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Hamstring tendonosis
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Hi all,

I've been off running for 6months due to pain in the hamstring and real sharp pain in the ischiums on both legs. To cut a long story short it came about after upping my cycling miles to avoid losing fitness whilst resting a knee injury. So no running or riding for the past 6months (interestingly I managed a week of fell running without pain but as soon as I returned to the flat it came back).

I've just had the results of an MRI back which have confirmed a hamstring Tendonosis. has anyone else suffered this? What treatments did people use etc? The consultant wants to inject (I've only just had the letter which doesn't state what will be injected but I suspect a corticosteroid), but I've not really done any conservative treatment on it yet. My physio was reluctant to get to hands on before the MRI so as not to exacerbate the injury.

Cheers for the advice,

Matt
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Re: Hamstring tendonosis [Herdwickmatt] [ In reply to ]
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Matt, I am having the same issue with my right leg. Total right knee replacement in February, 2015 and did 3 Sprint tri's in August and September 2016. Started having the problem in August after the first Sprint. I had also increased my bike mileage, as my run volume is voluntarily being restricted. Went to PT and they have me working on glute strengthening and hip stability. Also, lots of eccentric stretching. Here is something you may want to look at: http://www.jospt.org/...2519/jospt.2015.5762
Pete
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Re: Hamstring tendonosis [xdays] [ In reply to ]
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Cheers for that. I've just had some one on runners world forum say that if it's been around for 6months+ it will never heal... sort of worrying as I'm 31 and don't fancy another 60 years of pain in the buttocks...
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Re: Hamstring tendonosis [xdays] [ In reply to ]
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That is a really good article. I'm going to share it with my sport doc.

"Ain't no shortcuts to the Opry."
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Re: Hamstring tendonosis [Herdwickmatt] [ In reply to ]
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Herdwickmatt wrote:
Cheers for that. I've just had some one on runners world forum say that if it's been around for 6months+ it will never heal... sort of worrying as I'm 31 and don't fancy another 60 years of pain in the buttocks...
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My wife suffers from on again/off again hamstring issues ("high hamstring tendinitis"). Hers has been bothering her for more than 6 months but does get better when she keeps up with rehab (physio) workouts. If she stops doing these then the hamstring issues resurface. Also, she has had PRP treatment for this issue and she felt like it was very helpful.

So, long story short, her hamstring issue is chronic but is manageable if she keeps up the physio work, and does not slack off, along with the occasional injection (PRP)
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Re: Hamstring tendonosis [Herdwickmatt] [ In reply to ]
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So many things could be going on here.

How much physical therapy have you done? Targeted stretching/strengthening/massage is usually necessary to get over tendonitis.

What is your bike fit like? Biking shouldn't aggravate the hamstrings so it's likely your seat is too high, far back or your cleats are off.

How many miles were in that week of fall running? Start off at really low mileage (like 5 mpw) and build from there. Big miles will aggravate old injuries.
Last edited by: Karl.n: Nov 6, 16 6:07
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Re: Hamstring tendonosis [Herdwickmatt] [ In reply to ]
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Same issue here, for about 1.5 years now. Stretching and foam rolling hasn't really helped. If I lay off running for several days it gets better, but comes back right away when I run. About to go in for some ART treatment to see if it helps. I suspect its gonna take a bunch of ART therapy combined with strengthening exercises (eccentric loading), to keep this thing under control.. :(
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Re: Hamstring tendonosis [SBRcoffee] [ In reply to ]
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Tendinopathy isnt something one can receive treatments and get rid off. Actually, most injuries to the musculoskeletal system are such that passive treatments almost never do anything to the injury itself, rather just changes your perception of injury which allows you to start loading it through your regular exercise.

Here is the most up to date clinical commentary about proximal hamstring tendinopathy, which this thread is about.

https://www.dropbox.com/s/mti8khj5t6i1g62/Goom%20et%20al%202016%20PHT%20Review.pdf?dl=0

Endurance coach
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Re: Hamstring tendonosis [Herdwickmatt] [ In reply to ]
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I had high hamstring tendinopathy that sidelined me for two seasons (2011-2012) but I was able to get it under control and haven't had issues since. This is only my "n of 1" but perhaps it's still helpful because I found some things that didn't work (for me) as well as others that finally did work (for me).

Mine came on only in the left high hamstring and was brought about while I was overdoing speed work during the winter (lots of fast loops on a 200 m indoor track). It came on slowly over a few months and then I distinctly remember one track session where I didn't listen to my body, over did it, and hobbled off the track. I saw an orthopedic/sports medicine guy who told me to do a lot of static stretching and take time off running and it would get better on its own. I'm now convinced that advice put me back many, many months. Simply taking time off didn't promote any healing, and lots of static stretching probably aggravated it more than anything else.

Saw a second orthopedic, they recommended a PRP injection, tried that, no change (except for my wallet).

Finally I went to a 3rd sports med person who recommended progressive eccentric loading along with some soft tissue work. The eccentrics progressed from bridges to exercises with a Swiss ball and finally Nordic hamstring curls. (I can give more specifics if you want but it mostly followed the recommendations in: https://www.ncbi.nlm.nih.gov/pubmed/20086362). Once I was consistently doing eccentrics I was able to start jogging/running again and building up miles. It still took some time before I felt "normal" again, probably around 3-6 months, but progress was steady.

I think my recovery would've been much faster if I'd started with eccentrics and soft tissue work right from the start rather than wasting about a year doing essentially nothing and then crossing my fingers with PRP.
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Re: Hamstring tendonosis [Karl.n] [ In reply to ]
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Karl.n wrote:
So many things could be going on here.

How much physical therapy have you done? Targeted stretching/strengthening/massage is usually necessary to get over tendonitis.
So far not a lot. As stated in the OP the physio didn't want to get to hands on and start prescribing excercises which might exacerbate the injury. She originally had thought it was a stress fracture of the tuberosity (an injury she saw alot of as a former Army physio) and so had wanted it to settle and for confirmation before starting serious PT. I have however been strengthening the glutes and core as recommended by the physio to try to address weaknesses in the chain.


What is your bike fit like? Biking shouldn't aggravate the hamstrings so it's likely your seat is too high, far back or your cleats are off.
Bike fit is a fairly relaxed road fit. I'd changed to the saddle (the old one was very battered) and thought I had the fit the same but maybe not quite close enough. The new saddle was narrower and more racy.

How many miles were in that week of fall running? It was a low milage week but I did a tough session which took me a long way from home and got sore at the half way point and had to get home.....

Start off at really low mileage (like 5 mpw) and build from there. Big miles will aggravate old injuries.
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Re: Hamstring tendonosis [Northy] [ In reply to ]
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Cheers Morty and Northy.

That clinical paper made a good read and it's good to see people can come back from it with appropriate rehab.
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Re: Hamstring tendonosis [Herdwickmatt] [ In reply to ]
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I had it from an acute injury and what finally got me back after about 6 months of pain was ART and the PT (a lot of eccentric work) and the swiss ball work/bridges. If you do find someone good with ART, get the swear jar ready to go though, it isn't fun.\

It does occasionally become a niggle a bit, but the PT exercises get rid of it before it gets bad.
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Re: Hamstring tendonosis [Herdwickmatt] [ In reply to ]
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I had it onset after my last race in 2011. I struggled through PT in 2012, and ended up run-walking IM Lake Placid and 70.3 Worlds when it never healed. My insurance wouldn't pay more for PT, so I took a little more time off after 70.3 worlds that September and did a ton of yoga (1-2x/day) that fall along with the PT exercises. I was able to resume run-walking by the next spring. By the end of 2013, I was running faster than ever before, but I think I was still compensating and ended up with a hamstring injury on the other side (this time lower hamstring), that I am still working through... Hamstrings are frustrating.
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Re: Hamstring tendonosis [krull_etc] [ In reply to ]
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I think based on everything I've read it's a long process but sticking with PT keeps it at bay. Feeling pretty positive that I can sort this out.

Is it advisable to foam roller the surrounding muscles?

Also hot/cold therapies worth using?
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