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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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