Yes. I was posting on this thread back in 2013-ish, I think. It was a long hard road - involving PRP and a lot of hard work - but I made it back and ended up PR-ing at every running distance several years later, including my big goals of going sub-3 for a marathon and sub-5:30 for the mile.

There is hope.

I developed HHT back in 2018. At first, it did feel hopeless and I thought I'd never run or bike again.

I tried to run/bike through it, at the beginning. Even though the pain was tolerable, I knew it was not doing anything to help it improve. So, I stopped running and cycling.

Eccentric exercises also made mine hurt more, so I stopped doing these for a few months.

Physical therapy can be helpful and harmful. One wanted me to do eccentrics, and run easy, despite the fact that it hurt. The next PT said don't do anything that causes it to hurt. I decided to go with the opinion of the second PT because I was trying to think long term (ie, I want to run for as many years as possible).

I focused on building up my glutes/core. My glute medius and minimus were so weak that my PT thought I was not even putting out any effort when he was testing me. The work involved bridges, and band work where I did clam shells and walked side to side.

After a month of doing these, I did get PRP. Not sure if it helped or not but I was able to get back on the bike a month or so later (so only three months off the bike)

After six months, I no longer had that nagging ache (of HHT) and decided to start a slow/easy walk/run program. I progressed from there and have now run multiple ultras.

I went through all the same stuff as you, and in the end what helped was:
1. Stop running for a little while, no too long, to let pain ease
2. Really start religiously working on glute med and calf strength - not eccentric, but actual glute strengthening exercies (clamshells, light deadlifts, etc).
3. Lowered my bike saddle a little bit.
4. Started with some super easy runs on treadmill and shortened my stride as well so as to not stretch the hamstring on the forward leg.
5. When pain free - started doing super super light hamstring curls.

Took a long time, but I do feel that strengthening stuff is what beat it for me.

Oh - I should add, none of the magic therapies did anything for me, nada (shockwave, traction, dry needling, carbon patches, taping, etc).

Biggest thing to help my wife:
Better/slower progression into running and a very slightly less aggressive riding position on bike. Less hip flexion by a couple degrees.

That and some massage up in the area, plus basic hip strengthening work and super light full ROM stiff leg deadlifts.

Super basic stuff, all done very very conservatively and then slowly progressively. Very slowly.

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nice one i guess this really sums it up
and i would say use half the load you think is right at the beginning.

Thanks for the replies folks

Seems there is definitely no certain treatments that work for everyone. In all honesty, I had to Google PRP treatments and saw it stood for Platelet Rich Plasma. I remember reading about it in this very thread where several went that route. Glad it worked for a few people. I will ask my Chiropractor as to his opinion on it tomorrow. I do remember him telling me that Fresh Blood was the key to fixing this problem.

I got into Ultra Running after the Ironman thing and I think all the repetitive running has certainly contributed to the issue I am dealing with now.

I do hope more people from the past 11 years see this thread and chime in as to whether they got fixed or not.

GWK100

I have had this injury since January 2020.
At the advise of somebody here I started working with Dr. Peter Malliaras at Monash University in Australia.
I am in SoCal so the sessions are over Zoom which works out fine.
Peter started me on strengthening exercises and I have gradually increased them by adding weights.
I have gone from not being able to ride my bike at all and not walk up hills to now I am riding 4 days a week about 100 miles with moderate hills.
My first ride was 10 minutes in a flat parking lot. That was after working up to 30 minutes on a recumbent exercise bike.
I still have some pain but is different now, no longer going down my hamstring but more concentrated in the buttock area.
I think some of it is due to just sitting on the saddle. I got a custom made MELD saddle.
I like it because it fits my anatomy and has a lot of support, but it is darn hard and I feel my bones on it.
So I am trying out other saddle now in hopes of finding something a little softer but its not easy finding the right shape.
I find if the saddle is too soft I sink in and it actually aggravates the problem, probably because it puts more pressure on the tendon.
This is a tough injury, it takes a very long time and lot of work and patience to get over it. Also I am 64 so that does not help.
Prior to this a had a similar injury in my right hip. I did get PRP for that and did not help immediately, but after about 6 months It felt mostly healed, and then this happens.
I am tempted to get PRP again but since I am making progress with the strengthening I am going to wait.
Good Luck.

I'm so glad I found this ancient post! I had a bike refit in early 2021 and shortly thereafter experienced some significant changes in my hamstring on my right leg (and later in the year in my left leg). Proceeded to race through September of 2021 but was forced to a slow, very painful walk instead of running. The sciatic nerve pain was absolutely horrible on my right side. I spent October 1, 2021-April 10, 2022 seeing massage therapists, PTs, chiros, sports doctors, airrosti, and every other practitioner you can think of without any relief. I stopped cycling for a period of time, I stopped running for a period of time, I repeated those cycles twice until I finally had a doctor order an MRI. He quickly diagnosed me with HHT with sciatic nerve entrapment. Said it is in the top 3 most common injuries he sees and has a protocol to get people back to normal, but said it is a 7 month process.

No running, jumping, lunging, cycling, or really anything to use the leg. Scheduled a PRP injection for the next week into the tendon. Another one 2 weeks after that. Started seeing his PT/chiro/sports med team 2 weeks after the last PRP injection. I swam, I lifted upper body weights and calves, and spent the bulk of my "seated" time standing. The pain was unbearable when I started with him. I'm 3+ months into this and can say that I started running about 3 weeks ago without pain. I still get pain when I'm sitting, but not while I run and it's very specifically sciatic nerve pain in the belly of my hamstring. I can walk without pain, I can run without pain (just not "at speed" just yet), I can swim without pain, and I can do most other things without pain, other than sitting for long periods of time (over 2 hours and even then it depends on the surface for me). I am not on the bike and figure that will take more time and will need a thorough muscular based bike fit to determine if I am using all the correct muscles and not stretching that hamstring too far.

Protocol for me is progressive load approach with a ton of focus on glutes and core.
Glute bridge with pec fly
tabletops to bear
Tabletops one handed
reverse slider lunge weighted
lateral lunge weighted
deadbug contraholds
deadbug ipsi rotations
1/2 kneeling palloff press
weighted squats on heel lift

progressing into more things now that strengthen my hamstrings as my core and glutes seem really strong at this point.

My pain usually hits when the belly of my hamstring has pressure against it and it starts activating the sciatic nerve. I can be driving with my right leg, have pressure on that hamstring, and within 30 minutes I start to feel the nerve pain come back. I can raise my leg to remove the pressure and it instantly stops the pain now. I take that as a sign that I'm on the mend but the nerve is clearly still tangled up in some scar tissue in my hamstring. It's taking me a lot of time to get through all 9 pages of this, but I appreciate everyone's feedback on this life altering injury. I wouldn't wish this on my worst enemy.

The grateful part of me is knowing that I didn't experience a complete avulsion of the tendon and have to go through surgery. I have ready a thousand stories on that and it sounds worse than the injury itself.

I'm hoping for a complete recovery by the end of 2022, but we will see what happens.


sidebridge

I won't necessarily say 'definite', but if you read all the comments, I think you'll see the pretty obvious solution is easing off and taking time to strengthen everything in/around that area.

PRP treatments will do a good job making your wallet lighter, that's about it.