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Re: High Hamstring Tendinopathy Rehab Protocol [darkwave] [ In reply to ]
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thanks for your very detailed update, much appreciated. I will use your rehab updates as a baseline as to what I might expect if (likely when) I try the PRP injections.

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

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

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

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

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

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

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

Here's how my rehab looked so far:

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

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

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

Day 13-16 - start adding in some walking.

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

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

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


My current rehab protocol is:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Words of advice for tomorrow:

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

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

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

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

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

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

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

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

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

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

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

For me, it was two things:

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

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

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

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

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

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

As for me, I'm two weeks past my second round of PRP, and 2 months past the first. I really haven't noted much improvement since the second round, but then again, I know by now that I shouldn't expect to see it just yet. I've ramped up to doing 2 days running, one day off. Did my first 10 miler last weekend, with 3 miles at about 7:00 pace - held up pretty well. I tried some tempo-ish running this morning - no pain, though I was stiff after - perhaps attempting to run somewhat fast in 19 degree weather when rehabing a hamstring issue wasn't the smartest.... I don't think I did any major damage - just a note to myself to stay careful.
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