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Re: High Hamstring Tendinopathy Rehab Protocol [rock] [ In reply to ]
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Yes, there is hope!

I opted for surgery (as I have probably already indicated earlier in this thread) after a couple of PRP injections that diodn't really help. That was almost a year ago, and although I am still not pain/dicomfort free, I am now getting back in to the world of tri. I did Taupo 70.3 (for a laugh really) and felt ok (although somewhat undertrained hence the 5:43 finish time) and I've been doing some bike racing too.

Still getting pain/discomfort/tightness so I need to get back on to stretching (gentle) and glides, and not do too much too soon. Gonna be 49 this year (eeeek!) and aiming for IMNZ 2019. We shall see.

To be honest, the worst of it now is sitting down for extended periods. Mostly with work I can get up and walk around, but I fly twice a week for an hour and a half each way, and after 45mins to an hour I get a touch sore...

But yes, there is hope. Just don't rush it. You will get better.
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Re: High Hamstring Tendinopathy Rehab Protocol [TG] [ In reply to ]
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Yeah, this HHT is depressing. Any other injury, I've stopped cycling and/or running, rehabbed it, and could tell i was slowly getting better. With HHT, I stopped cycling/running, have been doing all of the eccentric exercises and building up glutes/core, and it seems like I'm no better than day one of injury. After two months, I decided to proceed with PRP for my right hamstring.

I had heard/read horror stories of how painful PRP can be. truthfully, it really was not that bad. My surgeon even did a little tenotomy (ie, scraping the tendon with a needle) work before the PRP. All under ultrasound guidance. It was swollen and achy the first few days but nothing tylenol can't handle. No biking for two weeks. No PT for two weeks. No attempts at running for at least six weeks.
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Re: High Hamstring Tendinopathy Rehab Protocol [eye3md] [ In reply to ]
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Can you keep posting your progress after your PRP? I’m at the point considering it as I’m really desperate. I read a lot about PRP as well. After PRP, it still requires all the rehab routines. I have not read anybody fully recovered from this injury even after PRP. Very depressing! So I’m not sure I should spend the money get it done or not. Both of my legs has this injury so I will have to do both. Can you tell me how much yours cost? My insurance will not cover it.
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Re: High Hamstring Tendinopathy Rehab Protocol [TG] [ In reply to ]
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TG wrote:
Can you keep posting your progress after your PRP? I’m at the point considering it as I’m really desperate. I read a lot about PRP as well. After PRP, it still requires all the rehab routines. I have not read anybody fully recovered from this injury even after PRP. Very depressing! So I’m not sure I should spend the money get it done or not. Both of my legs has this injury so I will have to do both. Can you tell me how much yours cost? My insurance will not cover it.

My wife had PRP for both plantar fasciitis and HHT, and had success with both. I've been researching a lot of blogs for other runners who have had HHT and PRP. There is a lot of variation in success vs failure. Like you, I felt like I was running out of options (except continue to wait and wait and wait) so I proceeded with PRP.

Right now, I'm exactly 5 days out from the procedure. The constant ache is now gone and I only occasionally feel any pain. I believe that's mostly related to the fact the area is still bruised and swollen.

For the first few day, you are supposed to rest it. On day 3, I jumped back in the pool but only swimming with a PB (so as to not put any extra strain on my hamstring). Also, I have started very gentle stretching.

I'll keep ya updated on my (hopeful) recovery. Its a very very frustrating problem
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Re: High Hamstring Tendinopathy Rehab Protocol [eye3md] [ In reply to ]
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The first two weeks, after having the PRP for PHT, my right upper hamstring/glutes area was not very comfortable. The first 3-4 days were the worst as far as the ache was concerned. The upper hamstring and glute actually ached more than before the PRP. Felt very tight and was a bit depressing as it made me feel like I'm never going to get better.

Day 4, I decided to start swimming (with a PB for support) and easy walking (flat terrain, very slow pace, and 1.5-2.0 miles). Had to give up swimming because my hamstring would ache even worse, vent with the PB. The walking has helped because it definitely helps to loosen the area up some. I walk SLOW and will slow down at anytime I feel my glute aching more.

Two weeks after PRP, I started physiotherapy. He assessed me before I was given specific exercises to do. One thing was startling was how weak my hips are. I had very little resistance when he pushed down. So, I've got ALOT of work to do to build up my glute and hip muscles. Still no biking but I've walked 18 miles this week.
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Re: High Hamstring Tendinopathy Rehab Protocol [eye3md] [ In reply to ]
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What's so frustrating about HHT is the mixed signals you get from your body. First two weeks, after PRP, kind of depressing because it hurt more than before PRP. I know that's to be expected but mentally I wanted to be healed NOW!!! All I did were easy walks a week after my injection. By the end of week two, I could actually tell my injury was loosening up some because I did not feel anywhere near as much tightness in the area.

Started PT, at start of week three. Easy PT, mostly to strengthen hips, and mild hamstring work. Very gentle stretching. After a few days of this, I felt like I was getting better but then I started stretching a little more (because it felt like it was making the hamstring better.....at first it did) and now the achiness has returned like I've worsened the injury or something. Drives me nuts so I'm going to stick with the PT and back off (or stop) any stretching.

One thing to add, my MRI did not just show hamstring tendonopathy but also glute mediums and minimums tendonopathy. Most of all of my pain is a severe ache right in the butt cheek, with a little bit of pain at the top of the hamstring
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Re: High Hamstring Tendinopathy Rehab Protocol [quintana who] [ In reply to ]
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This thread goes to shit as it goes towards PRP. Dont do it. If you have done it - dont do it again. It does not help and actually kills tendon cells.


Sorry for the blurry screenshot, but you can google the paper and read it if you are interested.

Bottom line; dont let anyone inject your tendon. Not cortisone, not PRP.

Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede
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Re: High Hamstring Tendinopathy Rehab Protocol [eye3md] [ In reply to ]
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I've been dealing with hip issues for years and HHT seems to be the last thing to fix, which seems to be on the way. First I had fix a Hyperactive SI Joint (which kept everything recurring), then Anterior Pelvic Tilt, Snapping Hip, Femoral Acetabular Impingement, Trendelberg Gait, and now this. When the hips start functioning improperly it just creates a crescendo of issues.

Everything I've read about High Hamstring Tendinopathy leads me to believe my issue (and some others on this thread) is the result of poor bio mechanics. Because of the above issues my left glutes completely shut down and the hamstring was doing that work, which in addition to being a major load isn't a movement the hamstring is designed to do. Some of the people that keep getting this may be following the protocols to fix it but they go back to running and cycling with their hamstrings instead of glutes and it comes back.

I've been focusing on glute activation exercises (bridges, band exercises, back kicks) and hamstring movement exercises to retrain it (curls while laying down, and practicing the natural hamstring movement all the time like golfers do with their swing). Its not really the strength I'm going for but to reeducate how they function. It also helps mentally focus and flex the glutes and hammies to gain better control. In the past I couldn't flex my glute at all now I can flex the minimus /medius, and max individually. It used to be my hamstrings would flex when my max flexed, now they're separate which seems to really help.

I have also changed my pedal stroke to focus on 2-4 o'clock which forces me to use the glutes. I can definitely feel the difference; cycling with the glutes feels like swinging a bat (natural) and using the hamstrings feels like a grind (unnatural). That being said after about 2 hours on the bike if I'm not focused on it my hamstrings will start taking over.

I don't run anymore but my guess would be shufflers who don't kick as much may have this same issue.

* I'll also end this with an important note that it is still a tendon injury so treat it as such. The only thing I'm suggesting is the type of hamstring use (i.e. replacing or helping the glute) is the cause.
Last edited by: furiousferret: Jul 30, 18 22:46
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Re: High Hamstring Tendinopathy Rehab Protocol [eye3md] [ In reply to ]
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Hi Eye3md,

How's the HHT after 3 months from needle tenotomy and PRP? I am considering this as well after a year of PT not yielding the results I want..
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Re: High Hamstring Tendinopathy Rehab Protocol [edub] [ In reply to ]
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edub wrote:
Hi Eye3md,

How's the HHT after 3 months from needle tenotomy and PRP? I am considering this as well after a year of PT not yielding the results I want..

I know there are a lot of folks who say "don't do PRP, it's a sham" but I feel like it was beneficial. Before PRP, nothing I was doing was helping......that included rest, PT, needle therapy with STEM, active release, etc... Yes, I would 100% do it again. HHT has to be the worst injury I've ever dealt with. I think anyone who has had HHT would also get desperate enough to "try anything" at some point.

I had PRP in June. No cycling or running for one month. First of July, started back cycling but very slowly. If it hurt, I backed off or stopped. Have now built cycling back to the point I feel completely pain free and ride as much as I want. As far as running is concerned, I'm trying a little here and there but still have a little pain. But, I'm a long way from where I started. I used to have that terrible dull ache even with an easy half mile walk. And hiking was out of the question because my right glute and hamstring would hurt so bad. That has gone. As a matter of fact, I just spent a week hiking up mountains in Colorado without any problems. I believe I am certainly getting closer to running again but I'm trying to build up good strength first.

I do make sure to continue my PT. Not doing eccentrics except maybe once a week or two. Mostly focusing on building strength of glute med/min and hamstring, rolling out tightness of hamstring and IT band (with foam roller), and performing glute bridges.
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Re: High Hamstring Tendinopathy Rehab Protocol [nachogreenbean] [ In reply to ]
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This thread should be given to all patients that are athletes desperate to returning to full activity. Its such a long term problem it seems it will never go away. It does. It takes discipline i've never had to use before in terms of staying on PT by reputable clinics and not over doing it. All cases are different. Some are worse than others. Mine was very bad. I have talked to a few PTs themselves whom are athletes and have the condition. I THINK (and don't know) this is caused by running. I also suspect long hours in the saddle and/or sitting at work help to create the pain by smashing the sciatic nerve onto the hamstring tendon causing nerve damage. Im not a PT but I have found a huge respect for these types of professionals for their abilities. Sports MDs, and very reputable PTs have shot PRP injections down all along and im glad they did. Its expensive and may or may not work. Steroids? no way. Surgery? Bad idea. This is all me. I cant give anyone advice im not a pro. Theres little point telling you the workouts prescribed to me because were all so different.1 universal PT is the eccentric loading. That stuff works and not just on tendinopathy. I am much like you tri people but I don't do triathalons. I do inline marathons, treadmill running, ice speed skating and swimming as cross training for cycling. I did that before I got this and now its nothing but a shadow, I still do it. Its been well over 2 years since my symptoms first showed up and Im pretty much doing whatever the hell I want. The longest hardest workouts will still stir things up a little but they fade away with all the skills I have learned to deal with this. And yes, omega core work is very helpful. My only advice is the same advice I give any athlete in training- DONT GET DISCOURAGED! My name is Pete D. im from Madison WI. The PTs I used are Heather Stokes (visceral manipulation) Stacey Brickson (PT),David Nissenbaum (dry needling and eccentrics) and GHC PTs. If your in this locality with this hell injury look one of these up. Im going to promote this thread to them if I haven't already. Also, herbal therapies from a reputable healer. Turmeric, solomins seal and st johns wort. Tinsures mainly. Not all brands are created equally keep in mind.
Last edited by: nachogreenbean: Nov 25, 18 21:12
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Re: High Hamstring Tendinopathy Rehab Protocol [TTC] [ In reply to ]
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Hey all, I wanted to first off congratulate everyone that has been contributing to this online gem for HHT. Esp. top contributors like TTC, jsmith, mtbdaddy, and others. As expressed by others here, it is frustrating to get so many mixed signals from PTs, sport medicine doctors, chiros, etc. In this thread, I hear from people 'in the trenches' (runners, triathletes) like myself and overall symptoms, diagnosis, and suggestions for getting better are much less of mixed signals than those coming from the establishment. Having gotten that out of the way, I'll provide context on my specific HHT and then ask my question. Many thanks in advance for your inputs (esp. TTC's, jsmith's, etc...)

Context: 26 yr old triathlete (Olympic distance as longest race), marathoner (~7 of them), trail runner (1x 50km). I got injured by training for that trail 50km w/out sufficient time and ramping up my weekend mileage too fast. Right hamstring. Hurts right at the sit-bone attachment.
Have been injured for 14 months. On & off running, on & off PT (inpatient so never too disciplined in doing the PT). When running these past 14 months, it has mostly been 3-5 mi with the occasional 6 mi in the road and 9 mi on trails w elevation changes. Pain isn't as severe as to not let me run. Minimal during run, most painful in the hours/day after.
I had a recent enlightenment and finally motivated to kick this injury where it's been kicking me for 14 months...in the ass. I won't run for at least 2-3 months. I've been swimming, just started doing yoga, and looking into boxing as replacement for the endorphins I got running.

I've been following a PT schedule similar to that proposed by TTC. Start w isometric strengthening week 1-2 +core, hip glute strengthening and slowly incorporate eccentric exercises as much as the hammie permits. Initial bent knee ROM test shows a bit of pain at the tip of the stretch. Nothing terrible and only at the end.

QUESTION: week 1-2 PT has been causing mild pain in my hamstring. Knowing that this injury has such a counter-intuitive recovery profile (i.e. 3 steps back and 4 forward for this injury is very typical), I wonder if this mild pain is ok and I should just carry on or taper what is already minimal week 1-2 PT. Thoughts? Below what I'm doing for PT and a proposed tapered version, if y'all recommend that:

2x 60 seconds double leg bridge
~60s speed skaters
~120s lateral band walks
60s front plank
60s side plank

Again, many thanks in advance for your inputs. Best of luck in injury and in health!
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Re: High Hamstring Tendinopathy Rehab Protocol [ffuentes] [ In reply to ]
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Hope your rehab is moving along well, as I'm replying to a question that's now a few months old!

For the benefit of others who read this, following in your footsteps, as a sports rehab therapist, I'd generally be okay with you feeling a degree of discomfort during and immediately after your rehab, especially with exercises like bridges. My one concern with the list of exercises you posted is the speed skaters - they might have you loading into too great a degree of hip flexion, and causing loaded compression of the tendon. I actually wrote an article with exercises for high hamstring tendinopathy a while back (hope it's ok to post here).

Best of luck with your rehab. Hope you're back to full training soon!
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Re: High Hamstring Tendinopathy Rehab Protocol [ffuentes] [ In reply to ]
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I was getting slight soreness after some eccentric weight exercises for the first 4-6 weeks then it stopped hurting. I can't state enough that my belief, and what fixed mine, was complete rest from running/riding and a dedicated strengthening programme.

I started with the unweighted bridges etc, but started noticing real improvement once I graduated to the hamstring curl machine (focussing on a very slow eccentric movement), stiff leg deadlifts and weighted glute bridges.
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Re: High Hamstring Tendinopathy Rehab Protocol [kmf7376] [ In reply to ]
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kmf7376 wrote:
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.

This sounds exactly like what is going on with me. Left distal medial hamstring "tightening". Prolonged sitting does not bother it, and there is little tenderness to palpation. Running is by far the single most consistent irritant, but it almost immediately stops if I stop running, or try to sideshuffle, or skip. Biking seems to just be achy without tightening but the day after I feel like is always a bit irritated. Occasionally the discomfort shifts to muscle belly or right at the ischial tuberosity. Strengthening and PT exercises can be mildly uncomfortable but then I always feel better the next day. Repetitive run or bike seem to trigger it again. To me it feels more like a combined tendinopathy and sciatic nerve irritation. Multiple PT and MD ruled out lumbar spine, but continue to find adverse neural tension and hamstring tests positive. Anyone ever hear of PHTrSNE?

https://www.ncbi.nlm.nih.gov/...articles/PMC5115258/
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Re: High Hamstring Tendinopathy Rehab Protocol [Nwpt88] [ In reply to ]
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Ugh. I have had this injury for the past 5-6 years. I have seen countless PT's, Chiro's, sports MD, etc. I have typically trained through this injury which has contributed to it becoming chronic and glitchy. I finally did a few different things that have made a change recently.......I stopped trying to train through it. I fired the tri coach who was just a d*&^ about this injury and couldn't understand why it was chronic, etc. I stopped training with exercise 'shamer's who also couldn't understand the injury and were hinting that I was 'lazy' because I couldn't run (mostly I couldn't do speedwork). Then, I found a PT who looked directly at the back discs and he began having me do the McKenzie technique (look up the book/website) because he believes that the issues with hamstring pain go back to the lumbar spine. So far I have had to stop biking/running for about a month now. I can swim, walk and do eliptical. I am hoping that this treatment helps and so far it has. I am relatively pain free. The PT says I should be able to return to running in at least a few weeks.
Hope that helps.
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Re: High Hamstring Tendinopathy Rehab Protocol [rock] [ In reply to ]
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rock wrote:
I was getting slight soreness after some eccentric weight exercises for the first 4-6 weeks then it stopped hurting. I can't state enough that my belief, and what fixed mine, was complete rest from running/riding and a dedicated strengthening programme.

I started with the unweighted bridges etc, but started noticing real improvement once I graduated to the hamstring curl machine (focussing on a very slow eccentric movement), stiff leg deadlifts and weighted glute bridges.


^^^^^ This, 100%.

I did the same. Quit SBR and focused on building strength first. Simple stuff like using a band and walking side to side, or doing the clam shell exercises. No hamstring curl machine at first but I did feel like it was a big (positive) contributor to my recovery, after a few months. A good PT should be able to help with a plan to start with your weaknesses and build from there. I think if they are focusing on the tendon, at the beginning, then they are starting at the wrong place
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Re: High Hamstring Tendinopathy Rehab Protocol [bullshark] [ In reply to ]
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Did you ever get rid of your PITA? If so, how did you get over it?

Much thanks!!
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Re: High Hamstring Tendinopathy Rehab Protocol [jsmith] [ In reply to ]
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Did you ever get rid of your High Hamstring Tendinopathy? If so, how did you get over it?

Much thanks!!
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Re: High Hamstring Tendinopathy Rehab Protocol [mtbdaddy] [ In reply to ]
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Did you ever get rid of your High Hamstring Tendinopathy? If so, how did you get over it? I am considering PRP myself right now -- and have also heard lots about using a cold laser.

Much thanks!!
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Re: High Hamstring Tendinopathy Rehab Protocol [EyeRunMD] [ In reply to ]
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EyeRunMD wrote:
rock wrote:
I was getting slight soreness after some eccentric weight exercises for the first 4-6 weeks then it stopped hurting. I can't state enough that my belief, and what fixed mine, was complete rest from running/riding and a dedicated strengthening programme.

I started with the unweighted bridges etc, but started noticing real improvement once I graduated to the hamstring curl machine (focussing on a very slow eccentric movement), stiff leg deadlifts and weighted glute bridges.



^^^^^ This, 100%.

I did the same. Quit SBR and focused on building strength first. Simple stuff like using a band and walking side to side, or doing the clam shell exercises. No hamstring curl machine at first but I did feel like it was a big (positive) contributor to my recovery, after a few months. A good PT should be able to help with a plan to start with your weaknesses and build from there. I think if they are focusing on the tendon, at the beginning, then they are starting at the wrong place

I will also echo this. My issues have not been HHT but actually my lower left hamstring, recurring for years, although I've gotten a much better handle on it recently. For me it seems that cycling aggravates it more than running, but I think the combination of the two makes it worse. Anyways my remediation strategy is:

1. When it flares up and is acute, I get extremely good relief from an A.R.T. session (usually just one is needed)
2. I'll say, I've had no issues since buying/using a Hypervolt Plus gun on the quads/hammies (before/after ideally, but at least once a day)
2. Stop/reduce what you're doing which is causing the issue (bike/run for me)
3. Strength training is critical, especially eccentric exercises. Start slow and build it up. The hamstring curl machine is great, do it single leg and go extremely slow. I'd start with kettlebell squats, lunges and side lunges for a few sessions to get some base, along with mobility work. Banded lateral walks are excellent and easy to knock out. Gotta hit the glute med and min, search YouTube. Glute bridges are also good but easy to mess up. I really like the romanian deadlift, start with medium dumbbells - it won't feel difficult, but then you'll be sore for days. Good stuff.

Basically: remove scar tissue/adhesions from recent injury (A.R.T), prevent it from coming back (reduce volume, use massage gun, mobility work etc), and lay down new muscle with strength work and eccentric work.
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Re: High Hamstring Tendinopathy Rehab Protocol [mortysct] [ In reply to ]
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Reviving this thread!

I have been following the protocol of progressive loading of the hamstring (9 months) and progress has been achieved. However, I feel that sitting down (ie squashing the hamstring insertion at the sit bones) is the thing that is stopping me from getting 100% recovered.

Questions: have others experienced this? What solutions have been effective? I have tried a kneeling chair and a special seating cushion. Hasn't helped much.

Looking forward to the feedback.

Eric
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Re: High Hamstring Tendinopathy Rehab Protocol [ejd_mil] [ In reply to ]
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I think this is what I have been battling for months. Does anyone have a diagram that shows where the pain is, or the structure of bones and tendons? Most pain while driving. I'd like to discuss this with my orthopedist.
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Re: High Hamstring Tendinopathy Rehab Protocol [Bio_McGeek] [ In reply to ]
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Bio_McGeek wrote:
I dealt with hamstring tendinopathy and trabecular edema for a little over two years. PT made my hamstrings strong but did nothing for the condition itself. Shockwave therapy (similar to that used to break up kidney stones) did nothing. Finally got PRP (platelet rich plasma) therapy and that really made a huge difference. It is now about 90% back to normal.

Good luck,
Jim

I believe my wife suffers from this. It's been a 2-3 ongoing sufferfest with suboptimal training, all alongside labral surgery.

Did you have a specific injenction-based diagnosis like the thread author, before getting PRP?

Do you have recommendations for where to go for this treatment? We may pay cash but will investigate insurance options first. We live full-time in an RV and frequently travel through your area.

How is your hamstring tendinopathy now? (~1.5 months after you shared this)

Dr. Alex Harrison, USAT-1, USATF-3, CSCS
PhD in Sport Physiology
Author, Coach & Lead Endurance Sport Consultant, Renaissance Periodization
https://renaissanceperiodization.com/...nce-macro-calculator
https://www.instagram.com/dr_alex_harrison/
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