'd bike 30-45 min easy

Wobble Board- started out working on double and single leg balance for a few mins. Progressed to balancing with eyes closed. (Worked on it just 2-3 min)

Speed skaters- I will send you a picture of it later, I just spent a good 15 min googling for it (Im sure there is another name I cant think of) , but couldnt find it.

Unfortunately the doctor is in Atlanta.

@Inthehunt

What rehab did you do for those 8 months? Did you do any eccentrics exercises? The "faceplant" exercise I linked in the video hits the distal hamstrings very well.




For the PRP, I cant really say what to do. My doctor told me that if I got the PRP injection done before I lengthened the tendon (through 12 weeks of eccentrics) that it would just be a waste. So he said to do 12 weeks and if I still had some pain he'd do the PRP.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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Once again, extremely helpful. I have been trying to get this sort of specific, practical information about of various PTs, doctors, etc for months - thank you!

I did the test and it is just barely noticeable at the very end of the ROM. I will start with the week 1-2 protocol, maybe swim with the pull buoy and then see in a week or so if it has progressed so that I can try the trainer for 30 minutes. Got my second PRP shot next week so hopefully together this will send me on the long road back to painfree riding and running. God, I hope so.

Send info on the speed skaters whenever you can and thanks again!

Inthehunt - one thing I learned in the course of this epic journey is that even the right rehab exercises won't help if you don't do them in the correct sequence. Living in europe last year I had a PT who gave me eccentric straight leg deadlifts to do daily but the problem is that the hamstring was that I was also still trying to ride and the hamstring was just not yet strong enough to that sort of thing so it could recover from the exercise and get stronger. You really need to start from square one with this thing, a fact I am just now understanding.

Jack
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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who is/was your doctor?
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Re: High Hamstring Tendinopathy Rehab Protocol [Camel's Toe] [ In reply to ]
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Dr. Garten at Atlanta Sports Medicine
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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whats your adductor strength? I bet adductors are weak and hamstrings are being recruited to stabalize.
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Re: High Hamstring Tendinopathy Rehab Protocol [jamdavswim] [ In reply to ]
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Breif update for others dealing with this condition. I have now had 2 PRP treatments so far and I have finally noticed a distinct improvement in terms of pain free range of motion, though I still have a ways to go before I am riding or running like I used to. The clue about the adductors is a good one: I have been stretching them from several different angles several times a day for a couple weeks and really noticed my hips loosening - myabe the hamstring was stabilizing and that was what was overstressing it. Not sure if its the PRP or the looser adductors or not training much (doing the every other day exercises mentioned previously in this thread, some core work and riding on a spin bike easy for 30-1:00, no running) but things seem to be moving slowly in the right direction. Still have some tightness near my SI joint but my PT thinks that should fade as my adductors loosen up. Be interested in any suggestions for exercises that strengthen/lengthen the adductors from anyone who has dealt with or treated this condition.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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In Reply To:
For the PRP, I cant really say what to do. My doctor told me that if I got the PRP injection done before I lengthened the tendon (through 12 weeks of eccentrics) that it would just be a waste. So he said to do 12 weeks and if I still had some pain he'd do the PRP.

Agree with this, did protocols of PRP with no results. You need to fix the issue causing the problem before this will help the tendon.

Good info here, been trying to find others with this issue for a while. Been out 2 years now and just starting to see some improvement...
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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Sorry I have been MIA.

@Jsmith

When you ride on the bike what do you feel in that 30 min / hour? Do you get any knots or tightness, any pain?

Also I forgot to add that you need to have any anterior pelvic tilt corrected. After I had the injury for so long I started getting some pain near the SI joint on the injuried side. I had a chiro do the hip adjustments and let the PT do their eccentrics stuff.

I'm glad you are feeling relief from the 2nd PRP, but dont go out running anytime soon just yet. The rehab is what knocks this injury out and also prevents it.


@FishH2O

I remember you saying you still have the problem, but have you done an eccentrics program?

Also where are you located, I might know some doctors that can help?


If you have any other questions feel free to ask, its a pain in the ass of an injury.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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TTC,
Right now I can ride a spin bike fairly easy for 1:00 with no issues and can do the hamstring range of motion test with no pain - this is a solid step in the right direction from where I was but obviously still a long ways to go. As recommended, I have not run or been on the bike outside at all yet. I have been getting consistent massage/PT to loosen and the muscles onmy glutes/hip for over 3 months now but only recently have I also had treatment on the adductors and focused on stretching them several times a day. As someone else said, I am thinking the adductors on my left leg have been tight/not firing causing overcompensation (and ultimate damage to my hamstring group) as well tension (and resulting tightness) on all the connected or opposing muscles (quadratus lumborum, glute medius, piriformis, tensor fasciae, etc). Next PRP is 10/7.

The hard part for me going forward is going to be gradually improving without doing do too much too soon. What would you suggest to add in for eccentrics for hamstrings/adductors (what/how much/how often) to the original first two weeks program you gave us earlier? Also, how did you go about gradually increasing your riding to the point you could get outside again - what did you use as benchmarks for further progression?

thanks again for all the advice,
Jack
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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Thanks for posting this, I have been through every type of physician possible and nobody has a clue. Already have a chiro and rolfing to address tightness and alignment. Will hammer at the exercises...
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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  Thank you for your informative posts. they have helped me diagnose this condition. I have had it for 9 months. I did some of the exercise and have been running training for my A race with reduced milage and no speed. Started after long runs but looking back I had R butt pain while driving for 2yrs, about as long as I have been running. My condition isn't as bad as I can still run and bike but the runs are often with pain unless I take a break for a few days. I ran my first marathon and now would like to heal this injury. I plan to stop running for 3 months and do the exercises, massage. I have a questions about the number of repetions that you started with and what was your progression in intensity and number. I plan to bike as it rarely bothers me but at moderate pace. Thank you for
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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Sadly yes, I'm in Chicago and have not been able to kick this. Partly due to my continuing activity (to some level), but I ask every practitioner if I should stop and have not received any legitimate feedback.

Mine goes back about 2 years +, I believe the trigger was plyo classes after IM in 2007. Post IM I was trying to ramp up my run speed as it is the limiter in most of my races. (:53, 5:20, 3:49). Oly is even more egregious. It began with some soreness after running deep in the gleut. Tightening on long car rides, etc. After a few months, it just got worse and worse. I can still run, but it strikes if I try to up the tempo, and is always sore. In my last Oly, it cramped up so badly after the bike, I just limped the run. It essentially became a permanent knot in my ass. I've gone through three chiros, two PTs, ARP Wave therapy, PRP, etc. Most have no clue, and the PT's always seem to be designed to treat couch potatoes. I am also hyper flexible so I still have above average hammie flexibility even with the injury.

I currently have a Chiro who is somewhat on the program. There is a very good Rolfer in the office who is working on loosening the hips, hammie, gleut med and periformous to try and get things back into shape. I also have a separate masseuse who can magically get the knot to loosen, but it comes back to some degree. The key I am missing is exercises/training - they are working on this, but don't have a facility at the moment.

I have been doing some exercises like the ones above, and feel like it is making some headway. I have not run in 8 months, but I have been cycling (road, mtn, cyclocross). I tried a HIM to see how the bike went after getting re-fit, and it just flamed out after 40 miles. The fit showed that I was using my hammies far more than the quads, likely contributing to the issue.

My plan is to stop riding in December after cross season for three months to try and kick this, but to really stick to the exercises above. Any advice, or other treatments/docs would be welcomed.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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@Jsmith

After the initial 2 weeks I would start with:

Hamstring Ball curl- 2x 12 to 15 reps (do the eccentric phase slowly)

Do double legged hamstring ball curls, later on your progress to single leg.

Faceplant exercise- http://i.ytimg.com/vi/qA82YSc5OH4/2.jpg where you slowly resist falling forward. Then push your self back up to starting position with your arms.

Start off with 2x15 to 20 reps



I know many studies say that eccentrics need to be done 2x a day 7 days a week, but in my experiance (and I am not a doctor) this doesnt work for this injury.

I recomend doing these eccentrics 1 to 2 days in a row. So either do them every other day, or like this:

M: Eccentrics
T: Eccentrics
W:Nothing
Th: Eccentrics
F:Eccentrics
Sa: Nothing

Etc
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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Thank you for posting this!!!! I am so glad I caught sight of this post last night...I have been dealing with this for 10 years!!!! I now have renewed hope that I can run pain free again!! I have seen the posts in the past (dealing with this), but no treatment protocol was given/suggested. I have done (almost) all of the exercises suggested, but the approach was pretty random, did not follow a set guideline, just knew I needed to strengthen glute medius...didn't completely stop running (just reduced time, frequency, pace). Seems the eccentric hamstring exercises are pretty crucial to the long term fix of this. So, my questions... TTC, how long have you been pain free? If it has been a while (greater than 6 months of resumed "normal" training), do you continue the exercises? Since you have been "pain free", have you had some flare ups? and if so, were you able to "contain" them? I have been pain free at times for up to a year, but it has always come back...with a vengeance! I have also tried the PRP injection with no relief (one injection, again...a random try at "curing" this with no protocol/guidelines). I haven't really run since late May because of this recent "flare up" (got my first DNF ever because I could not run after the bike...and I've been racing tri's 20 years).
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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I showed your abstract to my doc and he said it was spot on. This is the trouble I find with the medical industry, they are not willing to do the research. If you want something directive, you have to do it yourself.

Lucky you found a doc that knew what he was doing
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Re: High Hamstring Tendinopathy Rehab Protocol [FisH2O] [ In reply to ]
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@Mruthven

Its been 4 months since the rehab protocol ended. Everything has been fine, no flare-ups and training is what it was before. Believe me when I say that it is totally worth it to shut down running for 3 to 6 months (depends on how severe) in order to do the rehab protocol. Being able to train again without this pain is such a great feeling. I continue doing the eccentric hamstring exercises along with a core stabilization program every other day. I know from lurking these forums for a while that ST people think strengthing is worthless, but it's been the key to staying injury free.

And yes the PRP is a hit or miss. I believe (Again I am not a doctor) that the PRP should only be used after 1 to 3 months of the rehab / eccentrics.

@FisH20
Totally agree with you, I went to EIGHT different doctors. I actually diagnosed myself before even finding Dr. Garten. I had people tell me that I had a disc problem (MRI negative) then they said it was my pirifomis or nerve entrapment, then a labral tear (MRArthrogram negative). That article I linked by Michael Fredericson was the exact article that helped me figure this injury out on my own.


Again any other questions feel free to ask.
Last edited by: TTC: Sep 29, 10 21:03
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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JSMITH: I have been dealing with the exact symptoms you have described in your original post for over a year.
Can you give me an update on how you are doing?

Did you have the PRP? How long ago? Where are you at in recovery?
This issues is a BIG pain in the A$$ literally and I canít seem to shake it.
I can go through the motions of training but this thing will not allow me to really push the way I want to.

Any other advice would be appreciated.
Thank you for your update.

Doug

Trumpman

See ya at the races!!
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Re: High Hamstring Tendinopathy Rehab Protocol [Trumpman] [ In reply to ]
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Thought I would give an update, 2 years and running (actually not running).

Per above, after trying just about everything, I think I have found a path to recovery.
The old:
- Chiropracter - just for making sure everything is aligned
The semi-new:
- Rolfing - at the chiro so I don't have to pay. Fantastic for working the muscles without stressing them out. He has been able to relieve the pressure on the sacrum that was likely contributing to the pain in the gleut/ham. As always, the individual matters more than the treatment (ART, etc will work too)
The new
- After getting as far as I could with getting the muscles in shape, I have confirmed to myself that all the work in the world is useless unless you treat the problem with someone who is watching you like a hawk to be sure you are not relying on old habits to fake the movements.
- Working with Athlete's Performance in Chicago (originally out of Arizona) with Robbie Ohashi.
- Therapy includes some body work, Graston (I think it is actually Aston) muscle scraping, dry needling, and focused PT.
What he has identified so far:
- my left TFL is far to strong, and tries to pull everything to the left
- my right gleut is not firing, and is using the hamstring to create this motion. the right leg (injured one) will always cheat to the left if given the chance
- my entire body wants to cheat to the left (knees, hips, neck, head) because of the gleut imbalance

So, we are doing lots of work to activate the right gleut, build it up, and change the muscle memory so that it will fire when needed. Started with some simple exercises, and am working up to more explosive movements to work on the muscle memory. I am also working on my feeling of posture, and stance so I know when I am doing it right or not.

Per your question - I tried PRP with no results. CAVEAT: PRP without the therapy like the one above is useless as it might stimulate healing, but doesn't fix the issue so the net is no change. I personally think that the graston and dry needling will achieve the same results at a far lower cost (to me), and is far less invasive. That said, PRP would probably help when combined with therapy.

Here is who I am using:

Robbie Ohashi PT, DPT, OCS, ATC, CSCS Performance Physical Therapy Manager
Athletesí Performance at Attack Athletics
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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For those who had PRP, did insurance cover it?



http://www.triandcatchme.com
https://twitter.com/kevintaddonio
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Re: High Hamstring Tendinopathy Rehab Protocol [kevintaddonio] [ In reply to ]
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Not sure about the insurance but I would be more concerned about getting an injection next to the sciatic nerve and femoral artery. I suffer from the same issue and at a recent visit to Foundry Sports Medicine in Prov, RI I asked the Dr about PRP, prolotherapy etc and he said the risks far outweigh any potential benefit. I've tried ART but the relief is only temporary. I've a got a prescrip for PT and use meloxicam to relieve inflammation for but for now I'm stretching with a band and working the core muscles. Tried steroids a few years back with some success and may go that route again. Refuse to stop running which may be my undoing but have limited myself to nothing faster than aerobic threshold runs. It sure is a PITA!
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Re: High Hamstring Tendinopathy Rehab Protocol [Trumpman] [ In reply to ]
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Here is where I am at: I got a series of 4 PRP injections this fall and it really helped heal the hamstring and adductors. The problem is there was still something about how I was pedaling that was placing undue/unnatural strain on the adductors and inner hamstring. The doctor looked at my ankle and found the ankle joint incredibly loose and sent me for an MRI. Sure enough one of the major ligaments in that ankle was so stretch out as to be useless. The theory we are now working off is that instability in my foot caused the strains to my hamstring/adductor and peroneal brevis muscle (which has also been very painful at times) over the last 2 years as well as the pain/plantar fascitis in my heel (that's been 6 months now). The doctor said he has also successfully used PRP to help this condition and I have had one injection thus far with another set for next week. We shall see.

If all this is not enough, even as the hamstring and adductor pain has gone away I still have alot of tightness in my psoas + quadratus lumborum, particularly after I ride for even an hour or so. It seems that these muscles have shortened up and become less pliable as a result of trying to train through all these problems for so long. When I am in riding position they start to tighten causing strain on everything else in the chain - hamstring, adductors, etc I am seeing a massage therapist to try to loosen them up and its helped a little so far but not much.

This whole thing has been just unbelieveably terrible. Its been 20 months now of this and I just can't believe it as I used to be a guy who was never, ever injured now matter what training I did. Welcome to turning 40 I guess. I am not sure I will ever get back to what I was but I am really trying to find someone in the DC area who has dealt with cyclists with such issues and can give me a overall plan to release the psoas so when I ride it does not seize up.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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If it makes you feel any better, you are in good company. I'm 37 and this is going on year 2+. Nothing makes you feel old like an injury.

Don't know if this applies to you, but a lot of my issues appear to come from being hyper-flexible. I am able to get into positions where I can relieve the stress off a muscle/tendon, but it only works so long until you run out of things to compensate with.

Good to hear you have some dedicated docs - do you have to pay for your prolo? I did, and it just about bankrupted me last year.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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Thought I would add some new revelations from PT. After doing work to strengthen the Gleut and get it firing again, I have started running on the Alter-G treadmill. We started last week at 70% of weight, and have moved to 75% and 80% this week. One thing to note - I am hyperflexible which is causing some of these issues.

Here are the revelations
- On first view, my thighs/legs are too close together. As he was watching, I started concentrating on firing my gleut on foot strike. this immediately changed my stride, stopped the knee from collapsing inwards and improved my form.

- After this first run, my hammie was sore, but in the belly, not the attachment. Had some light attachment feeling, but not pain.

- 2nd go this morning, I was running on form from the get go. To me, it feels like I am kicking my heels out to the sides, and bringing my legs around in a semi-circle. On film and under observation, I am not actually doing this, it just feels like it to me. Walking to work, I have already noticed a change in my stride, my feet much farther apart. Also, no butt pain...

- When I don't pay attention, I have a tendency to foot strike, hyper flex the knee, then drag the foot back with my hammie. Likely this is what caused the injury in the first place. I am concentrating on keeping the knee slightly bent at all times. Likely I am doing this on the bike too.

- Lastly, I use the original speedplays with free float. Before that I used Time. We will check this out next, but it is possible that my heels are floating all over the place and causing issues. It doesn't look like it when I watch, but who knows. There is no physical reason why my knee needs to float so I may be getting zeros.

Hope this is helpful!
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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If all this is not enough, even as the hamstring and adductor pain has gone away I still have alot of tightness in my psoas + quadratus lumborum, particularly after I ride for even an hour or so. It seems that these muscles have shortened up and become less pliable as a result of trying to train through all these problems for so long. When I am in riding position they start to tighten causing strain on everything else in the chain - hamstring, adductors, etc I am seeing a massage therapist to try to loosen them up and its helped a little so far but not much.
.

A note on the lower back pain. I had this two, an almost constant "tightness" in my lower back, especially up the gleut into the sides of the back.

After starting this PT (with dry needling and graston) focused on getting my pelvic position right, and working on my pivot point, this has just about disappeared. Sometimes I will get fatigue in my lower back, but this is quickly rectified with a self adjustment (do a back bridge on the leg where the back is tight, then push as hard as you can on the opposing knee, while opposing this force with your knee).

Fixing the hip position, has also alleviated a lot of the other issues and lets me concentrate on fixing the cause, not the result.

The one thing that I still cannot do is the one legged hip pivot. Standing with weights in each hand, you stand on one leg, with the other moving straight out behind you as you pivot at the hip. When you move back up, it should be the hip muscle doing all the work. (the straighter the knee, the harder it is to prevent the hammie from helping)

I can do this no problem on my left leg, the right with the attachment issue, the hammie always wants to join the party.
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Re: High Hamstring Tendinopathy Rehab Protocol [FisH2O] [ In reply to ]
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FisH20-

I'm in the Chicago area as well and I have been seeing Dr. Michael Chin @ The Running Institute for an Achilles problem for the last year. (Long story....subject for another thread).

Anyway, you may wanna give him a call. I have been impressed with him and his knowledge of new practices, etc.

Chicago Cubs - 2016 WORLD SERIES Champions!!!!

"If ever the time should come, when vain and aspiring men shall possess the highest seats in government, our country will stand in need of its experienced patriots to prevent its ruin." - Samuel Adams
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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Well TTC, thanks for the info you've posted (and others - all good to hear). I'm trying your program and going to see how it goes for the next few months. I've had a high hamstring tendonosis for probably coming up four years now and am thoroughly sick of it. I've tried before to get rid of it with an exercise program but so far no luck. Don't think any were this comprehensive though so going to give it a try.

I've been given so much conflicting advice that it's doing my head in. I have chronically tight hammys and hips and this is probably what caused the injury in the first place (along with overtraining for sprinting etc), so the most frustrating advice has been around whether or not to stretch.

Anywho, I'm hoping for the best this time - I haven't had any luck finding a good sports doc so far (have seen 3 though), and I don't think PRP injections are common here in New Zealand as I've never had it mentioned before - so sticking with the eccentric exercise program.

Just some quick thoughts and questions on the program provided:

- The 'faceplant' exercise is called a Nordic, or Russian
- Is the 'Speedskater' exercise a theraband Monster Walk?
- For the bridges, are you doing reps or holding the bridge for a period of time?

The Hamstring ball curls (well, the whole lot combined really) was too much to start with, so I'm taking that one out (as it's the hardest). Felt a good ache in the butt/high hamstring after the first 2 sessions, so going to start a little slower. Will reintroduce those again (as I think they are an awesome exercise) later in week 2 or 3.

Thanks again, good luck to the rest of you suffering from this.

@Jsmith - how is your rehab coming?

Cheers,
Simon.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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Saw this thread come up again and decided to add a quick summary of my positive (so far) experience with a similar injury.

- After ~17 years away from exercise and with an extra 45 lbs on my frame I returned to hard running far too quickly in August of 2008 (age 38).
- In the middle of an interval workout in Sept'08 I experienced a severe, shooting pain up my backside and down my left hamstring. An MRI later revealed a stress fracture at the ischial tuberosity.
- My ~2.5 year recovery has had a number of ups and downs, but I've recently had good success using a program similar to the one outlined by TTC.
- During the last few months I've added my own cross-frictional massage by sitting on a softball and rolling it across the hamstring attachment. Hurts like mad, but it has REALLY helped. Wish I had tried this sooner.
- After a couple days of the cross-frictional massaging (which was preceded by months of core and eccentric exercises) I was able to run on a treadmill as fast as I wanted with zero pain at my hamstring attachment. Just one week prior I had significant hamstring attachment pain when running at slower paces on the treadmill.

Now the only issue that remains is I get some aching when I sit for prolonged periods. But that seems to be (slowly) improving too.

Most importantly, I'm finally at the point where my mileage and pace are limited by other issues (sore calves!) rather than my hip/hamstring attachment.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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I too have suffered through this for 8 months with no running. Followed the therapy plan found here the eccentrics were the key. I concentrated on the exercise with the stability ball and did one legged hamstring curls with very light weight using both legs to pull up and one leg to very slowly let the weight down. It took 8-10 weeks but I am able to run now about 95%. I had tried everything PT, ART, chiro, massage.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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I am a sprinter/mid-distance runner who happened to see this site a month ago after failed rehab over 9 months. I have had MRI that showed proximal hamstring tendon tear. PT with needling and eccentric strengthening, chiro with ART and graston and two rounds of PRP, the last 1.5 months ago. Then 2nd MRI 1.5 months ago showed healed tear. After each round of treatment I tried to start running or biking and I had an exacerbation of the injury with spasm through my left glut. (MRI also showed a normal lower spine without any nerve entrapment.) I started TTC's regimen three weeks ago, giving the PRP 3 weeks to do its work, and felt great progress. I did not do chiro over the last 3 weeks but I did do dry needling alongside the exercises. Yesterday I got in the pool to do 5 minutes of deep end jogging and my glut med/piriformis went into spasm after that and hamstring became diffusely sore. I can minimize the glute/piriformis spasm by rolling the proximal hamstring aggressively but now I am set back by a couple of days, it seems. Can someone speak to what sort of progression I should expect. I can do the face plants 5 times in a row without proximal hamstring pain but any rapid movement of the hamstring sets off a diffuse tenderness in most of the hamstring and the aforementioned glute/piriformis burn/spasm. Any thoughts would be greatly appreciated.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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Thanks so much for your post. I have the same issue you once had. I am following your protocol carefully and just started dry needling. I am curious to know if you had any pain or sensations down your leg when you had this issue. When I stretch the hamstring my calves flutter due to nerve compression in the hamstring attachment. I hope you have put this injury far in your past.

Best,

Dustin
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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TTC- I am desperate! My left HS is torturing me!
Can you please let me know where the doctor you spoke of is located? I live in So. California and have seen an Ortho and PT but unsuccessful! I really need an exact protocol so I can work with someone regularly. I was so encouraged to read about your success.. Hoping I am able to get done relief. Hurts most of the day,
Thank you for your help!
Grace[reply]
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Re: High Hamstring Tendinopathy Rehab Protocol [ay82mch] [ In reply to ]
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I have had a summer of activity- none running- but I keep re-inflaming the proximal hamstring tendon and then I have tingling in the gluts and some spasm in the medial/lateral hamstrings. Now that the activities are behind me, I have a block of time to actually get this behind me.


I gave the hamstring a week of icing and rest and proceeded to PT and chiropractic.


I do occasionally have some twinges of pain down my lateral thigh and to my toes from some entrapment of my sciatic,but I think it is sufficiently transient that I hopefully won't have long term sciatic nerve tethering with scar tissue to the healing tendon.

I am aggressively doing PT with therapeutic ultrasound to start then dry needling and some gentle stretching, tissue mobilization, pelvic alignment and baby steps of eccentric loading. Now that the tendon seems calmer, I am introducing the yellow theraband at home attached to a couch leg or my heel on the third step pulling with a slightly bent knee to do a quasi-isometric and sometimes eccentric load on the hamstring. Concurrently, I am following the protocol that TTC described. The article below gives a good description of how to progress:
http://runnersconnect.net/running-injury-prevention/high-hamstring-tendinopathy-injuries-a-pain-in-the-butt/


My chiropractor performs several rounds of ART on my gluts and then she does ten minutes of class 4 laser therapy on the hamstring tendon area then does a couple of rounds of ART on the hamstring.

I am trying to alternate chiropractor and PT. I have not done any reading that suggests that u/s and laser one day apart is harmful. If anything, daily treatment is supposed to be helpful. I also have found that my hamstring resists any progess without either laser or U/S. (So I'm doing both!)

My stretching is 4 times a day with gentle stretching of the hamstring laterally, medially, directly forward and some transition to the adductors. Most of this is done with my foot on the second or third step and some lean in with the pelvis and not a lot of lean of the head toward the foot. I have a tendency to overstretch so I have to double think every step of my exercises.


This week I have two PT appointments for Tuesday and Thursday. Tuesday will probably be mostly dry needling. Thursday will be continued eccentrics. Hopefully I can get chiropractic for Wednesday. I will likely decrease the amount of ART now that I am at a generally low inflammation state in order to focus on the eccentric strengthening phase.


All of my discussion above focuses on the hamstring with just a touch on the gluts, but I have been performing all of the core exercises extensively for glut/piriformis strength. Hopefully in the next week I will introduce some stationary squats and gentle lunges. Walking lunges inflamed me last month.


Gradualism is the key! I am not wired to do things gradually, so this is quite a process.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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What were the wobble board exercises?
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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@ jsmith


Iím a mountain biker suffering from what I think is the same thing you did back in 2010: Exquisite tenderness over both proximal hamstring tendons (at insertion point) when palpated, sitting at the office, riding, running, etc. Pain came on gradually last May (2013) and has been gradually increasing in intensity ever since. Pelvic MRI shows fluid buildup in both hips and both ischial tuberosities (sit bones), which could indicate partial tearing of proximal hamstring tendons. Iíve seen countless doctors, have done months of physical therapy, had steroid injections, stopped running and have cut way back on my riding. Nothing seems to be helping. Iíve never had anything so frustrating and so difficult to overcome.

My ortho recommends surgery. Iíve read about PRP and it sounds promising. Not sure what my next move is Ö how are you feeling today and what did your recovery program / protocol look like? How long did it take before you were pain free and able to resume activity?

Any thoughts or advice you might have would be greatly appreciated!
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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To start, I feel for you. This thing really sucks. The best advice I can give would be to do things very differently than I did. I kept doing a little riding and a little running as I tried to recover from this and I think it really increased the time for recovery. Much more importantly, it caused me to develop some very, very bad, deeply ingrained movement patterns as a result of compensations from the injury, scar tissue, etc. If I had it to do over again, the one thing I would do is stop running or riding cold turkey until you can do so not only without any pain but without any alterned movement patterns. To give you and idea, I have been back to racing the last 3 years but these bad movement patterns took me from a guy who did HIMs in 4:35-4:45 range in 2007-2008 and never got injured to now where I am in the 5:10-5:20 range and have several niggling issues in my hips,calves, etc. It is really starting to move back in the right direction for me recently but it has been a long long road. This road may involve no running or riding for several months which seems crazy but otherwise you might get set back several years. The PRP was good in that it forced me to take more time off. Hard to say if it healed the hamstring faster, it was no silver bullet to be sue but it certainly did not hurt the process, either. The second key to beating this thing is get a really, really good PT who has dealt with the issue before and who you trust. I was living overseas at the time and did not have access to a good sports PT and it really hurt me as I went from one practicioner to the next and tried a million things that were useless.

In sum, give it more time than you think, don't train through it even a little and get the very best PT in your area and do everything he says (and nothing else). Good luck.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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jsmith -

Thanks for your prompt response. X-rays show a rather substantial anterior pelvic rotation. I just started seeing a chiro to help rotate pelvis back and relieve the tension on proximal hamstring tendons. He also specializes in ART; hoping to get some relief with that. I'm also starting an earlier poster's protocol of glute and core strengthening in the first few weeks then gradually working my way up to hamstring specific isometric and eccentric exercises. Right now I just want to be able sit down on those sit bones pain free.

Any additional thoughts on recovery protocol?

Hopefully this isn't a permanent issue ... I'm only 39, I hope to have many more years of riding and running ahead .

Thanks again, matt
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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Mine comes and goes and I find the more I stretch it the longer it hurts. I also stopped stretching, grinding it with a lacrosse ball, and don't roll it anymore. Literally I do nothing for it. It's still there but I can do pretty much anything I want run/bike wise. Doc said it's probably here to stay so learn what works and does not work. He also said to leave it alone. No ice, stretch, etc.

My single best way for dealing with it is running with shoes that have at least a 9mm+ heel. Anything below that I it makes it worse. Newtons are around 6mm and they give me mucho problems. Really, anything that looks like a race flat. I'm running in the Adidas Boost now 9-10mm heel and life is great.
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Re: High Hamstring Tendinopathy Rehab Protocol [3Aims] [ In reply to ]
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I was diagnosed with this exactly one year ago. This past Sunday I ran a 12 minute PR @ Chicago. It took every bit of that year in between, for the problem to resolve.. and it's still not completely resolved. It will probably always be there, but I deal with it. The only thing I do, is foam roll the area. That seems to help.

Does anyone else have a hard time driving with this? It's my right leg, and driving seems to be where I feel the pain the worst. Something about stepping on the gas pedal. Very wierd.
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Re: High Hamstring Tendinopathy Rehab Protocol [chasiliff] [ In reply to ]
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chasiliff wrote:
I am a sprinter/mid-distance runner who happened to see this site a month ago after failed rehab over 9 months. I have had MRI that showed proximal hamstring tendon tear. PT with needling and eccentric strengthening, chiro with ART and graston and two rounds of PRP, the last 1.5 months ago. Then 2nd MRI 1.5 months ago showed healed tear.

Pardon me for jumping in...but....

I've been dealing with moderate pain and weakness in my left hammy for a while. Been doing PT, chiro, etc - and everyone's told me it was OK to run easy and do yoga, so I've been doing that. Plus a slew of rehab exercises.

I asked my ortho for an MRI, since everyone seems to disagree on whether it's hamstring origin, sciatica, or something else.

Just got the results back this afternoon. It's Friday afternoon, and so though I sent the results to my PT and called my ortho, I don't expect to hear back until next week.

Results are:
"There is edema within the left hamstring tendon origin with trace fluid signal intensity
at the attachment to the ischial tuberosity. There is also mild adjacent soft tissue edema.
Findings are compatible with a lowgrade
partial tear."

Any of you experienced people have any insight into how significant a finding this is? Based on this, should I be shutting things down for the weekend? Or should I go ahead with my normal rehab routine.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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One other thought I was reminded of by another post: don't stretch it. It feels like you want to stretch it out but I learned the hard way that doing so just reaggavates it endlessly. Your program sounds good, just be careful of the timing. Heal first, then loosen and only then try to strengthen. The only thing you can be sure of in terms of timing is that each stage will take alot longer than you want it to but you can't rush it otherwise you go back to square one. For me (I was 39, too when this hit me) the hamstring eventually healed only when I let it rest enough so I'd hold off on any hamstring strengthening exercises until you have zero pain. Instead focus on rollling and stretching the glutes/quads/hip flexors to deal with the tilt that caused it in the first place (and which will cause it to come back if untreated). I'd also look at daily postural issues and pelvic symmetry on the bike (that's where I am focused now) as you get back to training so you re-learn to move in a natural way with the right muscles firing at the right times.
good luck!
Jack
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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How long did you rest before your hamstrings started feeling better? Wondering how long I should rest before getting into week 1-2 protocol of rubber band work targeting glutes, hamstring ball curls, planks, wobble board, good mornings, etc.

Also, did you ever get into the pool to help with cardio? Or is that not hamstring friendly? Not doing anything for the next few months is very, very daunting.

thanks again for the feedback -matt
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Re: High Hamstring Tendinopathy Rehab Protocol [ay82mch] [ In reply to ]
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@ay82mch

have you had any relief from proximal hamstring pain? If so, what was the key for you?
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Re: High Hamstring Tendinopathy Rehab Protocol [Rforster] [ In reply to ]
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What were the wobble board exercises?

It looks like this was the only thread TTC posted on and is now history.

Wobble board exercises depend on how good your balance is and what type of board you are using. But in order of difficulty, these are what I've done:

Just get on it
get on it and look at ceiling
get on it with eyes shut
put one foot in middle and balance
one foot in middle and look at ceiling
one foot in middle with eyes shut
one foot in middle with eyes shut and look at ceiling

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Re: High Hamstring Tendinopathy Rehab Protocol [atl_runner] [ In reply to ]
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Does anyone else have a hard time driving with this? It's my right leg, and driving seems to be where I feel the pain the worst. Something about stepping on the gas pedal. Very wierd.[/quote]
I started to experience this back in July and by far the worst pain is when I am driving. A couple times a month I have to drive for 3 hours straight, I cant believe how uncomfortable it is. I try and use cruise control as much as possible and actually place an empty water bottle under my right hamstring/glute to help relieve some of the stress.
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Re: High Hamstring Tendinopathy Rehab Protocol [pauljra] [ In reply to ]
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I bought a doughnut from the drug store. Actually I bought 3. One for my car, one for work to sit on and one for home. It seems that sitting on a doughnut reduces the compression on the area where my hamstring hurts and allows for better and faster healing.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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Best of luck with this one, not easy. I always recommend a Feldenkrais session or two (no, I'm not a Feldenkrais practitioner, it just works for me) because for most chronic problems of this type the strain starts somewhere other than in the site of the pain. Feldenkrais fixed my knee, where all others failed (massage, PT, acupuncture, doctors with cortisone, chiropracters, coaches - though they each have their place, and I appreciate them), by determining the remote (by location and time) of the source of my debilitating running-induced knee pain. Got me back on the road to regular Ironman and marathon training, and never looked back as far as that knee was concerned, but I'm always working on something or other to keep these old bones moving as fast as I can. Wishing you well, Kevin aka FitOldDog
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Re: High Hamstring Tendinopathy Rehab Protocol [pauljra] [ In reply to ]
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Go to the Drug Store and get yourself a Dough Nut to sit on while driving. I have three of them. One for my car, one for home and one for work. You want to prevent compression of the glute area as much as possible when-ever sitting. The only draw back is that you have to explain to everyone who asks about the Dough Nut that it is for a hamstring pull and not hemorrhoids.
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Re: High Hamstring Tendinopathy Rehab Protocol [Rforster] [ In reply to ]
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Interesting. I'm actually sitting on a kneeling chair for work (I work from home), and it seems very comfortable for the hammy. I'm thinking that that's because the hip is at a more open angle with this set up, and so the tendon isn't being pressed while also being stretched.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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darkwave - what have your docs, PT's, etc recommended based on your "low grade tear" findings? My MRI in July indicated "fluid at both proximal hamstring tendons" which "may indicate partial tears". I dropped running in July and have scaled way back on biking. Dropped out from two races. Months of PT and a steroid injection and I'm still not feeling any better. Going to speak with sports medicine DO about PRP injections next week. @ $600 ea., not an inexpensive option. but at this point, I just want something to start the healing process and relieve the pain .
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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Mixed feedback.

Ortho: I'd just stick to swimming only until it stops hurting. However long that takes. I don't think PT is necessary, but you can go there if you want.

PT: This MRI isn't matching what we're seeing clinically. It's fine to do nothing but swimming for a week, but then I want you to try some easy jogs and see how it feels. He's also been doing dry needling, and gave me some eccentric exercises.

I also ran it by a teammate who is a PT - she wasn't that worried about my MRI, and commented that there were probably a lot of people out there with some sort of tear in their hamstring tendon that were asymptomatic.

So, I'm confused.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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jsmith - what has been the key for you the last three years to beat high hamstring tendinopathy and to stay pain free while returning to racing?
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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I am still not back to where I want and plan to be but I would say the most important things I learned are: 1 stop training until it heals; 2 be very careful coming back so you don't develop unhealthy compensatory movement patterns; and 3 get the best PT you can find so you can understand the imbalances that lead to the issue in the first place so it does not happen again
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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Just wanted to let everyone know that I'm scheduled for PRP on Friday (using the same Dr that JSmith used). I'll keep you updated on how it goes.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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What factors did you and the doctor weigh in to come to PRP conclusion? What is PRP recovery / rehab protocol? I've considered this as well, but @ $600/ea, not a cheap option. I'm currently seeing Dr. who specializes in ART. Hoping to see some relief soon.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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mtbdaddy wrote:
What factors did you and the doctor weigh in to come to PRP conclusion? What is PRP recovery / rehab protocol? I've considered this as well, but @ $600/ea, not a cheap option. I'm currently seeing Dr. who specializes in ART. Hoping to see some relief soon.


I've been fighting this on the left AND an annoying right plantar fascia/peroneal tendonitis issue for a while. The PF has been an issue since summer (July-ish). The high hamstring is a bit more difficult to determine the start, as I've had sciatica in that same leg, with similar symptoms for years on and off. When this issue re-emerged, we thought it was sciatica at first, and so I trained through it, with a cortisone shot (which I would not have gotten if we thought it was a tendon issue).

I've also already tried ART, PT with dry needling, activity modification, and rest. When I saw the PRP doctor, I brought him all my MRIs (I've had 3 - right foot, left hamstring, lumbar area), and my full case history. He said I was a "very strong candidate for PRP" in both the foot and the hammy. Separately, in the past I've always responded well to the more provacatory treatments - Graston, cross-frictional massage, dry needling, etc. Which points towards this working for me.

In deciding to go ahead, I consulted two PT friends, two other people who have had PRP (both of whom said they'd do it again), and my own PT. And my coach. Everyone said to go for it if I could afford it. And I can. And I REALLY want to be able to start training for Boston in January.

Rehab afterwards is a bit TBD. I'm getting it on Friday, and planning to be on the couch through the weekend. Then swimming with pull buoy only for the first part of next week. Part of the reason it's TBD is that we're not quite sure where I'm getting the PRP. Since the hammy issue still has some sciatic aspects to it, we're doing the following:

Thursday - get blood drawn

Friday morning early - I run two miles, then get some painkiller injections in hamstring tendon area. Then run two more miles. Depending on how that second run feels, he''' make a recommendation about whether we do just hamstring tendon, or also back.

Friday afternoon - PRP

As for rehab, I've been doing eccentric exercises and running with some improvement, but very slow.
Last edited by: darkwave: Oct 29, 13 14:00
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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Thanks for your detailed breakdown. Please keep us posted on how your PRP procedure goes and how your rehab shakes out. If PRP can get my partially torn tendons back in the game after only 8 weeks as it sounds it may for you, it would be worth the money. I've been struggling with this since May. Activity modification, rest, loads of PT, and a dexamethasone shot all providing no relief.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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darkwave wrote:
Mixed feedback.

Ortho: I'd just stick to swimming only until it stops hurting. However long that takes. I don't think PT is necessary, but you can go there if you want.

PT: This MRI isn't matching what we're seeing clinically. It's fine to do nothing but swimming for a week, but then I want you to try some easy jogs and see how it feels. He's also been doing dry needling, and gave me some eccentric exercises.

I also ran it by a teammate who is a PT - she wasn't that worried about my MRI, and commented that there were probably a lot of people out there with some sort of tear in their hamstring tendon that were asymptomatic.

So, I'm confused.

I have been watching this thread for a while because the symptoms I have sound spot on with everyone else. My right side sits bone has been sore for about a year but it has been fairly manageable as I have been able to train but not like I really want to. I have seen 2 PT's over this time and still sore enough that it keeps me from training like I want to and driving a car is uncomfortable. First PT said I was weak in core, so I have spent 12 months strengthening core and glutes. Second PT did ART and e-stim. After my last race (70.3) 2 1/2 weeks ago I have done nothing but swimming about 4-5 days/week and continued my core and glute exercises 2 times a week, no running, no riding. After 17 days still no relief, maybe even worse than before. I would have thought that after this short break from running and riding I would have had some relief. Is it possible that swimming aggravates this? To get to the bottom of this, what type of doc should I seek out? Is an MRI is in order? My primary doc ordered a scoped steroid injection in June and it got rid of the soreness for about 2 months.
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Re: High Hamstring Tendinopathy Rehab Protocol [bsherman] [ In reply to ]
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In my case, swimming aggravated it, too
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Re: High Hamstring Tendinopathy Rehab Protocol [bsherman] [ In reply to ]
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bsherman wrote:

Is an MRI is in order? My primary doc ordered a scoped steroid injection in June and it got rid of the soreness for about 2 months.

I think if it's been going on for several months, and you're not quite sure what you're dealing with, an MRI is unquestionably appropriate.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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darkwave wrote:
I think if it's been going on for several months, and you're not quite sure what you're dealing with, an MRI is unquestionably appropriate.

I really would like to get an MRI but my insurance sucks because the deductible is so high that the MRI is pretty much my expense. Also, dont you think no matter what the MRI reveals, the doc would say to rest? Maybe I just need to shut down for a week or 2 and then start with the process mentioned in this thread.
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Re: High Hamstring Tendinopathy Rehab Protocol [bsherman] [ In reply to ]
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Well first of all, I am NOT a doctor. But second of all, my entire family is in the medical field, and one thing I've learned from them is that the clinical exam is more important than scans/MRI. But the benefit of the MRI is that it can help distinguish between several possible diagnoses, each of which might have a different treatment strategy.

for example, we thought my issue was exclusively sciatica, and treated it that way, which wasn't optimal for a tendon issue. The MRI helped clarify the issue and change the plan. But if you and your doctor are sure that you have high hamstring tendonopathy, then maybe no need for MRI. But it sounded like you weren't sure, and also hadn't been seeing results over time. In that case, I'd ask for an MRI.[]
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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So, an update. Did the PRP on Friday - decidedly unpleasant (painful). Then was totally sedentary for 48 hours (Saturday-Sunday). I was very sore from the PRP for about 6 hours after, and moderately sore the next morning. As of 5 days later, the attachment point is still a bit tender.


On Monday-Tuesday I swam some with a pull buoy and did some very gentle rehab exercises (nothing that hit the hammy specifically, just glute bridges). On Wednesday I went in for PT, and was told to shift to normal swimming, and then start phasing in the elliptical.

I went for an easy 3000 yards this morning - was going for 4000, but the hammy started getting sore, so I stopped. Interesting thing is that the hammy did NOT hurt when doing freestyle before the PRP, except for the occasional twinge. This morning, I definitely got some soreness radiating down the hamstring. Don't know what to take from that - I do know that I'm still very early in the PRP response, so it hasn't worked whatever magic it has yet. But uncertain as to whether I should back off on the swimming for a few more days. I have an email in to my PT to ask.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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Did you get an update as to any specific PRP rehab protocol from your PT? your hamstring tendon still sore? I'm considering PRP as well, but it would be bilateral for me .... :(
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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mtbdaddy wrote:
Did you get an update as to any specific PRP rehab protocol from your PT? your hamstring tendon still sore? I'm considering PRP as well, but it would be bilateral for me .... :(

It was the belly of the hammy that was bugging me along with the attachment, but that's how my injury has been (and why it was first confused with sciatica). There's definitely some impingement of the sciatic nerve.

PT wasn't too concerned. Said that I should try swimming, alternating 500 yards buoy with 500 yards normal. If I wanted to be really conservative, I could stick to the buoy for a day or so. It was a bit sore this morning, so I stuck to the buoy.

Separately, I'm doing lots of bridges with my feet at different distances from my rear. From there, the progression will be to "walking out the bridge" to something closer to supine plank, and then back again.

Everything I've heard about PRP is that for the first 2 weeks it can make things worse, and the effects don't kick in until 3-4 weeks post procedure. So I'm not too concerned.

It does seem to me that the people who have had the most success with PRP took it VERY easy the first 2 weeks. On the other hand, my PT feels very strongly that right now it's better for me to be doing exercise that gently engages the area and uses the range of motion, rather than total rest.

The site of the injection at my ischial tuberosity is still tender, a week post injection (conversely, my foot isn't tender at all). Fortunately, I telecommute, and so I've been able to position myself in a way that spares the sit bone.

I'm actually hoping that the tenderness is a good sign - seems that those with more soreness post-procedure also benefited most, based on the very small sample size of blogs and friends I've consulted. Like I said, my foot isn't tender, but that didn't need treatment anywhere near as much as the hammy.


Question for all other sufferers - do you JUST have pain right at the sitbone/attachment? Or do you also have soreness down the upper third of your hammy?
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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I am teetering on the edge of going with PRP injections. One ortho is all for it, another says it won't help. How has your recovery been coming along, now that you've had PRP?
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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mtbdaddy wrote:
I am teeterieng on the edge of going with PRP injections. One ortho is all for it, another says it won't help. How has your recovery been coming along, now that you've had PRP?

I'm not quite at the 2 week period post PRP, so still too early to make a call. I've been told by others that the first 2 weeks I'd feel the same to worse, and then I'd see a general trend of improvement there after. PRP is not a quick fix, just a quicker and more complete resolution.

That being said, I've noted somethings that seem positive. I still have a bit of pulling sensation in the hammy, but my range of motion seems improved (my pt noted this as well, even before I did). When I bend down to pick something up off the floor, I don't reflexively protect it anymore. And I've noted improvement on many of my PT exercises, though I'm not yet to the point where I can do a supine plank pain free.

There seems to be a positive trend. And I'm not sure it could be explained by just the rest - I did that before (took a week off) with no real improvement.

But again, still too early to be certain.

As for whether to go ahead, my decision basically came down to....the worst case scenario was that I spent money and endured some discomfort for nothing. There wasn't the same downside risk to PRP that there would be to surgery or a cortisone shot (not that surgery was ever discussed in my case). And I'm really hoping to be able to train for and run Boston, and so was willing to risk wasting money if it possibly improved my chances of healing in time.

[my decision was also affected slightly, believe it or not, by a random unexpected check I received from my old home mortgage company - I sold my home in September, but apparently I was owed some extra money. The random check arrived just as I was deciding whether to do PRP, and covered the cost. I took that as a sign from somewhere.]

I'll definitely keep you in the loop as to how things progress. I do note that I am STILL a bit tender right where the shots were (it's now the 13th; I had the shots on the 1st).
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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Before I started ART 5 weeks ago, pain was localized to just insertion point on ischial tuberosity. Now my tendon at the insertion point is the most painful it's ever been and I do have some pain in the upper third of the hamstring muscle. My ROM is less too (because of heightened pain). No more ART for now ... I'm really hoping I didn't make things worse by trying it.

Darkwave - you're 20 days into PRP rehab .... how are things going thus far?
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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mtbdaddy wrote:

Darkwave - you're 20 days into PRP rehab .... how are things going thus far?

Short version: Things are progressing, though slowly, and in a "take a step forward, take a half step back" way.

Longer version (in case details are helpful).

Since I last posted, I've progressed back to full swimming freestyle for 3000-4000 yards (did 50/50 pull buoy, then 25/75, then canned the pull buoy altogether). I also added in some walking.

I got a deep tissue massage done last Wednesday (10 days post PRP), and my massage guy RAVED about how good the hammy felt. So that was nice.

I've also noted that I'm no longer protecting the hammy in my daily activities. For example, I bend down to pick something up without shifting or twisting to spare it. And I just checked my range of motion, and I'd say the left hammy has about 95% the range of motion of the right. That's a big improvement.

For rehab exercises, I shifted from doing just normal bridges to "walking out the bridge" - basically going into bridge, then walking out to nearly supine plank, and back in. On Sunday, since I was tolerating that exercise fine, I transitioned to eccentric hamstring ball curls. I lie on my back, with my feet on exercise ball, then go up into a bridge pose. Then roll the ball out, so that I'm in supine plank with feet on ball (the eccentric part), lower my rear to the ground, and pull the ball back in.

Nice thing about today was that I did that with no pain on the eccentric part (some mild pain on the bridging part).

On Sunday I did 8 minutes on the arc-trainer. That went fine, so I did 20 minutes on Monday. It felt fine during, but was mildly stiff and achy afterwards, and I worried I had overdone it. I emailed my PT (he wants emails every few days) and he told me that some mild achiness was to be expected, and that I should try the arc-trainer a few times more, noting how I felt. If things don't improve after three sessions, then we'll back off. But it's normal for there to be some achiness after reintroducing anything, so I should give it a few more tries.

I'll fess up that I also jogged 3 steps, twice, in the parking lot to test it. (I couldn't resist). That did NOT go well. Definitely not ready to run yet.

So plan for the next few days is more bridges, more eccentric hamstring balls, more arc-trainer. I feel like I'm definitely seeing improvement. But I just wish I was off of the emotional roller coaster.

In terms of flexibility, I'm much better than I was pre-PRP. In terms of how I feel while swimming, about the same. Based on the three steps I took running, that is still WORSE than pre-PRP (I was running with moderate discomfort before). But I also haven't run in nearly three weeks.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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mtbdaddy wrote:
Before I started ART 5 weeks ago, pain was localized to just insertion point on ischial tuberosity. Now my tendon at the insertion point is the most painful it's ever been and I do have some pain in the upper third of the hamstring muscle. My ROM is less too (because of heightened pain). No more ART for now ... I'm really hoping I didn't make things worse by trying it.

BTW, in my experience for ART, the practitioner matters a lot. I've had some very effective ART, and some that has made it worse. There are some people that are just too rough when administering ART. In my experience, if it hurts a LOT while getting it done, it doesn't help much. ART that is just moderately uncomfortable helps a lot.

I don't suppose you're in the DC area? I do have two people in the DC area that I trust for ART.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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thanks for your very detailed update, much appreciated. I will use your rehab updates as a baseline as to what I might expect if (likely when) I try the PRP injections.

You're right about ART. the first 2-3 weeks there was mild discomfort, nothing bad, and I felt like I might be heading down the right road. The last two weeks he hit those tender tendon spots hard, maybe too hard, and I'm in worse shape because of it.

In Grand Rapids, MI .... thanks for the offer though.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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Just another update. I've seen some more improvement the last few days. I'm still a far way from "healed" but definitely improving.

On Thursday, the hammy started feeling a lot better, so I jogged a few test steps in the gym. And...no pain. So, I hopped on the treadmill and did 3x90 seconds VERY SLOW jog, split by 60 seconds walking. No pain, just a sense of weakness. I was slightly stiff after.

On Friday morning, did a bit more of the same. This time it was 4x90 seconds jog, 60 seconds walk. (still - very slow. I maxed out at 4mph for the jog - by contrast, I ran my last marathon in 3:08, so this is REALLY slow). Followed up with another 20 minutes on the arc-trainer. Very slight stiffness after that resolved within 30 minutes.

This is small stuff, but still feels like great progress.

Other development is that I was getting a bit more pain from the eccentric hamstring ball exercises, so my PT asked me to "step back" slightly. Basically, I'm shifting to doing bridges with my feet propped up on a bench. I'm starting with both feet, and then will progress to doing it on one foot, with the other foot assisting. When that is pain free, I'll shift back to the hamstring ball curls.

I was scheduled for my next PRP appt on Dec 2nd, but my PT suggested that I push it back at least a week to get a better feel for how things are progressing. He and I are both thinking that further PRP may be unnecessary. PT wants me to slowly progress to regular runs before seeing him again.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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Thanks again for the update, I really appreciate it. I'm sure others that are suffering from the same affliction can learn from your experiences. Glad to hear too that you are making some positive gains. If you had to summarize your 0-4 week rehab protocol for PRP, what does it look like? In other words, what exercises is your PT having you do at his facility, and what exercises are you doing at home/gym? I imagine you want to keep the proximal hamstring area engaged without overdoing it.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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Well. I've just seen the end of 3 weeks (had the PRP on 11/1 - it's now 11/23)

Here's how my rehab looked so far:

days 1-2. nothing. Lay on couch all day, try to use hip as little as possible.

days 3-5. start back with Egoscue posture exercises, a few glute exercises and stuff like side planks. Also swim with pull buoy.

Days 6-12. Start transitioning from swimming only with pull buoy to swimming normal freestyle. Also start doing glute bridges walking legs out to near prone and back, as well as glute bridges with my shoulders on ball.

Day 13-16 - start adding in some walking.

Day 17 - add in use of arc-trainer, starting with 8 minutes and progressing over next few days up to 20 minutes. Also add eccentric hamstring ball curls.

Day 20 - add in some gentle jogging on treadmill at very slow pace, starting with 30 seconds walk, 30 seconds slow jog

Day 21 - decided that eccentric hamstring balls a bit too much, so swap to doing bridges with heels up on bench.


My current rehab protocol is:

1) an extended set of marching bridges with my shoulders on a ball, lifting one leg and then the other, while keeping my pelvis level. - I do about 4-5 sets of 10, but I'm focusing more on correct execution than actual # of reps

2) bridges with my heels on a low bench - doing 3 sets of 10 or 2 sets of 15 twice per day.

3) alternating jogging and walking on a treadmill. Aiming for no pain here. A pain level of 1-2 is OK on the bridges exercises, as long as it doesn't linger. I do not currently feel pain on exercise 1. I do feel some with exercise 2.

BTW - the above is just how it has played out for me, not a prescribed schedule. My PT did NOT give exact #s of reps, or exact days on which I should shift from one exercise to another. He and I have worked together for several years now on different injuries, and he knows me well enough to "trust" my judgment on how many reps and when to progress. When I see him, he does some manual therapies (ART) and also assesses the injury (checking flexibility, strength). Then we discuss how my exercises have been going, and he checks form and maybe shows me a new one or two. Then I update him every few days by email before the next appt (seeing him every 10-14 days).

If it helps, my training log is here: http://www.runningahead.com/...6f3d600517f/calendar
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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Just another update. I'm at 4.5 weeks post PRP, and jogged 4 miles at easy pace, no pain. Legs are tired from lack of fitness, but I'm still thrilled.

Was it the PRP? I'll never know for sure, but I'm thrilled with where I am.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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That's great news, really glad to hear things are moving in the right direction for you. I have PRP scheduled for 12/13. Not sure if I should do both sides. RH is 2x-3x worse than LH, but LH needs some attention too. I'm kicking myself for trying ART; gave up 5 weeks of PRP treatment/recovery time, only to come out in worse shape ... very, very sore now. Really hoping I will experience some of the benefits that you and others have experienced with this therapy.

Where was your tendon pain prior to PRP? Was it at the insertion point on ischial tuberosity? Or, lower, closer to muscle/tendon interface? Mine is right on the sit bones, very medial (i.e. closer to groin). Hurts like heck to run or sit down ... this is a really tough injury to overcome.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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mtbdaddy wrote:
That's great news, really glad to hear things are moving in the right direction for you. I have PRP scheduled for 12/13. Not sure if I should do both sides. RH is 2x-3x worse than LH, but LH needs some attention too. I'm kicking myself for trying ART; gave up 5 weeks of PRP treatment/recovery time, only to come out in worse shape ... very, very sore now. Really hoping I will experience some of the benefits that you and others have experienced with this therapy.

Where was your tendon pain prior to PRP? Was it at the insertion point on ischial tuberosity? Or, lower, closer to muscle/tendon interface? Mine is right on the sit bones, very medial (i.e. closer to groin). Hurts like heck to run or sit down ... this is a really tough injury to overcome.

Honestly, I would do both. The main cost comes from the overall procedure, it doesn't cost that much more to do additional sites. So better to do everything at the same time than to decide 6 weeks later that you really should have done the LH too and go back. Plus that way you're only on the couch once.

The sitbone itself wasn't that sore for me - just moderately so. The bulk of my pain was referred just outside of the sit bone, and then down the back of my hamstring. There's definitely some sciatic referal going on with me (which makes sense, when you think about it -tendon is close to that nerve)

I had the injections RIGHT at the sit bone, though. (and that area was quite sore after).
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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I'm in Grand Haven and have been dealing with the same issue. Signed up for Boston and haven't run since June.... I've done ART and PT and reached the end of my rope. Tried to run again but I think too much too fast (strated at 15 min) and the pain came back after 20. I've looked into prolotherapy but didn't pull the trigger. Where are you going to PRP? Too $$$ for me but not dismissing prolo just yet. Good luck to you!
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Re: High Hamstring Tendinopathy Rehab Protocol [123kab] [ In reply to ]
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123Kab - where is your pain? Is it in the tendon at the attachment point (sit bone) or a bit lower, more in the muscle / tendon interface? What aggravates it most ... running, sitting, squatting, etc? Sitting, running and cycling pain free has not been an option for me since May .... this is by far the most difficult injury I've ever tried to overcome. Like you, ART, PT, Chiropractic care, and steroid injections have all failed to provide any relief. That leaves me with two more options, surgery or PRP. I have a consult with a surgeon tomorrow. I'm scheduled for a PRP injection on 12/13 with Dr. Axtman. Cost is $600 ea (I'll need two since I'm bilateral), but at this point, I'll do whatever it takes just so I can chase my kids in the backyard pain free again. You might check with your insurance provider just to be sure it's an out of pocket cost for you. Code is 0232T I think. Not sure about prolotherapy, I've read mixed reviews on that. There's a few promising case studies out there where athletes with partial proximal hamstring tendon tears have done well with PRP, so, pending the outcome of my conversation with the surgeon tomorrow, I'll likely go with PRP.

We're practically neighbors as I'm in Hudsonville ... please keep me posted on your progress!
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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Interesting that you're charged for each shot. The practice that I saw, it was a significant overall charge for the procedure, and then incremental for each shot.

Also interestingly - I had to sign a form promising NOT to submit to my insurance.

FWIW, my doctor offered both prolo and PRP - said that he generally recommended prolo for simply daily use, and PRP for athletes, due to the greater degeneration athletes perpetuate on themselves.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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Can you post the link to the ROM test again? Interested to know where I stand. Thanks!
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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It's at the sitbone. I can easy cycle , do the elliptical 85-90% pain free and for a while my swimming was getting ok until I ran too far. It didn't hurt when I ran, but later in the day was sore jusst as when the whole debacle started. Would your surgery be to repair a tear? My PT thought my dr should look at x-rays taken by my chiro (did you follow all that? geez) but she's out this week and frankly I don't think it's my back. But, I'm not a doctor so we'll see what happens. Asked jsmith for the ROM exercise test since it is feeling better but I'm nervous. Good luck with your consultation and keep us informed. BTW-Dr. Dew does prolotherapy in Rockford.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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How are things progressing so far for you? I have PRP scheduled for tomorrow afternoon ... any last words of advice/wisdom?
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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mtbdaddy wrote:
How are things progressing so far for you? I have PRP scheduled for tomorrow afternoon ... any last words of advice/wisdom?

Ran 5.5 miles yesterday at an aerobic pace. Leg had some sciatic issues (foot cramping, lack of coordination) but PT said that may just be getting used to using it. No pain when running I have to concentrate on how I use it when running, but I did when reintroing the elliptical as well.

I'm up to 60 second supine planks with a pain level of 0.5. Also doing lots of hamstring curls using a balance ball - I've progressed up to single leg. I'm also able to do single leg deadlifts with a very light weight with no pain (I do have a little stiffness on that side, as compared to the other).

Words of advice for tomorrow:

1) Take some acetaminophen with you, so you can pop it right after.
2) plan on taking the rest of the day plus the next day off. I'd treat the next 48 hours or so post injection as if you had a bad flu - just stay on the couch. Even if it doesn't hurt that much, you want to move the area as little as possible. I did all my grocery shopping and house cleaning before, which was great, as I wouldn't have wanted to do it after.
3) make sure you have someone to drive you home.
4) For the first 2-3 weeks, you're most likely NOT going to see any improvement. And despite me telling you this, there will be points during those weeks when you'll get depressed - you've invested in this procedure, and you just feel the same or worse. You'll need to hang tough. It's somewhere after that point that it starts to kick in.

Good luck!
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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So - how did it go?
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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procedure went well. Doctor targeted both medial and mid hamstring tendons at their attachment points on the ischial tuberosity (RH). Saturday and Sunday I either just stood around or laid around on the couch, taking it easy all weekend long. For the next two weeks, doc wants me to lay low and stay away from activities that target the hamstring. PT will start back up right after Christmas where we'll focus on core, quad, and gluteal work. at 4-6 weeks, if tendon is feeling OK, we'll start getting into hamstring specific isometric and concentric exercises. 8+ weeks eccentric exercises to help strengthen the hamstring and then a gradual return to sport .

Trying to stay positive. Tendon is SUPER tender; sitting, squatting, putting my socks on, etc. are all very painful and challenging. I've already put up with this for so long; another 2-3 months to see "if it worked" is a bit overwhelming to be sure.

Thanks for the pointers earlier and for checking in. Hoping/praying in the next week or so the area will start to calm down and that I'll have some good news to report.
-matt
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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You had mentioned right around 3 weeks is when you will start to see improvement (if it works) ... how long did the "reactive" phase last for you? e.g. the constant throbbing, the exquisite tenderness to palpation, etc.?

And, how have you been feeling @ week #7? are you seeing a steady improvement in strength, flexibility, mobility, pain reduction, etc?
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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Fro me, it wasn't that long. Probably 4-5 days. FWIW, the people who seem to have the strongest reactive phase also seem to get the most out of it (based on my completely unscientific review of a few blogs and convos with friends).

In week 7, I'm still seeing improvement. Some days are better than others, but I think that's the nature of this. I am going back for a second set of injections tomorrow. I debated whether to do it, since I feel like one injection was probably enough. But I want to be totally sure I fix this, and the doctor told me that I don't need to take much time off this time.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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Got my second set done yesterday. Funny enough, I ran in the morning before, and did 9 glorious pain free miles. Which made me wonder again if I really needed to do the second round. But what the heck, I was already committed.

This time, after checking with the staff, I took the max dose of Tylenol BEFORE the injections. Not sure it helped, though. We started with my foot, where I'm trying to tighten up some ankle ligaments. Did about 8 shots, getting three separate ligaments, the peroneal in two places, the plantar fascia, and the posterior tib. Then we went to the hamstring.

Interestingly, hamstring didn't hurt much this time. Doctor said that that was likely because it was mostly healed (which goes along with that theory of "the more it hurts, the more effective it was..."). Might also be because I took the Tylenol, but on the other hand, the pain from getting my ligaments done was exquisite, so I'm not sure how much the Tylenol helped.

Plan for me this time is 36-48 hours off, and then ramp back up. With caution NOT to run 9 miles my first time out.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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What was the tipping point for you to get a second round since it seems as though you're well on your way to being 100%? Did your doctor recommend? And, is the rehab protocol the same for round II? My doc mentioned if I need a second round, we start over with rehab, as if it was the first time receiving the injection therapy. i.e. string out rehab for another 6-12 weeks post 2nd injection

Medial tendon insertion point (into ischial tuberosity) is still very, very tender to the touch and my ROM is severely limited. I realize this is only day 7 post injection, but I thought by now the pain from the procedure would have settled some. I'm trying hard to stay positive, just seems like there is such a long, uncertain road ahead.

Thanks for your update, glad to here you're progressing along so well.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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mtbdaddy wrote:
What was the tipping point for you to get a second round since it seems as though you're well on your way to being 100%? Did your doctor recommend? And, is the rehab protocol the same for round II?

For me, it was two things:

1) We were attacking two different things with the PRP - my hamstring, but also loose ligaments in my ankle. The ankle is still clicking some, though no pain, so made sense to get a second shot there. And since it doesn't cost much more to do the hammy at the same time, the doctor said I might as well - it was one of those "can't hurt" things. Doctor also made the analogy of adding logs to a fire. You start the "fire" of healing with the first PRP, and then add logs to the fire with more PRP (bigger logs) or prolo (smaller logs).

2) I was well on my way to 100%, but not 100% yet. And I'll be jumping into marathon training in January; I didn't want to go into that not having maximized my chances of staying healthy for the cycle.

As for the recovery/rehab - much shorter this time. Really just the day or two of total rest, then back at it (but keeping it on the easy side for the first few days). I guess it's because I'm so far along in the process. I have the same doctor as jsmith, and IIRC, this doctor was a lot more conservative with jsmith. So it's not like my doctor is cavalier with recovery.

As for you, hang in there. The next 7-10 days will be the most depressing - it will seem like it's been forever since you got the PRP, and no improvement. But in my and other's experience, it seems totally normal and expected for the first 2 weeks or so to be the same or worse. It's only after that that you start noticing the change.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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Does anyone watching this thread have hamstring pain but not gluteus pain? My left medial hamstring pain started in October 2012 slowly and progressively got worse. I started chiro and PT in Dec 2012 and have been doing it for the past year. Was committed to my first IM last summer and managed to train and complete it, though every run was painful. My hamstring would tighten and feel as if it was twisted around my bone and continued running just made it feel tighter and more painful. It is deep pain, not surface. Stopping to walk relieved it, but when I start to run again, it tightens up quickly and I'm all but dragging my left leg. Minimal pain biking, no pain swimming. After an IM and HIM this past summer I'm trying to take time off to heal whatever this is. (6 weeks so far, no biking or running). Problem is I don't have a definitive diagnosis. I've seen PTs, chiros, a pain mgmt doc and an ortho surgeon. One PT said tendonosis. MRI reveals nothing significant. Received three rounds of cortisone injections fall of 2013. PRP was next recommendation. Running is the single act that consistently triggers pain. (But I can't give it up for good.) Want very much to do another IM. Practitioners here haven't seen my problem so they don't have a confident rehab plan to recommend. My symptoms are just inconsistent with common injuries. This thread has been extremely helpful in giving me ideas for what to try but I'm wondering if the gluteus pain that many of you reference is an indicator that mine is something different. Most other descriptions of the pain is spot on with what I am feeling. Thank you very much.
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Re: High Hamstring Tendinopathy Rehab Protocol [kmf7376] [ In reply to ]
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bump to front.

Also I contacted AgilePT.com and their website link to this article is now funtional:

http://www.agilept.com/downloads/high-hamstring-tendinopathy-in-runners.pdf
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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day 21 update: injection / procedural soreness is gone. ROM is a little better. Pain level is still the same as pre-PRP ... all the leg and pelvic movements that hurt before still hurt at the same level now. Sitting still painful. Really hoping I'm not in that small minority of PRP recipients where this doesn't work. Starting PT this past Monday ... dynamic stretching, glue and core exercises to start, then work our way up from there
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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MBTdaddy - hang in there. It's not an instant fix, but more of a gradual improvement. And I did find that with each new thing I added, I'd be sore the first day, and then better the second time. The first time I did 15 minutes on the arc-trainer, I was very stiff after and was sure I'd set myself back. Waited a day, tried it again, and I was better.

As for me, I'm two weeks past my second round of PRP, and 2 months past the first. I really haven't noted much improvement since the second round, but then again, I know by now that I shouldn't expect to see it just yet. I've ramped up to doing 2 days running, one day off. Did my first 10 miler last weekend, with 3 miles at about 7:00 pace - held up pretty well. I tried some tempo-ish running this morning - no pain, though I was stiff after - perhaps attempting to run somewhat fast in 19 degree weather when rehabing a hamstring issue wasn't the smartest.... I don't think I did any major damage - just a note to myself to stay careful.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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day 40 PRP update: pain at rest is improving. ROM better. dynamic pain remains unchanged though (squatting, attempting to run, sitting, etc.) unfortunately, I'm just not seeing the improvements that so many have seen by now. still working with PT on dynamic stretching, balance exercises, glute and core strengthening. We introduced standing hamstring curls yesterday and I'm pretty stiff/sore today. Hoping we didn't set anything back.

I haven't run since May 2013, haven't ridden my bike since Oct 2013, PRP 6 weeks ago along with months of rehab and I'm still not seeing much improvement. Not exactly the athletic existence I'm used too ... this has been really, really tough.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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I have had high hamstring tendinopathy in both legs combined with entrapment of components of the sciatic nerve for 3 years which is causing horrible nerve pain down my legs and into my feet. No lumbar pathology found and my high hamstring tendon is very tender to the touch. It seems impossible to find any docs, PTs, chiros who have experience with this problem and I either get blank stares or someone trying to convince me its a herniated disc.

Does anyone on here have any recommendations for doctors to help with this problem in the southern California region, specifically LA?? Or even a place to start looking?
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Re: High Hamstring Tendinopathy Rehab Protocol [FisH2O] [ In reply to ]
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Guys
So glad I found this thread! I thought it was just me. Have just registered purely to post here

I get the dull ache in the butt, I can rest for months and it still comes back, especially when driving. Docs can't diagnose it, even after an MRI, but I'm convinced it's this (even before I saw this thread).

I've seen doctors, osteopaths, physios, done loads of strengthening exercises (although some of those above are new to me) - planks, bridges (with good form), clams, squats, lunges, step-ups, hip hikes, the list goes on.

The pain goes.. I start training again.. fitness comes back and I start to feel good... and then that dull ache appears again :(

Two questions for you guys who have been through this
- what do you think about minimalist running ("pose" or "chi") and this injury? Good, bad or no impact?
- the pain I feel sitting at my desk and (even more) in the car - is this actually doing me some harm, and preventing it from healing? This is how it feels to me.. but I need to sit at a desk all day for my job...

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Re: High Hamstring Tendinopathy Rehab Protocol [Try-ing Hard] [ In reply to ]
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I hate to say, but I still have not beaten this and I have tried everything I can possibly think of to fix. I had not luck with prolo, needling, scraping, etc, etc. Massage, chiro, rolfing, structural, etc etc.

For me, it is only running that really triggers it. I think I was using my hamstrings too much in the tri-position on the bike and my gleuts were not firing correctly and doing their job. Pushing my running mileage started the light burn which progressively got worse. The hamstring, and gleut-med are thrashed, but primarily the tendons attaching to the sit bone (ischial tuberosity) are necrotized and causing stress on the hamstring/gleuts.

I really think the key to fixing this are as follows:
- lots of ice, don't let this thing get inflamed
- find someone who can get out the scar tissue. Scraping, or other means, the tendon needs to try to heal
- Eccentric hamstring exercises - try to get the tendon to heal and lengthen once you have the scar tissue out
- Get a bike fit where they use sensors to track your muscle activity - hard to find but likely this is the root of the problem
- Stretch out your hip flexors - these can get tight from swimming, and from being contracted so much on the bike. Contracted, they are making things worse
- Palates or something similar to strengthen your gleut meds, if you are like me, they are weak as shit

To your question - I didn't find any relief whatsoever with minimalist running.
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Re: High Hamstring Tendinopathy Rehab Protocol [Try-ing Hard] [ In reply to ]
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Try-ing Hard wrote:


Two questions for you guys who have been through this
- what do you think about minimalist running ("pose" or "chi") and this injury? Good, bad or no impact?
- the pain I feel sitting at my desk and (even more) in the car - is this actually doing me some harm, and preventing it from healing? This is how it feels to me.. but I need to sit at a desk all day for my job...


All subjective.. I switched over to minimalist running in January of 2012, and my HHT came on, in September of 2012. After two months of trying to rehab it, rest it, I started back running in Adidas boost (far from minimalist), and completely backed away from minimalist thinking. I still have flare ups from time to time, but I am able to run with zero limitations. This doesn't indict minimalist running in any way, other than in my own mind, but I will not be going back down that path. In my mind, switching over to minimalist running was definitely a contributing factor to my HHT.
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Re: High Hamstring Tendinopathy Rehab Protocol [FisH2O] [ In reply to ]
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FisH2O wrote:
I really think the key to fixing this are as follows:
- lots of ice, don't let this thing get inflamed
- find someone who can get out the scar tissue. Scraping, or other means, the tendon needs to try to heal
- Eccentric hamstring exercises - try to get the tendon to heal and lengthen once you have the scar tissue out
- Get a bike fit where they use sensors to track your muscle activity - hard to find but likely this is the root of the problem
- Stretch out your hip flexors - these can get tight from swimming, and from being contracted so much on the bike. Contracted, they are making things worse
- Palates or something similar to strengthen your gleut meds, if you are like me, they are weak as shit


Thanks for the replies

I think the phase I'm missing/ haven't tried is getting someone to work on the scar tissue. I'll look into that

I'm more and more convinced that the pain while sitting is actually making things worse. Or at the very least it prevents it from healing.

Had to drive for 4 hours at the weekend and took a cushion with me, made a huge difference (even though my head touched the roof!)

Currently sitting at my desk and wondering if I could get away with a cushion here. It would probably get some comments (open plan office). But then it's been more than a year, what's more important to me...

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Re: High Hamstring Tendinopathy Rehab Protocol [Try-ing Hard] [ In reply to ]
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Try-ing Hard wrote:
FisH2O wrote:

I really think the key to fixing this are as follows:
- lots of ice, don't let this thing get inflamed
- find someone who can get out the scar tissue. Scraping, or other means, the tendon needs to try to heal
- Eccentric hamstring exercises - try to get the tendon to heal and lengthen once you have the scar tissue out
- Get a bike fit where they use sensors to track your muscle activity - hard to find but likely this is the root of the problem
- Stretch out your hip flexors - these can get tight from swimming, and from being contracted so much on the bike. Contracted, they are making things worse
- Palates or something similar to strengthen your gleut meds, if you are like me, they are weak as shit



Thanks for the replies

I think the phase I'm missing/ haven't tried is getting someone to work on the scar tissue. I'll look into that

I'm more and more convinced that the pain while sitting is actually making things worse. Or at the very least it prevents it from healing.

Had to drive for 4 hours at the weekend and took a cushion with me, made a huge difference (even though my head touched the roof!)

Currently sitting at my desk and wondering if I could get away with a cushion here. It would probably get some comments (open plan office). But then it's been more than a year, what's more important to me...

Sitting is just plain bad for you in general. I mostly don't get the butt pain driving anymore, but seat angle, height, support is important. Could you get a different chair for the office? If you really want to get razzed, just get an exercise ball to sit on.

The more you can get up and walk around the better. Humans weren't designed to sit all day
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Re: High Hamstring Tendinopathy Rehab Protocol [FisH2O] [ In reply to ]
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Regarding sitting: to me it feels like the further I lean forward in my seat, the more I am stretching the tendon around my butt, and therefore it hurts more.

Leaning back/ slouching in my seat creates less of an angle and it hurts less (but doesn't look so good in an open plan office).

This thread has rejuvinated my ambition to beat this - I've got a doctor's appointment on Wednesday to sort it out.

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Re: High Hamstring Tendinopathy Rehab Protocol [Try-ing Hard] [ In reply to ]
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Sitting, especially on hard surfaces aggravates and inflames the upper hamstring area for me as well, to the point where I get numbness and nerve pain in the bottom of my feet. One doc I saw has a theory called sciatic channel syndrome: http://www.advtherapy.net/html/sciaticchannel.pdf where components of the sciatic nerve get trapped in the scar tissue or swelling of inflammed tissues around the ischial tuberosity hamstring attachment points.

Has anyone tried a cortisone and deadening agent injections in the hamstring area? I'm considering this next just so that I can start a rehab program and get a step-up on this thing.
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Re: High Hamstring Tendinopathy Rehab Protocol [Try-ing Hard] [ In reply to ]
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Sitting is definitely an aggravator. I recommend trying either a standing desk or a kneeling desk.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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I've had 3 PRP shots for HHT, two in Oct 2013 and the last on Dec 4, 2013. I have improvement from where I was (I couldn't even walk at a fast pace), but I am nowhere near 100%. I didn't run from mid-aug to Jan 1st. I did only pull buoy swimming for 10 weeks. This injury is devastating. I'm going to muddle through next season and unless I have radical improvement, I'm getting surgery in the fall. Ortho told me to expect 4-6 months of recovery including 6 weeks post-op on crutches. I suspect this injury truly set in when I increased my cycling. I ran two marathons prior and never had any hamstring issues.
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Re: High Hamstring Tendinopathy Rehab Protocol [wkrp75] [ In reply to ]
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wkrp75 wrote:
I've had 3 PRP shots for HHT, two in Oct 2013 and the last on Dec 4, 2013. I have improvement from where I was (I couldn't even walk at a fast pace), but I am nowhere near 100%. I didn't run from mid-aug to Jan 1st. I did only pull buoy swimming for 10 weeks. This injury is devastating. I'm going to muddle through next season and unless I have radical improvement, I'm getting surgery in the fall. Ortho told me to expect 4-6 months of recovery including 6 weeks post-op on crutches. I suspect this injury truly set in when I increased my cycling. I ran two marathons prior and never had any hamstring issues.

I also had 2 PRP shots which helped a bit but also not back at 100% and keep re-injuring the area. What kind of surgery are you getting? Are they going to try remove scar tissue around the sciatic nerve that runs between the tendon attachments?
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Re: High Hamstring Tendinopathy Rehab Protocol [ghulley] [ In reply to ]
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ghulley wrote:
Has anyone tried a cortisone and deadening agent injections in the hamstring area? I'm considering this next just so that I can start a rehab program and get a step-up on this thing.

I wouldn't. I got a cortisone shot at the very beginning of my saga, when I was misdiagnosed as sciatica. I do wonder sometimes if that's what resulted in a bit of moderate pain deteriorating into a tear.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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Also suffering from HHT and just got second PRP today. First one was 3 weeks ago and still not much different. I am told to avoid hamstring focus exercises at this time swim no fins, no run, and can bike zone 1 only. Anybody have a recommendation for saddles that might put less pressure on the insertion. I don't really sense any pain when in the saddle but was wondering if others felt more or less inflammation after using a particular model?
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Re: High Hamstring Tendinopathy Rehab Protocol [triathmd] [ In reply to ]
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triathmd wrote:
Also suffering from HHT and just got second PRP today. First one was 3 weeks ago and still not much different.
Wow that's not very long between shots. Ligaments/tendons fully heal after about 6 weeks so you should really only be getting PRP every 6-8 weeks. I am trying to focus on getting my biomechanics right before trying PRP again because if you have imbalances then the hamstring will just get injured again and you'll have to start all over (which is costly with PRP).
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Re: High Hamstring Tendinopathy Rehab Protocol [ghulley] [ In reply to ]
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I also had 2 PRP shots which helped a bit but also not back at 100% and keep re-injuring the area. What kind of surgery are you getting? Are they going to try remove scar tissue around the sciatic nerve that runs between the tendon attachments?[/quote]
The process was explained as removing the tendon from the bone then scraping the bone to re-attach the tendon. This process would remove the essentially dead stuff.

With me, I find doing the rehab exercises cause discomfort for 24 hours after, then I feel better. I ran two days back-to-back for the first time last week. Speed and incline are a no-go. I use the heating pad every night. It really helps me. Plus I roll out with the rumble roller. I've worked on strengthening the hell out of my glute max and hips. I activate all those muscles before every run and cycle session. I still sit on pillows in the car and at my desk. I never sit more than 30 mins at a time. My coworkers are used to seeing my stretch and do dynamics all daylong at this point.
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Re: High Hamstring Tendinopathy Rehab Protocol [wkrp75] [ In reply to ]
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I injured my high hamstring last fall running a 28 hour relay race. And then insisting on running a half marathon two months later. I haven't run since December at this point. I have been in PT since then and have been really focusing on glut and core strengthening. I can bike or elliptical for about 50-60 minutes without significant pain but with fatigue. My gluts on the right (injured) side are still weaker than the left, despite good gains. My doctor diagnosed the tendinopathy (with overlying tendonitis) by ultrasound.

I'm still a month away from attempting running but I'm nervous. Is there a protocol anyone followed or found helpful when getting back into running? How many reinjured and how soon? I am captain of this relay team in September. The average runner does 3 legs and the total distance is 14-18 miles. I've already told them there is no way I'm doing three legs. How realistic is it to think I will be able to run 5-6 miles? It will be four months after I might start running if all goes well.

My doctor also does PRP....it seems like mixed results on the thread. So much to think and worry about...any words of wisdom?
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Re: High Hamstring Tendinopathy Rehab Protocol [nhrunningmom] [ In reply to ]
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First I want to thank those who posted their rehab protocol in this thread as if not for you, I would have never found my solution. I just wanted to post, in case what I did could help someone.

It was late December and I was signed up for Lake Placid Ironman 2014, and had just spent 4 months not running bc of what i was 99% certain was high hamstring tendinitis, which just did not seem to be going away with rest, and i kept reaggravating even though i was not running ... and knew i was at the make/break point, i had to start running. When i read TTC's protocol, the hamstring ball curls caught my eye, as I had read an article in the NYTimes 6 years ago about using eccentric exercise for curing elbow tendinitis (tennis elbow), and showed it to my boyfriend who successfully used the exercise to cure his elbow tendinitis, which he had from swimming.
http://well.blogs.nytimes.com/2009/08/25/phys-ed-an-easy-fix-for-tennis-elbow


I decided I had nothing to lose, either i started running, or i wasn't going to be able to do LP, so I did the hamstring ball curls (3 x 15 reps) 2-3 times a day and i started slowly running again. What i found interesting was my daughter had introduced me to the hamstring ball curls in the fall as one of her new dryland swim team exercises, but i rarely did them bc that more than anything seem to aggravate my hamstring. But now i was doing them 2-3 times a day, no matter how my hamstring felt.


I looked at all the other things in the protocol and of all the other things there, the only other thing i did consistently was the double/single legged bridges, and occasionally the monster walks.


In addition, for the first month (January) i went to my chiropractor 1-2x/week, who did normal adjustments and light Grastons. I talked to him about kinseology tape (which i had used successfully for other injuries), and he had gone to a seminar w a top expert who said, don't bother w online videos just tape to your pain. I really had no idea what that meant, but i felt the thing that would feel the best for me was to take 2 strips and starting just above the back of my knee place them as an "X" with the "X" more or less crossing high on my hamstring just around/below the point of my pain (each time was probably slightly different). I stretched the tape to about 50% before applying.


So for the month of January that is what i did, hamstring ball curls and I stayed taped (Rock tape i find sticks best) for most of the week. Oh, and i also did a lot of standing at work (bc as you have all noted, sitting hurts), and when i did sit at work I sat on a ball which didn't bother it as much. I slowly increased the amount i was running, and threw in some moderately intense intervals, and while some runs were better than others, I found i could keep increasing my mileage/intensity and it at least wasn't getting worse and was slowly improving. As it improved i gradually reduced the hamstring ball curls to 1x/day, stayed taped, and kept running. I probably stopped hamstring ball curls about a month ago (i was down to like 1x/week) and stopped taping a few weeks ago, and while i still feel an ache in my hamstring every once in a while (mostly sitting or if i just think about it, like it is really achy right now just from writing about it) I can pretty much run how much/how ever i want pain free (i ran 15 miles this morning), and am on track for LP.


I just want to add 2 additional things i did (just in case they mattered). The only stretching related things i did was lying on my back and holding each knee across my chest to work on releasing my SI joint, which my chiropractor highly suggested. And, this other video i came across on a stretch for better running position, I found to be extremely helpful (video at bottom of post):

http://www.kinetic-revolution.com/proximal-hamstring-tendinopathy-a-real-pain-in-the-butt-for-runners/


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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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Hi Jack,

While this is a complicated situation, over the past 25+ years I've worked with many thousands of people (mostly athletes) who have hamstrings that are so tight they are in danger of tearing off of the posterior pelvis. I'm happy to say that it can be reversed. After re-writing the long explanation I finally put it onto a forum I moderate. The post (http://forum.julstrointernational.com/...ic.php?f=9&t=762) has the details of this problem. In short, it's very common for cyclists because you are bent forward in the aerodynamic position for many hours. This position totally contracts your psoas muscle which will cause your anterior pelvis to rotate down in the front, and due to the interaction of several other muscles, your posterior pelvis moves up in the back. Your hamstrings originate on your posterior pelvis, so the origination point has moved up which puts a strain on your hamstrings and on the insertion point (exactly where you are feeling your pain).

Of course, your hamstrings have multiple spasms of their own because as you are cycling your legs are never totally straight, which means your hamstrings are held in the shorten position for hours. The spasms would be enough to cause pain at the two insertion points (at the base of your posterior pelvis, and behind your knee on the top of your lower leg), but then when you add in the fact that the origination point has moved up, you can see that the shortened hamstrings (from the spasms) are now being overstretched.

If you read the link I posted this will make a lot more sense. I'll be happy to continue the discussion if you'd like, I really believe you can reverse this situation and eliminate the pain you are feeling.

Wishing you well,
Julie

Don't let pain cause a DNF! YOU are your own Best Therapist! Visit http://www.FlexibleAthlete.com and http://www.Julstro.com to learn logical solutions to repetitive strain injuries and how to stretch safely.
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Re: High Hamstring Tendinopathy Rehab Protocol [willabby] [ In reply to ]
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Going on a year now for me. Vancouver Sun Run Mile 3, in front of the Sylvia Hotel, English Bay...on my way to match my time from the year before...POP. I have never felt so much pain in my life. Stop? No way...keep running, it will go away...1 mile later...LIMP...the next two miles practically dragged my right leg to the finish line - the absolutely stupidest thing I've done in my sports life.

A year of physio, compression, zapping, massage and patience.

I am now "racing" again, with a significantly slower run but enough to often win age group so how can I possibly complain?. As long as I keep the intensity DOWN and the mileage "conservative", it does not flair up. But it's not over yet. I want my old speedwork back. I want to move UP in the triathlon run, not just fight to not lose positions.

Thank you to everyone who's posted the exercises they do. You have inspired me to not just give it time, but get going on the specific exercises again :)





I'll see you in the run
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Re: High Hamstring Tendinopathy Rehab Protocol [JulieDonnelly] [ In reply to ]
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julie,

you may be right, or right in some cases. still, it seems to me that you're ascribing to this the same cause as you (famously) have for ITB syndrome: spasm, as in, your TFL is in spasm, and if you have ITB problems for years then your TFL has just been in spasm for years. please correct me if i am misstating your view on ITB syndrome.

the problem i have is your blithely ascribing a single cause for these problems laying like an umbrella over all the folks with this problem. i don't believe for a minute that ITB problems are universally, or even usually, caused by a TFL in spasm. i also don't believe that this problem can be attributed to a single etiology. every time you swoop into one of these discussions on this forum with an "i know what's wrong with everybody - and i can fix you all if you migrate over to me forum," you can expect a similar reply from me.


Dan Empfield
aka Slowman
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Re: High Hamstring Tendinopathy Rehab Protocol [Slowman] [ In reply to ]
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Hi Dan,

I'm so glad you wrote to me so I can explain my view of muscle/joint pain. I agree with you that there are other causes for just about any pain a person may experience, but my expertise is only in muscle pain so that is where I focus.

My experience is that people will go to their doctor and have x-rays, MRIs, etc., and go to physical therapy and have all the programs they offer, but the thing that is frequently overlooked is how a tight muscle may be causing pain. Also, if a person has had pain for years, the odds are they have already tried everything they can think of, or that the professionals can offer. Since I don't have the training to speak from a medical position, I only offer my insight about muscles.

I've been specializing in the treatment of chronic pain and sports injuries caused by repetitively straining muscles for 25+ years. My initial education was as a massage therapist, and then I had the good fortune to be trained by an Osteopathic MD, an acupuncturist, and an amazing PT who had his PhD in physical therapy. In each of these cases we continued my training by focusing on only the muscular component of pain.

You're right that it appears I'm ascribing a single cause for all problems, and looking at the body through my narrow lens, I agree. My entire premise is that a muscle is repetitively strained causing it to shorten into spasms, and that this puts a strain on the tendon. The now-taut tendon is pulling on the insertion point on the bone and will cause pain, as well as the potential for inflammation. I've seen the tight muscles be responsible for tearing the tendon from the bone, whether it is the biceps tendon, the Achilles tendon, hamstrings, etc.

My feeling is that it's easy enough to self-treat the muscle at home without all the expense and time that the other therapies require, or the need to take medications or buy expensive items such as orthotics. If the self-treatments don't work, then move on to explore other options.

Having said all of that, I'm taking your comments seriously and in the future I will preface my statements with "I am a muscular therapist so I'm offering you only one solution out of the many that may be available." What do you think? Does that explain it better?

Thanks for bringing this to my attention, I appreciate that you cared enough to tell me and not just tell the world without asking for my input.

Have a great day,
Julie

Don't let pain cause a DNF! YOU are your own Best Therapist! Visit http://www.FlexibleAthlete.com and http://www.Julstro.com to learn logical solutions to repetitive strain injuries and how to stretch safely.
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Re: High Hamstring Tendinopathy Rehab Protocol [JulieDonnelly] [ In reply to ]
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julie,

i think in general you're onto something. for example, i don't know that i've ever read from you about this paradigm in calf muscles but if you spend much time on slowtwitch you'll find people - men mostly, over 40 - complaining of calf strains and i suspect the underlying cause of many of these strains is calves going into spasm, shortening, you continue to run, and so forth.

therefore, the underlying cure is to stop cramping. and this is another common thread on slowtwitch. i've often wondered about the schizophrenic message delivered to consumers over the last generation: don't eat salt, that's bad for you - except we all need to take mega amounts of salt when we're training and racing. so we don't oversalt our food, but we take grams of salt tablets every long training day. i'm still trying to wrap my brain around this.


Dan Empfield
aka Slowman
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Re: High Hamstring Tendinopathy Rehab Protocol [Slowman] [ In reply to ]
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Hi Dan,

I agree with you about preventing cramping. I'm not a nutritionist, but I know just enough to believe that the cramping is likely coming from a nutritional imbalance. It seems to make sense since athletes are burning up the nutrients in their bodies with all the sweating and strain they put on themselves. I know a technique that will help to hasten the completion of a cramp, and then force out the toxins that were created during the cramp so you can stretch safely without harming the muscle fibers, but the best is to prevent the cramp from happening in the first place.

Some triathletes have told me that Boiron has a homeopathic product (I don't know the name) that was specifically made for endurance athletes and that you take during your event. I saw the tube and the wafer is about the size of a quarter. One of the triathletes told me that she would always cramp on her long training days, and during all events, and as long as she used this homeopathic products it didn't happen. I wish I could remember the name so I could tell you, but I imagine if you go to Boiron.com you may be able to track it down.

With the way the medical community keeps changing things (ie: salt, no salt), it's really confusing. I have an excellent Osteopathic MD that I like to listen to as he pays attention to the entire body, and not just one piece of the body (orthopedics, chiropractic, etc.), and I also know a man (Steve Chaney, PhD) who spent the first 35 years of his career teaching biochemistry and nutrition to medical students, and he's on the Shaklee scientific team. He knows nutrition inside-out and he's always debunking myths and half-truths. He writes a column called "Tips from the Professor." If you can't find him I can get his info to you, from the little bit I have taken from you, I think you'd like his work.

Have a great day,
Julie

Don't let pain cause a DNF! YOU are your own Best Therapist! Visit http://www.FlexibleAthlete.com and http://www.Julstro.com to learn logical solutions to repetitive strain injuries and how to stretch safely.
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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Do any of you have trouble sitting? I have a desk job and think it maybe making the problem worse. Sitting on my hand or foot a lot to avoid pain. Soft cushion is not helping. Any ideas?
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Re: High Hamstring Tendinopathy Rehab Protocol [bsherman] [ In reply to ]
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bsherman wrote:
darkwave wrote:
Mixed feedback.

Ortho: I'd just stick to swimming only until it stops hurting. However long that takes. I don't think PT is necessary, but you can go there if you want.

PT: This MRI isn't matching what we're seeing clinically. It's fine to do nothing but swimming for a week, but then I want you to try some easy jogs and see how it feels. He's also been doing dry needling, and gave me some eccentric exercises.

I also ran it by a teammate who is a PT - she wasn't that worried about my MRI, and commented that there were probably a lot of people out there with some sort of tear in their hamstring tendon that were asymptomatic.

So, I'm confused.


I have been watching this thread for a while because the symptoms I have sound spot on with everyone else. My right side sits bone has been sore for about a year but it has been fairly manageable as I have been able to train but not like I really want to. I have seen 2 PT's over this time and still sore enough that it keeps me from training like I want to and driving a car is uncomfortable. First PT said I was weak in core, so I have spent 12 months strengthening core and glutes. Second PT did ART and e-stim. After my last race (70.3) 2 1/2 weeks ago I have done nothing but swimming about 4-5 days/week and continued my core and glute exercises 2 times a week, no running, no riding. After 17 days still no relief, maybe even worse than before. I would have thought that after this short break from running and riding I would have had some relief. Is it possible that swimming aggravates this? To get to the bottom of this, what type of doc should I seek out? Is an MRI is in order? My primary doc ordered a scoped steroid injection in June and it got rid of the soreness for about 2 months.

I've been asking myself the same question: Is swimming responsible for the hamstring tendinopathy b/c it began when I ramped up my swimming volume from 500 yrd/week to 5,000 yrds/week (yes, it's too fast, but I thought that not much bad could happen from swimming).

What is your perspective now?

Proud Representative of Slowtwitch Anti-Atheists Society.
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Re: High Hamstring Tendinopathy Rehab Protocol [noneoftheabove] [ In reply to ]
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bumping this b/c its relevant to me. Just got recommended to get another MRI and ultrasound done on hamstring. Just had labral reconstruction in my left hip and this started just as I was picking up biking again. I've been slow and steady. This though is something that showed up on my original MRI. I don't have the money to just try PRP so I wanted to see if anyone that did found that it works.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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I just had PRP last week for this injury and have been reading and re-reading this thread closely. I first had problems on Thanksgiving and only got a firm diagnosis 6 weeks later. Since then, PT has been very specific for hamstring with eccentrics and core strengthening, and I've been able to do elliptical and deep water running. I'm hoping the PRP kicks in in 6-8 weeks and that I get the green light to start the return to running and biking protocol. I'm signed up for the New York marathon in November. What do people think? Is that realistic?
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Re: High Hamstring Tendinopathy Rehab Protocol [theroadback2016] [ In reply to ]
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Any updates on the PRP?

Also, are the symptoms for this and piformis similar? I think I have tendinopathy but I just can't seem to shake it!
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Re: High Hamstring Tendinopathy Rehab Protocol [theroadback2016] [ In reply to ]
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I'm also located in NYC and heading in to get a PRP injection today. Any specific advice for what to do / not do in the days after? How quickly were you able to get back to any type of low effort crosstraining (walking, stationary bike, eliptical)?
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Re: High Hamstring Tendinopathy Rehab Protocol [jarrod] [ In reply to ]
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Well, it has been a while, but I think the PRP really did the job, though my recovery was slower than some of the other people posting to this thread. I'm now 7 months out from the PRP and am running 3 days/week with a slow but steady weekly mileage increase. I took it really easy, per doctor's orders, for 8 weeks after the injection--no workouts, just light walking to and from the car, around the office, etc. Resumed PT work at 8 weeks. Started to re-introduce running in 1 minute bouts a full 4 months after PRP and have been steadily adding time/mileage, all the while continuing the PT regimen.

Patience is the key. Good luck.
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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I read the thread on this topic and can agree that HHT is a big pain and very frustrating even for a recreational runner like myself....in addition the constant pain while sitting makes it difficult to enjoy everyday life. After much trial and error, (i.e. spinal injections, SI injections, etc).... I was diagnosed in Nov 2015 and an MRI confirmed a partial tear in my right hamstring and hamstring tendinopathy in both hamstrings. I have been to several PT providers (regular PT , ART PT), chiro who performed Graston, 2 PRP injections (right hamstring only.....done at suggestion of doctor who wanted to see if I had any relief before trying the left hamstring)....

The ART PT wants me to continue with eccentric exercises and slight hamstring stretches, my chiro does not recommend any hamstring stretches, etc.....my niece who is a newly minted PT is suggesting dry needling....as you can see very confusing as I have been getting conflicting guidance.....bottom line is this has been going on for 3 years now....

Does anyone have a recommendation for a doctor in the New York/New Jersey area who has specific experience in providing/managing a protocol to treat HHT.....would greatly appreciate any guidance...
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Re: High Hamstring Tendinopathy Rehab Protocol [joer] [ In reply to ]
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I don't have an. Doc suggetion, but I had some degree of relief from dry needling, much better than any combination of Graston, ART, etc.

I would also be very suspect of any diagnosis from a chiro in this area unless they also have PT or similar license. Just my $.02.

Chicago Cubs - 2016 WORLD SERIES Champions!!!!

"If ever the time should come, when vain and aspiring men shall possess the highest seats in government, our country will stand in need of its experienced patriots to prevent its ruin." - Samuel Adams
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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jsmith,

After reading your posts I'm convinced I have the same injury. I broke my tibula and completely tore my interior ligament when I was 18 from skateboarding. I moved on to cycling and in my later 20s started to develop symptoms in my high hamstring. Stopped cycling all my 30s then came back with a vengeance in my 40s putting on 10000 mi my first season back. Then the symptoms really came on hard with the pain coming only when I sit. I have been misdiagnosed at least twice and now nobody dares to give me any kind of tx or diagnosis but I'm convinced I have high hamstring tendinopathy. Ive had it for over 6 months. I'm using a neck pillow to sit on to keep the pressure off that interior hamstring tendon and using holistic medicine: turmeric and solomons seal. Its working but I found very valuable information reading your story. From your ankle injury to no stretching and rest to out of whack hips. I almost think we should collaborate and write a book on this injury management lifestyle we are in and the quackery that got us here.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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TTC wrote:
@Jsmith

If you look at page 8 of the article I sent you it says that if you can do this test: http://www.physsportsmed.com/...figures=89?figure=75 pain free then you can start cycling and elliptical.


TTC: I know this was a very old post....but I'm intrigued to know what test you are referring to above. I have the exact same history really, and am keen to know when I can return to light cycling (it's incredibly frustrating to be immobile!). the link does not appaer to work now....can you possibly clarify?

many thanks!
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Re: High Hamstring Tendinopathy Rehab Protocol [srg] [ In reply to ]
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Bump, because I'm curious too.
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Re: High Hamstring Tendinopathy Rehab Protocol [jstonebarger] [ In reply to ]
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This is the best thread in the www regarding high hamstring tendinopathy. I have a question. Do you get problems when running and cycling?
I developed this deep pain through cycling over 2-3 years. Last year I started trail running because I could not stand the pain anymore. I get absolutely zero problems when running. Finished a half and a marathon and I can run full speed up and down the steep mountains.
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Re: High Hamstring Tendinopathy Rehab Protocol [Cattiy] [ In reply to ]
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I feel obliged to write a little something about this since I see soooo many replies in this thread where people have been completely mislead by their medical professional. I'm a final year PT student with a special interest in pain science, tendinopathies, movement in general and sports and triathlon in particular.

First let me explain Jill Cook's continuum model about tendinopathy:

As you can see, a tendon that has been put through more load than it can take will become reactive. This is what many of us athletes have felt when ramping up swimming or running volume: our shoulder/achilles start hurting. It's a load-induced hurt and the pain is usually 0/10 in rest. Taking a few days off, maybe some ibuprofen and like magic, its gone. That is "appropriate modified load" for the reactive tendinopathy.
However if one continues to apply excessive load, or if any other individual factors becomes worse, the tendinopathy will not resolve by itself and will enter a dysrepair/degenerative phase. This is often called "chronic" tendinopathy because it's much tougher to get rid of, but as you can see looking at the model "appropriate modified load" can get you out of the degenerative phase as well.

So what loads a tendon?
Tendon is loaded by movements, and there is 3 types of load we can apply to the tendon.
The first, most basic load is tensile loading; this is simply done by flexing the muscle that inserts into the tendon. This is generally well tolerated even by a degenerative tendon. The amount of tensile loading is proportional to the muscles contraction (add weight and it's more loading). An example for achilles tendinopathy is to just raise your heel 1 inch off the ground, standing on your toes. A easy way to quantify this type of load is to start with isometrics and count time under tension. Isometrics might also immediately reduce tendon pain through a mechanism way out of scope for this text, but its a cool thing to try. A good isometric for proximal hamstring tendinopathy is the supine bridge.
The second type of loading is compressive loading. This is when a tendon wraps around a bony structure and is put under tensile loading, compressing it towards that bone. A good example is the peroneal tendons, wrapping around the lateral malleolus:

This type of loading is often aggravating for tendons. The reason is also beyond this text. Here is a pic which describes where the common tendons are compressed.

The third type of loading is energy storage; what tendons are best at. This is also often aggravating and especially if it is combined with compression (like the peroneal tendons or distal achilles tendon when running). This type of loading comes from a passive lenghtening of the tendon from an external force when the muscle is 'locked' isometrically. Think of the calf complex when running; the calf will contract isometrically but the foot will reach maximum dorsiflexion at mid stance; this loads up the tendon with mechanical energy that will be released at toe-off.


So this gives a very basic understanding about what tendinopathies are; an inability to tolerate the current load. By modification to this load, we can create adaptation and get the tendon functional and pain-free again. How long this takes depends on how long you've had the tendinopathy, individual factors (training response, morphology, psychological factors, etc) and how much demand you will put on your tendon.

So how does one start rehabing a tendinopathy?
Step one is to find your current load tolerance and build from there. Start with tensile loading out of compressive positions. For the foot's tendons this means maximum plantarflexion, for the proximal hamstring tendinopathy it means maximum hip extension (since the tendons wrap around the ischial tuberosities when the hip is in flexion, such as in the time trial position or when you sit on a chair. Sitting also increases compressions since well, you sit on it). Start with an isometric program only for a few days and see if this calms the tendon down or aggrevates it. If you tolerate it, start doing some actual movement. If you dont, reduce load. Keep track of what you do and add in more exercises the more you can tolerate. When you can do pretty much, start adding in some compression. When you tolerate this, add in energy storage. It's all simple in writing but takes time, tears, commitment, experimentation. It's like ironman finish times; easy to do it fast on paper.

An example progression of exercises for proximal hamstring tendinopathy could be this:
W1: 3x30s supine bridge, adding some time daily
W2: 6x45s supine bridge with extended legs, feet resting on something
W3: 5x60s suping bridge, feet up + 3x10 ball curls
W4: 1x60 supine bridge, 3x10 ball curls, 1x10 dynamic supine bridges (glute bridge)
W5: 4x10 ball curls, 2x10 glute bridge, 1x10 one-leg glute bridge
W6: 3x10 glute bridge, 2x10 one-leg glute bridge, 10 one-leg straight leg deadlift
W7: 2x10 glute bridge, 3x10 one leg glute bridge, 2x10 one leg straight leg deadlift
W8: 3x10 one leg glute bridge, 3x10 one leg straight leg deadlift, 3x5 deadlifts

Somewhere in there one can also start running, it's energy storage but with pretty little compression.

Hope this gives some insight and also makes you question all the passive modalities that it seems like every PT/GP/Chiro prefers here in the US (injections, dry needles, different ways to hurt you with tools like graston/art whatnot). A tendon needs load, a tendinopathic tendon needs smart, well progressed load. Good luck!

Endurance coach
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Re: High Hamstring Tendinopathy Rehab Protocol [mortysct] [ In reply to ]
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Thanks for posting this info.

Quick question - the supine bridge.....does it actually do something to the hamstring directly, or is it more about strengthening the glute, which in turn will give the ham a break?
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Re: High Hamstring Tendinopathy Rehab Protocol [SBRcoffee] [ In reply to ]
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They are both hip extensors. Possible a stronger glute will take load of the hamstring, but tendinopathy rehab is primarily about increase the load capacity of the tendinopathic tendon. It's a progression into something more hamstring-dominant, like the ball curl. Start easy and increase load over time. If you can get to a gym, the lying leg curl is of course a great machine. Possible to work eccentrics as well on that one (but it's not necessary to work eccentric only for tendinopathy rehab, but its a progression if eccentric-concentric is too much load right now

Endurance coach
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Re: High Hamstring Tendinopathy Rehab Protocol [mortysct] [ In reply to ]
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Thx a lot! By your post I am able to to all of your excersises including running but cannot tolerate compressed loading for example while cycling.
If sit more forward on the saddle nose on my road bike I get no problems but this position gets uncomfortable. If I sit more upright on my MTB I also get less problems. How do I advance from here?
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Re: High Hamstring Tendinopathy Rehab Protocol [Cattiy] [ In reply to ]
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If you can tolerate w8 exercises but not cycling yet, do the week 8 exercises real heavy (5 reps of deadlifts at 6-8RM for example, and add weights in the glute bridge) about 2x week. For extra control and an additional effect, count 3 on both eccentric and concentric phases. You can even try to add in cleans to get some energy storage + compression loads.

Meanwhile you do this, do your cycling upright. There is still compressive elements in upright cycling but not nearly as much as in TT position. Gradually increase how much time in aero you can do, add a few minutes per week.

You'll be fine by summer. Maybe even faster, since resistance training improves running economy.

Endurance coach
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Re: High Hamstring Tendinopathy Rehab Protocol [mortysct] [ In reply to ]
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mortysct wrote:
If you can tolerate w8 exercises but not cycling yet, do the week 8 exercises real heavy (5 reps of deadlifts at 6-8RM for example, and add weights in the glute bridge) about 2x week. For extra control and an additional effect, count 3 on both eccentric and concentric phases. You can even try to add in cleans to get some energy storage + compression loads.

Meanwhile you do this, do your cycling upright. There is still compressive elements in upright cycling but not nearly as much as in TT position. Gradually increase how much time in aero you can do, add a few minutes per week.

You'll be fine by summer. Maybe even faster, since resistance training improves running economy.

I know it is key to avoid exercises that aggrevate the pain in the high hamstring. But let`s say when cycling I get 3-5 min of discomfort (not sitting good, to much power...) in my 40 min commute. Is it enough that I make no progession to heal the high hamstring?
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Re: High Hamstring Tendinopathy Rehab Protocol [Cattiy] [ In reply to ]
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I dont think so, no. Generally, when rehabilitating from tendinopathy, there will be pain.

Endurance coach
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Re: High Hamstring Tendinopathy Rehab Protocol [mortysct] [ In reply to ]
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Looking back it makes sense that avoiding compression is key. Last year in may, I bought a cross country MTB to try something different. My position on the MTB was of course more upright and I got much less problems (same position to the bottom bracket and same saddle). Unfortunately the higher Q-Factor of 155 mm and the SPD pedals did not get along with me knee, so I sold the MTB.

Before that I tried a full carbon saddle. Sat only on my sitbones and also got no problems. But in the end the saddle was to hard I got pressure damage on my left site, because of my uneven hips.

Maybe I try to ride without my Assos bibs and just some MTB shorts and seamless underpants, because maybe the thick chamois is to soft and leads to compression of the high hamstring. Was not an issue with the full carbon saddle, but with my "softer" Prologo Zero II CPC. The idea is that I ride softer than with a full carbon saddle and bibs, but on a harder surface than the Prologo Zero II CPC and the Assos bibs.
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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TCC, on the remote chance you may still be following this thread: The link you provided to an article with a test for pain-free readiness to commence the training program you followed is broken. Could you let me know what the name of the article was (or send a updated link)? Many thanks! Peter
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Re: High Hamstring Tendinopathy Rehab Protocol [Pladegaard] [ In reply to ]
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I second that!
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Re: High Hamstring Tendinopathy Rehab Protocol [Cattiy] [ In reply to ]
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Just a bump on this one with my on-going experience.

A couple of weeks or so out from IMNZ last year I pulled my calf (or so I though) stepping off a kerb. Did IMNZ anyway, although head wasn't in it and walked much of the run.

Anyway, to cut a long story slightly shorter, it got diagnosed as HHT after a series of X-rays (which showed nothing) and a couple of MRI's. I had a couple of rounds or PRP injections, which improved things, but only a bit. I still had issues which limited cycling and running.

Just over three weeks ago I had surgery "high hamstring origin repair" - surgeon is Dr Matt Brick (ex-triathlete and all-round nice guy) - although I had to travel to see him, as an ex tri-head he understood where I wanted to get to. He told me that the tendon was about 60% detached.

So, after only three weeks I still have pain, but it's getting better. I can walk without a crutch but can't sit down for very long. I have hopes of getting back into some gentle biking and running soon, but I won't be rushing it. In the meantime I have lots of nice pain meds to keep me happy!
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Re: High Hamstring Tendinopathy Rehab Protocol [quintana who] [ In reply to ]
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I wonder why a detached hamstring could not be seen on multiple MRIs? I am asking because I also had a MRI that showed nothing...
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Re: High Hamstring Tendinopathy Rehab Protocol [Cattiy] [ In reply to ]
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Cattiy wrote:
I wonder why a detached hamstring could not be seen on multiple MRIs? I am asking because I also had a MRI that showed nothing...

Or did they see it on the MRI, thus the decision for surgery? I'm going through the same type of injury, haven't had an MRI yet, takes forever in Canada... :(
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Re: High Hamstring Tendinopathy Rehab Protocol [Cattiy] [ In reply to ]
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My bad and misleading English...

The initial MRI was lower back - the thought at that stage was sciatic nerve pinched where it appears from the spine (so MRI not in the correct area). Second MRI picked up the deterioration of the tendon hence the decision to go see Mr Brick and try PRP, which then lead to surgery.

TBH I think it's all to do with the skills and experience of the person reviewing the scans - it isn't a particularly clear image!

In any case, good luck with it, and I hope you find some resolution. My only advice would be to go see the best person you can, and someone who appreciates the sport you do.

I'm still on one crutch some 5 weeks after surgery. Sitting is still a problem, and I haven't done any exercise (so am going slowly insane...). Perhaps I shall try a gentle swim at the weekend?
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Re: High Hamstring Tendinopathy Rehab Protocol [quintana who] [ In reply to ]
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This is very timely for me. I got a nasty bout of deep glute soreness 2 weeks out from IMNZ this year (I wrote another post about it, and the different diagnosis I received from treating practitioners). Anyway, ended up getting a cortisone shot dee in the glute where the pain was coming from, did IMNZ but got through the bike/run fine.

It's now a good 10 weeks or so post race and the pain has been severe. MRI with a top quality private practice sports doc shows hamstring tendon tear, tendinopathy and bone bruising. I'm waiting to see a referral from the doc to start a rehab program. Doc recommended PRP but I want to try and resolve it without the shots first, of straight rehab and shots don't work he has said surgery is next option.

I did a fair amount of research once I got the diagnosis and have placed myself on a program that involves every second day doing eccentric hamstring loading on a hamstring curl machine with the tendon decompressed (hip not in flexion). Over the space of a week or two it started to improve, slowly, but I can tell the difference.
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Re: High Hamstring Tendinopathy Rehab Protocol [rock] [ In reply to ]
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Hey mate - best of luck with it - mine went undiagnosed for a loooong time, through no fault of any of the folk I saw, it was just that the symptoms I was getting were suggesting other things (calf pain, back pain - possible disc or sciatic issues). Did IMNZ in 2016 (run was v slow) which wasn't the best idea in hindsight...

I did end up doing a lot of work as you described and saw some improvements, but it then plateaued hence PRP and then surgery. I'm 5 weeks on from surgery now and still sore - sitting and driving is the worst....

Not sure if you're based in NZ but I would recommend Matt Brick up on the North Shore. He was pretty fast in his day so knows about triathletes, and has given me confidence that this will get fixed eventually. Good luck with it!
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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Hi! I know this is an old string. But was curious the outcome of this @Darkwave. I have the same thing...have had fenestration and PRP two weeks ago - but have been off running since dropping a marathon on May 7th. Have NY in November that I'm just going to jog...but the big one is Boston and I want to kill that one. So, trying to figure out the realistic road to being back....PT starts this week.
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Re: High Hamstring Tendinopathy Rehab Protocol [teauxja] [ In reply to ]
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Endurance coach
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Re: High Hamstring Tendinopathy Rehab Protocol [mortysct] [ In reply to ]
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Thanks....I'm familiar with what to do and not to do. And, frankly, am not worried if I cannot do NY. I was curious on Darkwave's return back for this specific injury. I have coaching, rehab and a plethora of Orthopardic surgeons (whom work with professional sports teams) at my disposal, but opinions differ, as well as clinical studies and infographics, so was just interested in one persons's experience.
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Re: High Hamstring Tendinopathy Rehab Protocol [teauxja] [ In reply to ]
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Hi - I ended up doing three rounds of PRP, with the first on November 1, 2013. I tried to do Boston 2014, but ended up canning it, since I was still battling injury. Eventually, I was able to run Philly 2014 - a year after my first PRP injection. (Philly 2014 sucked, but it had nothing to do with the PRP or the hamstring injury).

I don't think doing Boston next year is unrealistic. In my case, I missed Boston not because the PRP didn't heal me, but because I hadn't yet solved the issues in my gait that kept getting me re-injured. If you don't decypher the underlying cause of your injury, you're just doomed to repeat it.

So key for you is figuring out WHY you injured your hammy.

If it's helpful, my training log/blog is here: http://wellimtryingtorun.blogspot.com/

You can read starting in November of 2013 to see how I structured my come back. I also have the tag "PRP" for specific blog entries describing the injections.

I hope this helps - good luck! FWIW, I set a whole slew of running PRs this spring, so it is possible to come back from this injury and eventually run better than you did pre-injury.
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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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Thank you @Darkwave. I'll definitely check out your log. I can pinpoint EXACTLY when and why I injured it - I shorted a warm up trying to merge up with my morning run crew because I got out late. It was last speedwork session leading into the 2 week taper before the Eugene Marathon and was 5X1K repeats. Happened about 1:30 min in on the 5th one. I also had not been diligent on keeping the strength in the glutes and core. :) I'm working on those parts to prevent it in the future.

Bad timing as I had just inked out a 15 min PR 5 months earlier at CIM and BQ'ed by more than 10 minutes...I had been hitting PR's in all distances the last 5 months of 2016 and for Eugene, was looking at shaving off another 5 min from the CIM time. (This after 3 years of getting the same times over 5 different marathons).

Thanks again - I appreciate the response! Particularly since the thread was an older one!

And Way to Go on the PRs!! :)
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Re: High Hamstring Tendinopathy Rehab Protocol [teauxja] [ In reply to ]
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Thought I would share my experience with PHT. Picked it up in the Spring of 2015, got too aggressive on the TT bike, along with a really long hard run in the hills, both legs got injured within 2 steps on that long run.

I've taken months off of running/biking over the years, which did nothing, I've been to ART, needling, myofascia release etc, with no help.

I'm currently about 80% better, I'm running 2:15min/wk with minimal pain, biking 4-5hrs, and swimming 2x week. I'm working on getting back on the TT bike, I can could the position for about 3-4 minutes.

I started a rehab program about 5 months ago, leg bridges, hamstring curls, Swiss ball, and Nordic curls. I think I have 5 months to go before I'm back to 100%.

IMO here's why this is such a hard injury to heal:
-it takes months of rehab to repair the tendon, which makes it hard to stay focused and positive
-my pain is better, but every week that I add more load, the tendon gets grumpy and acts up. You have to push your tendon a little to make it heal.

I have the same amount of pain each week, but my hamstring can handle more training. I'm putting in about 8-10 hrs per week. Hopefully when I get to 15 hrs and back off, my tendon will be used to the new load and the pain will settle.

i hope this helps someone out there, it's a dark hole, with very little light, I know plenty of people that finally gave up and changed thier lifestyle.
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Re: High Hamstring Tendinopathy Rehab Protocol [M&M Tri] [ In reply to ]
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Just a thought that may help some. I initially had this diagnosis, only to later find out it was a labrum tear and FAI causing the pain.
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Re: High Hamstring Tendinopathy Rehab Protocol [winchester] [ In reply to ]
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winchester wrote:
Just a thought that may help some. I initially had this diagnosis, only to later find out it was a labrum tear and FAI causing the pain.

Thats what I'm dealing with as well. High ham tendonopathy pain, glute pain. Xray shows CAM FIA. Waiting for MRI w/contrast to see what damage is in the joint.
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Re: High Hamstring Tendinopathy Rehab Protocol [mortysct] [ In reply to ]
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Hello

Do you have any reference to specialists in Southern California? I have a complicated case and am seeking the advice of a professional.

Thank you.

Alex
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Re: High Hamstring Tendinopathy Rehab Protocol [ap13evans] [ In reply to ]
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ap13evans wrote:
Hello

Do you have any reference to specialists in Southern California? I have a complicated case and am seeking the advice of a professional.

Thank you.

Alex

No, sorry, I dont know squat about which caregiver are the best anywhere. I'm just nerdy and into my own studies. I'll be a chartered physio in Sweden in a few months so welcome over ;)

Anyway: you can call around to those who look promising and explain your symptoms. Dont use much medical terms, use "tendon pain" or something open and ask how they manage it. You want to listen to those who are into exercise therapy, know about what kind of loading tendons like and someone who want to cooperate with you, be your guide in the rehab process. Shy away from anyone who explains about their PASSIVE adjuncts, whatever they might be. PRP has no evidence (might even be worse than saline injection), cortisone is worse than anything, massage does bat shit, manual therapy probably even less, it's not your gait, it's not your shoes. Tendon pain is "easy" in that terms, the tough part is figuring out what load you tolerate and how to progress it into meaningful activity.

Endurance coach
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Re: High Hamstring Tendinopathy Rehab Protocol [mortysct] [ In reply to ]
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Ok. Thank you, I appreciate all the info and your nerdy studies :)

By the way what do you think of surgery for managing chronic hamstring tendinopathy?

Have you heard of Doctor Sakari Orava in FInland who does Hamstring Syndrome surgery?
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Re: High Hamstring Tendinopathy Rehab Protocol [mortysct] [ In reply to ]
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If anyone out there is looking for guidance, do yourself a favor and listen to mortysct, everything made sense after reading the posts, and I started making progress. Extremely tough injury to overcome.
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Re: High Hamstring Tendinopathy Rehab Protocol [M&M Tri] [ In reply to ]
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ap13evans wrote:
Ok. Thank you, I appreciate all the info and your nerdy studies :)

By the way what do you think of surgery for managing chronic hamstring tendinopathy?

Have you heard of Doctor Sakari Orava in FInland who does Hamstring Syndrome surgery?

If surgery should be indicated, one should have failed a well planned and properly executed conservative protocol. At least 16 but preferably 24 weeks and surgery can be indicated imo. The problem with surgery is that you remove some tissue that might be causing pain but the degenerated tendon often lies deep and is not possible to remove. And post-surgery you will follow a very slow rehab protocol, which will cause the tendon to de-adapt further. Sometimes it's what someone needs. Also important to remember that the surgery is a very potent behavioural modification. I want to believe that patients that have had surgery will follow their rehab protocol more closely.


M&M Tri wrote:
If anyone out there is looking for guidance, do yourself a favor and listen to mortysct, everything made sense after reading the posts, and I started making progress. Extremely tough injury to overcome.

Thanks and wonderful to hear that you are making progress.

Endurance coach
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Re: High Hamstring Tendinopathy Rehab Protocol [M&M Tri] [ In reply to ]
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M&M Tri wrote:
If anyone out there is looking for guidance, do yourself a favor and listen to mortysct, everything made sense after reading the posts, and I started making progress. Extremely tough injury to overcome.

What exercises have you used to start loading the hamstring?
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Re: High Hamstring Tendinopathy Rehab Protocol [SBRcanuck] [ In reply to ]
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I started with the bridges, double then single leg, then progressed to light hamstring curls on the bench progressing slowly with weight, Nordic curls, and Swiss ball curls. I'm not 100%, but getting there slowly. I was told this could take 18 months, I'm 6 months in and believe I still have ways to go. The key is not loading the tendon too much, you know it's too much when you hurt longer than a day after exercising. I found out that 3 days of rehab a week is enough, anymore and the recovery process doesn't happen, just like training.

Let me know if you have more questions, persistence is key!!
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Re: High Hamstring Tendinopathy Rehab Protocol [M&M Tri] [ In reply to ]
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Thanks, thats pretty much what I've been doing for the past month now. Have had this for over a year now, but only stopped running, not biking, over the fall/winter/summer. So now am off the bike and run, and in the gym hoping to rehab this.. Just never really seems to go away, top of bicep femoris is always hurting...
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