I've had it, summer/fall 2019

I’ve had it, made life miserable for at least 6mo.

---

Dimond Bikes Superfan

Yep-on/off issues with it for the past several years. Well-versed in that one, by this point.

Yep. Either side at different times. I may be an outlier, though, as it seemed to stem from a spine fusion a few years earlier...

I would be happy to answer any questions. I battled bilateral HHT for years, saw 5 orthos and got 5 different opinions. I had full reattachment surgery in 2017....the best thing I ever did. Unfortunately, I know this injury oh too well! I did everything you could imagine prior to surgery- prp, graston, lasers, needling, acupuncture, tenex, physical therapy etc....The joys of iron distance training and racing. Worth it though!!!

Had it. Started about a year ago. 99% healed as of this week.

---

"Good genes are not a requirement, just the obsession to beat ones brains out daily"...the Griz

there's a pretty huge thread on this

Yup. Had it. Did IMNZ on it 2016, thought it was just a niggly calf pull.

Reattachment surgery 2017 by the always excellent Dr Matt Brick. Several halfs since then and IMNZ this year.

Happy to answer any questions based on my own experience!

yes. we have it archived in hot forum topics.

---

Dan Empfield
aka Slowman

Yep, took me out of racing throughout all of 2011 and most of 2012.

Yes, took about 2 years to get rid of.

let's back up. my assumption here is that we're talking about the origin of the biceps femoris, in the region of the ischeal tuberosity, i.e., the sit bones. where the ass and the leg meet. is this what you all have in mind when you answer this question? or are you thinking of something else?

i ask because i don't see how the calf would be involved in this. and, yes, matt brick is excellent. i think about him often. i have often thought of stalking him down for an interview.

---

Dan Empfield
aka Slowman

Had it/have it since 2015, never fully heals, but I can bike/run as much as I want with a proper adaptation period during a build. Its really mild most of the time.

Summer's been dealing with it for the past year or so. Seen a number of chirps and PTs and is finally getting it under control.

---

Benjamin Deal - Professional - Instagram - TriRig - Lodi Cyclery
Deals on Wheels - Results, schedule, videos, sponsors

Wont speak for Quintana who but for me- yes at sit bone and yes- pain can come down your leg, calf and foot If you train on this injury long enough. You can develop scar tissue on sciatic nerve right at site where sit bone and 3 tendons attach if you are lucky like I was! :( . My pain began to travel down my leg and foot. During my 4 hour surgery to reattach tendons- 2 hours was cleaning up all the scar tissue. I feel like a miracle after years of suffering. I read all the threads and learned on ST when first diagnosed years ago as it was hard anywhere else to find info on.

Hullo Mr Dan,

As another respondent suggested, it was inferred pain from the (sciatic?) nerve that sits next to the tendon at the leg slash bum interface. Matt B noted after surgery that the tendon was 60% detached, and that the scar tissue (which he also cleaned up) from the injury and the surgery resulted in what felt like a calf pull. For this reason it was a frustratingly long time to diagnose, as we were looking at the wrong part of my leg. MRI of the correct area identified it though.

He also said that it would be six months before I was pain free (running) after surgery - he was correct pretty much to the day!

Think I have his email address somewhere if you want to PM me (or however that works here on ST). I noticed that he's started racing again and is pretty speedy still.

Had this forever... probably 4-6 years. I continued trying to run through it and that was a big mistake. Then, it began bothering me on the bike, sitting, etc. I saw at least 10+ providers such as chiro, PT, sports doctors, etc. Had everything under the sun done to treat it...stretching, dry needling, etc. The only thing that worked was to address back issues and the PT I saw recommended McKenzie Method (used to treat sciatica, etc.) and I took 12 weeks off from running and 4 weeks off from the bike. I also strengthen the hamstring as well. Be careful stretching it since that seemed to irritate it more. Good luck!

I have had the injury twice, about 3 years ago on the left leg, and in January this year on the right, There are several excellent YouTube videos on therapy. It took from late January to mid March to resolve my most recent injury.

This is my the topic for my PhD which I'm currently undertaking.

We are currently recruiting for a trial for people with Proximal Hamstring Tendinopathy (PHT) in Melbourne, Australia. https://twitter.com/.../1389182504343523330
(I'm also testing some theories!)

Would you be willing to share how you healed it?

---

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

I've been dealing with this since August 2019, ask away

---

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

yes, ongoing, currently in remission. Literal pain in the ass.

[/url]I got this in October 2013 (still clearly remember finishing the race and thinking - what is that pain in my ass?) and battled with it until sometime around May 2019 when I finally gave up. In that time, I saw several physios and got several misdiagnoses. I spent 9 miserable months basically sat on the couch or at work. I did nothing but eat, work, sleep and be thoroughly miserable for that entire 9 months. My wife made a baby in 9 months, I could not even repair a fricking sheath around my hamstring. Once it finally healed and I could feel no pain at all I slowly got back to it and became a changed person. I took things really steady, had nothing in particular to train for through Covid and have managed to make a full recovery. What a long and frustrating journey it’s been. After years and years of pain I can finally train and recover pain free. In all that time I only found 1 physio who gave me the correct diagnosis along with any helpful and meaningful advice. Needless to say, I am so looking forward to the end of Covid and the start of my active pain free life style again. For anyone who lives an active lifestyle like me and my wife, it’s hard to articulate what an infuriating injury this is. Look after your hamstrings and sit bones peeps.

Just for info, my rehab had many elements - but anecdotally some of the ones that I think really helped. Hot shower on my ass every morning to promote blood flow around the area. Hot wheat bags out the microwave and onto my ass for the same reason. Bought a kneeling chair and a saddle chair for work instead of the usual office chair. The relief around my sit bone was almost instantaneous. Now use a standing desk around 50% of my working day and take mobility exercise seriously instead of just giving it lip service. I still use the kneeling chair every now and again as well - although it can make my knees sore.

---

He who understands the WHY, will understand the HOW.

Slowman: Had it.

Tigerchik: Dedicated eccentric exercises seem to have been my solution. I use TRX style strap and do a medley of bodyweight curls. Exercise ball would work too. Also runners arabesque.

Many other factors seem to be involved for me. Premature speed work seems to contribute, stretching too. I can't tell if cycing helps or not. Skiing helps, wrecking doesn't.

For me, yes.

Great article on treating your hamstring issue:
https://cdn.shopify.com/...18009094848855083734

Tom Michaud is a chiropractor in Boston and in my opinion has been a great resource for my practice and patients and has authored a number of running textbooks and a patients self care book that’s currently being updated called “Injury Free Running”. He provides links in all his articles to the latest research. I’ve emailed Slowman suggesting he interview him :-)

There’s lots of options out there and my best suggestion is find a solution that makes to you.

---

Mike

Sure.
Male. 64 yo

1. It just slooooooowly got better. There wasn't one "ah ha" moment or exercise that made a difference. Time is the key. First symptoms appeared in June 2020 after I did one too many hill repeats. I didn't let it heal completely and it morphed into tendinopathy


2. Rest did not seem to help. I continued to run, albeit a lot slower. Pain was my my guide with respect to how fast. It didn't seem to make a difference how far I ran. If i kept the pace manageable and "relatively" pain free, it was rarely more sore afterwards than when i started the run. If i pushed the pace, I felt it the next day.

3. Lots of eccentric tendon loading, hamstring curls, squats. Foam rolling seemed to aggravate it. It sure didn't help.

4. The turning point for me was when I thought..."eff it, I'm going to run through this and just deal with the discomfort". I switched my mindset from focusing on how it felt day to day, week to week to just grinding it out. See 3. above.

4. It wasn't a linear healing process. Lot's of minor setbacks. Lot's of weeks when it just seem to drag on. Some good weeks.

As of today, I can still feel it when I pick up the pace significantly. But, like I mentioned above, it's slooowly getting better. The pace at which I notice it has increased.

---

"Good genes are not a requirement, just the obsession to beat ones brains out daily"...the Griz

Thanks. Mine is also pace-dependent. I'm working on form; overstriding aggravates it for me.

---

maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

Yes 5years of pain but finally feel like getting fit again. Took a year to diagnose properly with MRI, got some poor physio advice, couldn’t shake it, then got a really good physio who switched me on to the idea that my stress/worry about it was making it worse. It’s been incredibly slow but I’ve found deadlifting/Nordic curls to be the best thing. Also doing mindful exercises so when it does niggle I don’t fixate. I developed a mantra of “sensation isn’t pain” to repeat to myself when it niggled!

This is spot on!!!!

Slowman wrote:

i have some questions i'd like to ask you. testing some theories.

Ask this guy.....

https://forum.slowtwitch.com/forum/?post=6253105#p6253105

---

"Good genes are not a requirement, just the obsession to beat ones brains out daily"...the Griz

I had it back in 2016 and had to quit running for six months. No cycling or swimming for three months.

As you stated, it involved pain up high, near the butt cheek. Yes, it can cause some people to have calf pain but these people also usually have the high pain as well.

Mine started in March. Had PRP in June when it did not seem to be improving with rest (no running) and rehab. Who knows if the PRP really made a difference or not but I was getting desperate and felt like it certainly could not make it any worse.

For me, eccentric exercises made mine hurt more. So, besides no running, I focused on strengthening the muscles around the area (the glutes....max, med, and minimus). My glute med and min were extremely weak, to the point that my PT asked "are you even trying?" when he was testing me. Also, I did bridges with a band. It wasn't until about two months after I started doing these that I actually felt comfortable trying eccentric exercises.

Once I was back to running, I had this weird numbness, and fullness, feeling to the back of my leg for a few months. For this, I started doing something called "nerve flossing" and it seemed to clear it up (though time itself may have been what cleared it up).

Had it years ago. Took lots of stretching and massage to finally get it resolved.

I had a proximal hamstring rupture with a complete avulsion of all three tendons, if that's of interest to you. I had it surgically repaired and was able to resume riding my bike and running.

---

Mike Sparks


I have competed well, I have finished the race, I have kept the faith.

Spot on?
Respectfully, for most people who end up getting HHT, if they do what he said in #4, its never going to get better IMHO......

I took 2 years off running, lifted weights, had a needling procedure etc.. Never helped, I finally said screw it, and slowly started running with pain, and it slowly started going away. I was doing hamstring curls 3xweek while starting to run again. I was told by a couple Doctor friends that stopping running was not the way to recovery, of course I didn't listen, but looking back, they were right.

Just my experience with the injury. I'm 95% healed. Still can feel it now and then, last summer I built up to 85 miles/week of running, so not bad!!

I'm not necessarily saying all running should stop. That didn't work for me either. What did work was finally doing the exercises that physio recommended, glute work, calf work, nordics, and super super light hamstring curls IF they were completely pain free.

But with regards to the running, I would never tell anyone to 'just work through the pain. Go ahead and run, but don't push through pain. I would only run as hard, and stride as long, as you can pain free.

Anyway, just my .02....

Yeah, thats great advice. Theres tons of articles that match what you are describing. It just didn't really work for me. Seems like like lots of different opinions on the way out of the injury.

One thing for sure, its a tough, long process to get through.

I think there is a massive mental focus in this injury, because it’s constant and impacts everything in life (sitting down/bending over to pick up the kids/riding/running) it can feel totally overwhelming.

I think if you get yourself into the mindset of not worrying about it (different to ignoring it) you are on the way.

When I first had it I tried to grind it and it definitely had massive set backs. I should have rested/stabilised it then got back on the horse.

I have HHT. Didn't notice it happen, just slowly started to bother me around August 2020. Not sure what triggered it but i did mess with my bike position (more aggressive) and cleat position (back all the way). It was also during a high loading (for me) of 1000TSS, and running some sprints 2 weeks after 2 half marathon practices in 2 weeks. Gave up on the PT after three weeks and just did the exercises. Still feel it but not as painful unless I sit on an airplane for 4 hours, or run/bike uphill hard.

Yep. Took me the better part of three years to finally get past it. Got so bad initially that I had to buy a sit/stand desk.

---

Trust me I’m a doctor!
Well, I have a PhD :-)

Same age although three years younger when it started and this is basically how I got/am getting over mine. Worse issues was all the other little niggles that appeared as I ramped up distance and intensity along with the loss of fitness, mojo, and confidence.

Still struggling mentally to pick up training load not for fear of injury but because of apathy.

---

Trust me I’m a doctor!
Well, I have a PhD :-)

I have had it - as someone pointed out previously any tears to the proximal hamstring don’t really heal, you just have to work around them. I have on and off been dealing with it for almost 10 years, mostly able to run through albeit modified. I have completed several IMs, many marathons etc.
Here’s what doesn’t work:
Stretching
Yoga (sooo many people get injured and are told yoga is the answer to their problems- proceed with caution)

Here’s what did work:
Adjusting expectations
PT
More PT

Basically if I don’t keep up with mobility and PT exercises it will pop up and manifest somewhere else (for me, my hip or calf). I’ve gotten into a better habit of keeping up with the PT work so fingers crossed.

One more victim here.
Suffered on/off for 3 years (2016-2019) before finding a fix in 2019. Agree that stretching/yoga didn't help.
Went through 3 PTs before finding that strengthening the hamstring in isolation was key for me.
Single leg Hamstring curls started the healing. Initial strength difference was close to 50%.
Adding deadlift made it go away. Close to 100% recovered now.

I've had it twice, H Wurtele had it as well.

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

Yes HHT. Proximal hamstring though i think mine was the semi tendinosis (not femoral biceps).

Like "show me your ride" and the "hotties" thread, this thread needs some pictures to help identify the usual suspects in this case, the biceps femoris and semitendinosis (ie. the hamstring group), and pubic bones and sit bones, ie. inferior pubic ramus and ischeal tuberosity, the attachment point of the upper hamstring group.

Posterior view of the hamstring group, with unlabeled pelvic bones:



Side view of pelvic bones:



Front view of pelvic bones:

---

Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

what do you think causes and effects are?

---

Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

at the time i would have considered the cause a tight hammstring and too much speed work. But now i'd be thinking more about upstream effects of how the posterior chain was doing and what issues that might have on the hammies.

effects? you can't sit on a saddle. The scarring tends to happen at the ischial tuberosity where the hammy connects to the bone. The IT being your "sit bones" so a snub nosed saddle is completely out of the question and a regular saddle aint much better.

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

This is where I'm at. Calcification at the injury site has led to an 1.5 inch long ossification, ie, a bony bump in my butt. Surgical consult suggested that removing the ossification would do more harm than good, and no guarantees that it wouldn't just reform.

It is very painful when sitting on a saddle. I've tried improvising cutouts, foam pads, etc but have not yet found anything that works. TT position is less painful than road position. Even moderate, low intensity training has been impossible.

Have you found any solutions?

---

No coasting in running and no crying in baseball

my last instance of this was over 10 years ago. My remedy was staying off the bike and a ton of PT at the insertion point.

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

If for your entire TT cycling career you had been sitting rotated forward on pubic bones instead of on sitbones where the tendons insert do you think that would have made any difference?

ERic

---

Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

when you've got no ass like me even when you're fully rolled over your sit bones are still hammering hard on the saddle.

should also note that the injury doesn't result from riding, it happens while running but continued riding prevents it from healing. (at least in all the cases (7-8) that i've been party to)

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

Yeah, completely on board with you about the continued riding aspect on the injury and healing.

I’d like to focus on saddle and position in this thread but should say that doing deadlifts is the best way to heal and/or prevent this kind of stuff IMO. Deadlifts, RDLs, Nordics, etc. Work that ass...

Now, that said, do you think you were still on your sit bones so much because your cranks were too long, making hip angle too acute at top dead center?

Also, with the trend toward tilt as of late and getting weight onto the front end thru this mechanism, any more thoughts on 2000s MarkyV’s hammies and lack of a butt in light of today’s modern positions and modern fitters making bike work for athlete instead of other way around? I’ve got a theory going about this...

Eric

---

Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

Dealing with it now. Got really bad in October. But, there were probably some tell tale signs that I ignored like what felt like tight piriformis. Took 5 months off of running, but continued swimming, riding, skiing (up and down and XC). Tried Chiro, MT, Accupuncture, Dry Needling, Shockwave, PT. After PT and likely some Shockwave....and really working the strengthening excercises, I started running again in April. It's been a slow go, but I've been able to increase from running 3m on, 2 m off to running a full hour. Now I'm trying to get enough fitness back to race Nats in August.

---

Pat Dwyer
@pdwyer99

 
I'd be careful about saying anything that could prevent this stuff. You can do all that and still overreach with the running and have something like this happen. I haven't looked any time recently but last i checked there's zip in the literature to suggest that lifting weights "prevents" injury. The literature is also incredibly exacting.

¯\_(ツ)_/¯

Not sure what this trend is, help a brother out? :)

I always fit myself and it was always based on pseudo FIST principles and fundamentals. Sure we know more, but time and again my fit was seen as outside of norms by most but i always found it very comfy. Enough so that when i was really exhausted I'd have to be careful not to close my eyes cuz i was so comfy in aero that i very well might have been able to drift off to sleep 😬

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

With regard to your fit, you and I are the two mutant dots way out to the lower right quadrant of the graph, so I know what you’re talking about re: comfort.

As to prevention, I meant with my own post-hamstring problem self, not the general population.

E

---

Eric Reid AeroFit | Instagram Portfolio
Aerodynamic Retul Bike Fitting

“You are experiencing the criminal coverup of a foreign backed fascist hostile takeover of a mafia shakedown of an authoritarian religious slow motion coup. Persuade people to vote for Democracy.”

Your experiences are very enlightening. I've been dealing with this since February 2021, not really knowing how bad it would get, continued to race through Sept 2021, only to be completely sidelined after that and a lot of walking in the IM Marathons. After stopping all three sports at different times from Oct 21-Apr 22, I finally got the proximal hamstring tendonopathy diagnosis, stopped everything but swimming, had 2 PRP injections and followed up with 8 weeks of intense PT and strength training. Finally was able to return to running and am good through about 10-11 miles until the fatigue starts to flame up the tendon. I started cycling again 4-6 weeks after I was running, but that lasted only a few months. I have been off the bike now for about 3 weeks, pain is subsiding even though I'm running more now. I believe you are spot on that it's the pressure on the sit bones, right where it connects to the scar tissue/tendon/sciatic nerve, that causes my pain. While cycling, I couldn't even do dead lifts, couldn't sit in my "special old man cushion" at work or in the truck. With 3 weeks off the bike, I'm already seeing about 80% improvement in the flair ups. The only issue with this is that I want to return to some level of competition which will be impossible if I can't ride any of my bikes.

If I read your comments well enough, time off the bike was the best medicine so you aren't compressing your sit bones/soft tissues. I'll dedicate this winter to running, swimming, therapy, and strength with hopes that a few months off the bike (again) will remove this pain. I just fear the scar tissue will never fully let me return to all sports.

Thanks!

I have had it forever. Worst mistake I made was trying to stretch it or do intense yoga. I had PRP about 8 weeks ago and stopped running, stayed off bike for about a month. I am back on the bike and have been doing intense PT starting with concentric first, building strength and now am on eccentric strength. I had to find a very, very knowledgeable PT who really understands this injury and will work on a strength protocol to gradually build strength rather than treat the symptoms.....PT has me working on hip strength, lower leg strength and overall stability.

I also had some pain from sitting that related to the sciatic which was entangled in the tendon. This may explain your pain while on the bike because the two are right next to each other and the compression of sitting can aggravate the tendon and or the nerve. Check out Brodie Sharpe podcasts. I steer clear of very aggressive treatments, stretching, yoga and I finally stopped trying to just run through it because that just made it worse.....that's what caused the tendon to be inflammed and thickened. Also, tendons take a lot longer to heal.

Good luck!

KK

i would guess your situation has more scar tissue and thus is more susceptible to recurrence. Ask a PT or ortho about what the best non-surgical remedy to that is?

---

36 kona qualifiers 2006-'23 - 3 Kona Podiums - 4 OA IM AG wins - 5 IM AG wins - 18 70.3 AG wins
I ka nana no a 'ike -- by observing, one learns | Kulia i ka nu'u -- strive for excellence
Garmin Glycogen Use App | Garmin Fat Use App

Thanks for your feedback...working on that now.

Yes, agreed to all that. I think sitting is definitely making it worse for me, likely due to scar tissue and the sciatic nerve. Nerve glides are my friend, strengthening it seems really solid, just need the scar tissue to get smoothed out somehow.

I'd be interested to see if there's a way to sort out scar tissue. I had 6years off the bike due to this. The thing that finally sorted the issue for me was seeing a physio who essentially said that there was a crap ton of fear and stress in my head to do with the injury and that every time I tried to run and ride I was stressing about it which led to suffering not pain. So I started a chronic pain meditation plan, slowly began to run again and then after about a year started to ride again. I know run between 60-80mile weeks generally off road, and am getting to the very pointy end of trail marathons and short ultras, I commute on my bike (an hour each way) maybe once or twice a week. There are days when the bike is uncomfortable and days when it's fine, I find *smooth* sit bones makes a massive difference to comfort. In short, it passes but it can be a proper pain in the arse, be gentle and kind to yourself, and maybe find another hobby for a bit (bouldering is a lot of fun! As is multipitching!)

That's very interesting Herdwickmatt. Yes, my plan is to give this until the end of the year with zero cycling and continuing to ramp my run mileage while continuing my swim and strength/PT work. I'd like to have a new MRI done in the new year with my last doctor to see how things have improved or if he can see a lot of scar tissue, etc. There's definitely a mental component to this, being "are you hurt or are you injured" mentality. What I have discovered personally is the bulk of mine is really the sciatic nerve entrapment through that tendon. I have had other nerve injuries related to my bike saddle and I know very well the difference between nerve pain and tendon or muscular pain. I'd like to hope I can race iron distance again, but really just want to be able to ride my bike pain free whenever I want, even if that means I'll never ride 112 miles again. Until I can sit on any surface for more than 45 minutes without pain firing, I won't consider myself cured from this ailment. I sit on a special cushion right now that has cutouts for my sit bones and use it on long road trips and when I sit at work in my home office.

This is the best I have felt since probably February 2021, so I'm counting my blessings that I'm running the distances I want right now. I am a little gun shy about pushing the pace, but I know that in time this is all part of the mental side of things to feel confident in my body.

Hi everyone, wanted to bring some more of this to the surface, based SOLELY on my experience. Short preface, been battling HHT for 2 years with significant sciatic nerve entrapment issues in my glute down to my foot. 2xPRP injections in my hamstring tendon, 12 or so weeks of intense PT and strengthening exercises, on and off running for months at a time, on and off cycling for months at a time, with "some" relief in the past 6 months. After laying off the bike for about 5 months last summer, I got back on the bike in August, had been running for 6 weeks or so with good success. Come early November 2022, I was unable to continue cycling due to the nerve pain. My dr. wanted to get more MRIs done to see if it was nerve entrapment, scar tissue or what was causing the nerve pain since it seemed the hamstring tendon issues had been resolved. I got an MRI and found out I have an L5-S1 herniated disc that is causing issues with the sciatic nerve in my lower back that is referring pain down my leg. I stayed off the bike and am still not on it. It's been 10 weeks today since I rode the bike, but in that time, my nerve pain is completely gone. I can sit on any surface for any length of time without it causing me pain, including a 6 hour road trip without my "old man seat cushion". I still use the cushion in the office and on road trips, just forgot it for that one. So now I have an accurate diagnosis for the nerve issues and am working on some PT to help the pain, which seems to be working. I'm so scared and hesitant to get back on the bike again and will probably give it another month or so in hopes of resolving the nerve pain in my back so it's not referred down my leg again.

Hope this helps someone else on their journey, but for me, not sure long course triathlon is in my future.

     Problem in the US (since the post originated in the US) is there are not enough PT's and Chiro's and especially orthopedists who focus on and do pelvis work. And...then know how to apply it to bike position. So it can become a debilitating injury, especially in those old enough where it takes longer to heal (i.e. low testosterone etc) and those of us refusing to back off training when it gets aggravated. Dan, it's a good topic.
Read the papers on how hamstring injury often really is piriformis and they often go hand in hand. It's a common mistake and often over read by radiologists as a hamstring injury.... as piriformis syndrome can be so hard to diagnose. Good PT's please chime in.
PRP/Prolozone with targeted Laser/photomodulation will usually accelerate recovery dramatically (Please....the German pain clinics chime in....they are too busy taking care of the US pros). However, need an experienced PT or Chiro who checks pelvis alignment, rule out limb length discrepancy, low spinal column alignment....and be careful not to overdevelop the quads and neglect strength workouts. i.e. when spending so much time on a bike/run and developing those quads and neglecting the backside. Perhaps when we spend many winter months on a road bike, MTB, or gravel bike overdeveloping quads.
And let us not forget, the older we get, the longer it takes to warm up before we start inducing micro tears. It now takes me 11-13 min to get my Moxy Sm02 up to a reasonable level in the quad formis but even longer in my biceps formis/hamstring. Probably because my bike position indoor on Wahoo Smart bike over emphasizes the quads.
Sorry for jumping in on the thread.


Bill

Was one of your symptoms numbness in your lower leg and foot?

Yes, numbness and pain in my calf and foot was from scar tissue engulfing sciatic nerve near insertion. Keep training with tears, scar tissue will build. Thats one of the reasons the ortho said I had to get surgery asap once numb foot started happening. Over 2 hours of my surgery was cleaning all the scar tissue off nerve then reattached tendon for another couple hours. The crazy thing is, when I woke up from surgery- all the pain and numbness was gone. 6 years later... I still say that surgery (fab ortho important) was best thing I ever did. I paid the price for pushing myself hard as a long distance athlete (9:53 IM at 45 yrs female) but worth it for all the fun and achievements. I stopped racing but still swim bike and run 100% pain free today for joy..... but slow and shorter. I think If I returned racing, I would have re-injured with speed and distance.... but dial back and lived happily ever after!