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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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In Reply To:

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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