Hi all,
I have battled chronic hamstring tendinopathy for a number of years. I do not stretch the hamstring when it is glitchy because I have experienced that stretching causes it to flare up.
I will rehab (stop running and let it calm down) with a PT, slowly start running again and then attempt something more intense (ie. a few hills, alittle bit of speedwork) and it flares up. Starts of as a pain in the butt. In the past it flared up when a coach had me running trails, hills and doing yoga (little did I know that yoga is very bad for glitchy hamstrings). I stopped running on that occasion for about 2 months before it would calm down and then I gradually started running again.
Now, I have been running almost 6 months pain free and attempted a few hills without a good warmup and it flared up again (not as bad this time). I have stopped running (yet again) but will do elliptical machine. I have continued to do a plethora of hip/glute strengthening–band work, bridges, hamstring curls, etc. Has anyone tried PRP for this? Red light therapy (saw this on a post awhile back), anything else?
I haven’t had any hamstring issues, but I’m 3 weeks out from PRP and one week into red light therapy for a nasty case of ITBS that caused some effusion. My treatment was: cortisone shot to reduce inflammation → two weeks later was the PRP → then two weeks later started red laser. From the day I had the PRP to my follow up two weeks after, my Dr. saw an 80-90% improvement in the reduction of the effusion. The pain after PRP can be strange (it comes and goes for no reason), and everyone’s experience is different, however the healing I saw with my own eyes on the ultrasound was incredible. According to my PT and the Dr. that performed the PRP, they also see excellent results when combining PRP with red light. After a week of red light I felt comfortable enough to go for a short run. I only ran a mile, but it’s the first time I’ve been able to run pain free in nearly 3 months. My cousin, and multiple patients at my PT clinic also report similar experiences with PRP & red light. Talk to your Dr., but I would recommend it.
I’m halfway through a PhD on this exact topic! We are running a large randomised trial in Melbourne Australia comparing two treatments for the condition.
Here are the things I could recommend:
graded strengthening program
pain contingent exercises
understanding what are high and low load activities for the hamstring tendon
shockwave therapy
I would avoid PRP under almost all circumstances. It’s painful, expensive and ineffective in pretty much all tendon research and experience.
This unfortunately can be a difficult condition to manage but should improve with a diligent approach.
Thank you. Could you please specify the strengthening and exercise programs. I am currently recovering (about 6 weeks in) from my first bout of hamstring Tendinopathy, and a race I would like to do well in in 2.5 weeks.
Thank you Aidan. I have been doing alot of research about this issue. I would really enjoy reading your research upon completion of your study. So many treatments are just hype and not effective so it can be challenging to sort out what is research based and effective from what is just a trend.
Thank you. Could you please specify the strengthening and exercise programs. I am currently recovering (about 6 weeks in) from my first bout of hamstring Tendinopathy, and a race I would like to do well in in 2.5 weeks.
Thank you,
The best hamstring strengthening exercise, at least when it pertains to running is the Nordic Curl. Google it and you’ll see how it’s best performed. Don’t overdo it at first you might be very sore. But it really loads the muscle eccentricly which is similar to load on the hamstring during running.
I struggled with hamstring issues for years and now they’re a non-issue due to doing these exercises. It’s a exercise favored by soccer players in Europe as a way to drastically reduce the prevalence of hamstring injuries. These injuries were actually getting out of control among soccer players until about 10 years ago when they came up with the Nordic curl protocol.
I’m halfway through a PhD on this exact topic! We are running a large randomised trial in Melbourne Australia comparing two treatments for the condition.
Here are the things I could recommend:
graded strengthening program
pain contingent exercises
understanding what are high and low load activities for the hamstring tendon
shockwave therapy
I would avoid PRP under almost all circumstances. It’s painful, expensive and ineffective in pretty much all tendon research and experience.
This unfortunately can be a difficult condition to manage but should improve with a diligent approach.
Curious if you could provide some more info on why PRP isn’t recommended for the hamstring? Tendon vs. ligament?
Ya I have this too, for about a year. I often feel it right at the sit bone when sitting on a bicycle seat. I believe mine is the bicep femorus and the feeling is more of an aching. Fortunately I can still run but I feel the effects of it sometimes the next day. Eccentric loading seems to be the way out of it from what I heard. Listen to the Endurance Planet podcast episode 257 about halfway through. They talk about this is great detail and recommend nordic curls and single leg RDLs.
Also once I got shockwave therapy done on mine and the aching went away for a week. But then it returned haha
It’s a bit challenging to explain it all here in a couple paragraphs, and the rehab protocol isn’t published yet. However we are using exercises including isometric and isotonic hamstring bridges, hip thruster and calf strength. 2.5 weeks is a pretty tight timeframe so you’d be unlikely to see significant changes over that time although some people experience good pain relief (and increased strength) with isometric hamstring bridges.
Thanks, we are hoping to publish the hamstring rehab protocol in the next 6 months.
As you will have seen there isn’t much high level (RCT) evidence on treatment for PHT - there are only 2 RCTs (1 is shockwave vs conservative treatment, 2 is comparing two types of blood injection)
There isn’t biological plausibility for PRP being beneficial for tendinopathy. There have been multiple studies comparing PRP to an inert injection (saline) in different tendons and they show no difference between groups. A few studies compare PRP to cortisone (harmful) which often shows benefit to PRP but probably only due to the comparison used.
It’s tricky, as if people ‘fail’ conservative treatment (physio/other) they want another option before chatting to a surgeon, which is when PRP often gets mentioned. Unfortunately it’s not a great option.
I dealt with this for two years. My experience/thoughts:
Don’t waste your money on any of the ‘treatments’…ie. PRP, shockwave, carbon patches, ultrasound, cold laser…they will do next to nothing other than lighten your wallet.
What finally did the trick for me was plain simple strengthening. Start by strengthening the shit out of your glutes and calves, basically everything -around- your hamstring that is weak and caused your hamstring to get overloaded in the first place. Do not do any hamstring exercises until you can do them without any pain. For me it was both eccentric and concentric hamstring curls with almost no weight to start. And do NOT try to stretch your hamstring!!
Ironically the very first physio I saw at the beginning of my 2 year ‘journey’ told me exactly what I said in number ‘2’ above…but I was too stubborn and went looking for the quick fix. After a good 1.5 years of wasting time and money, I finally started doing the exercises etc and that fixed it.
Yes, I have battled this as well on and off for many years but managed it with acupuncture which I found to be the best treatment for it. As for rehab I started doing the hip mobility sessions with Erin Carson on her YouTube channel and just purchased a subscription to her basic plan on her website. I felt a difference in my lower back, hips and hamstrings right away. This is really the only thing that gets to the root of the problem. I do it religiously every morning and it is a quick workout of about 20 minutes. It is a perfect warm up before I go out for a training session. Sometimes I do it after a workout as well depending on how tight I am and how I feel in general. Check it out. ECFit.
I am not trying to sell anything here at all. My bike fitter recommended her and I tried it and it worked for me. I think if you are a triathlete that is fit and fairly seasoned as I am than strength isn’t the issue. Perhaps getting your posterior chain functioning the right way is the answer. I have been doing triathlons since 1983 so believe me when I say I have done every stretch, strength, massage treatment that you can think of is an understatement. Good luck.
rest. then i would do pilates for your hips, hammies & core. all those muscles around your arse & hammies will get strong. It’s a strange workout, but I’ve found the low impact but high intensity stuff is very beneficial for hips & hamstrings. I’m almost two months into adding hot power yoga 4x per week into my run training and I drop a pilates class into the mix from time to time. My wife does pilates, so she pulled me into it.
I started with the mobility Mondays on you tube and still do those every morning. I also do the pre flight before my workouts and started the yoga but I am careful with the yoga.
I have been suffering with this for over two years. I found that local doctors and physical therapists here in SoCal do not really know how to treat it.
At the recommendation of somebody here I have been working with Dr. Peter Malliaras at Monash University in Australia.
I meet with Peter over Zoom every few months and he gives me exercises and monitors my progress.
When I first had this injury I could not do anything expect short walks on flat terrain. Now I am back to riding my bike at almost 100%.
I still have pain in that area but it is totally different than what it is originally was and could be psychogenic pain which can develop when chronic pain lasts a long time.
But it is not really limiting for me like it was before. Other possible treatments are PRP and Extracorporeal shock wave therapy.
Peter suggested trying the latter to help as it is less invasive. I highly recommend Peter if you want to be treated by an expert in the field.