I showed your abstract to my doc and he said it was spot on. This is the trouble I find with the medical industry, they are not willing to do the research. If you want something directive, you have to do it yourself.
Lucky you found a doc that knew what he was doing
Its been 4 months since the rehab protocol ended. Everything has been fine, no flare-ups and training is what it was before. Believe me when I say that it is totally worth it to shut down running for 3 to 6 months (depends on how severe) in order to do the rehab protocol. Being able to train again without this pain is such a great feeling. I continue doing the eccentric hamstring exercises along with a core stabilization program every other day. I know from lurking these forums for a while that ST people think strengthing is worthless, but it’s been the key to staying injury free.
And yes the PRP is a hit or miss. I believe (Again I am not a doctor) that the PRP should only be used after 1 to 3 months of the rehab / eccentrics.
@FisH20
Totally agree with you, I went to EIGHT different doctors. I actually diagnosed myself before even finding Dr. Garten. I had people tell me that I had a disc problem (MRI negative) then they said it was my pirifomis or nerve entrapment, then a labral tear (MRArthrogram negative). That article I linked by Michael Fredericson was the exact article that helped me figure this injury out on my own.
Again any other questions feel free to ask.
JSMITH: I have been dealing with the exact symptoms you have described in your original post for over a year.
Can you give me an update on how you are doing?
Did you have the PRP? How long ago? Where are you at in recovery?
This issues is a BIG pain in the A$$ literally and I can’t seem to shake it.
I can go through the motions of training but this thing will not allow me to really push the way I want to.
Any other advice would be appreciated.
Thank you for your update.
Doug
Thought I would give an update, 2 years and running (actually not running).
Per above, after trying just about everything, I think I have found a path to recovery.
The old:
So, we are doing lots of work to activate the right gleut, build it up, and change the muscle memory so that it will fire when needed. Started with some simple exercises, and am working up to more explosive movements to work on the muscle memory. I am also working on my feeling of posture, and stance so I know when I am doing it right or not.
Per your question - I tried PRP with no results. CAVEAT: PRP without the therapy like the one above is useless as it might stimulate healing, but doesn’t fix the issue so the net is no change. I personally think that the graston and dry needling will achieve the same results at a far lower cost (to me), and is far less invasive. That said, PRP would probably help when combined with therapy.
Here is who I am using:
Robbie Ohashi PT, DPT, OCS, ATC, CSCS Performance Physical Therapy Manager
Athletes’ Performance at Attack Athletics
For those who had PRP, did insurance cover it?
Not sure about the insurance but I would be more concerned about getting an injection next to the sciatic nerve and femoral artery. I suffer from the same issue and at a recent visit to Foundry Sports Medicine in Prov, RI I asked the Dr about PRP, prolotherapy etc and he said the risks far outweigh any potential benefit. I’ve tried ART but the relief is only temporary. I’ve a got a prescrip for PT and use meloxicam to relieve inflammation for but for now I’m stretching with a band and working the core muscles. Tried steroids a few years back with some success and may go that route again. Refuse to stop running which may be my undoing but have limited myself to nothing faster than aerobic threshold runs. It sure is a PITA!
Here is where I am at: I got a series of 4 PRP injections this fall and it really helped heal the hamstring and adductors. The problem is there was still something about how I was pedaling that was placing undue/unnatural strain on the adductors and inner hamstring. The doctor looked at my ankle and found the ankle joint incredibly loose and sent me for an MRI. Sure enough one of the major ligaments in that ankle was so stretch out as to be useless. The theory we are now working off is that instability in my foot caused the strains to my hamstring/adductor and peroneal brevis muscle (which has also been very painful at times) over the last 2 years as well as the pain/plantar fascitis in my heel (that’s been 6 months now). The doctor said he has also successfully used PRP to help this condition and I have had one injection thus far with another set for next week. We shall see.
If all this is not enough, even as the hamstring and adductor pain has gone away I still have alot of tightness in my psoas + quadratus lumborum, particularly after I ride for even an hour or so. It seems that these muscles have shortened up and become less pliable as a result of trying to train through all these problems for so long. When I am in riding position they start to tighten causing strain on everything else in the chain - hamstring, adductors, etc I am seeing a massage therapist to try to loosen them up and its helped a little so far but not much.
This whole thing has been just unbelieveably terrible. Its been 20 months now of this and I just can’t believe it as I used to be a guy who was never, ever injured now matter what training I did. Welcome to turning 40 I guess. I am not sure I will ever get back to what I was but I am really trying to find someone in the DC area who has dealt with cyclists with such issues and can give me a overall plan to release the psoas so when I ride it does not seize up.
If it makes you feel any better, you are in good company. I’m 37 and this is going on year 2+. Nothing makes you feel old like an injury.
Don’t know if this applies to you, but a lot of my issues appear to come from being hyper-flexible. I am able to get into positions where I can relieve the stress off a muscle/tendon, but it only works so long until you run out of things to compensate with.
Good to hear you have some dedicated docs - do you have to pay for your prolo? I did, and it just about bankrupted me last year.
Thought I would add some new revelations from PT. After doing work to strengthen the Gleut and get it firing again, I have started running on the Alter-G treadmill. We started last week at 70% of weight, and have moved to 75% and 80% this week. One thing to note - I am hyperflexible which is causing some of these issues.
Here are the revelations
On first view, my thighs/legs are too close together. As he was watching, I started concentrating on firing my gleut on foot strike. this immediately changed my stride, stopped the knee from collapsing inwards and improved my form.
After this first run, my hammie was sore, but in the belly, not the attachment. Had some light attachment feeling, but not pain.
2nd go this morning, I was running on form from the get go. To me, it feels like I am kicking my heels out to the sides, and bringing my legs around in a semi-circle. On film and under observation, I am not actually doing this, it just feels like it to me. Walking to work, I have already noticed a change in my stride, my feet much farther apart. Also, no butt pain…
When I don’t pay attention, I have a tendency to foot strike, hyper flex the knee, then drag the foot back with my hammie. Likely this is what caused the injury in the first place. I am concentrating on keeping the knee slightly bent at all times. Likely I am doing this on the bike too.
Lastly, I use the original speedplays with free float. Before that I used Time. We will check this out next, but it is possible that my heels are floating all over the place and causing issues. It doesn’t look like it when I watch, but who knows. There is no physical reason why my knee needs to float so I may be getting zeros.
Hope this is helpful!
If all this is not enough, even as the hamstring and adductor pain has gone away I still have alot of tightness in my psoas + quadratus lumborum, particularly after I ride for even an hour or so. It seems that these muscles have shortened up and become less pliable as a result of trying to train through all these problems for so long. When I am in riding position they start to tighten causing strain on everything else in the chain - hamstring, adductors, etc I am seeing a massage therapist to try to loosen them up and its helped a little so far but not much.
.
A note on the lower back pain. I had this two, an almost constant “tightness” in my lower back, especially up the gleut into the sides of the back.
After starting this PT (with dry needling and graston) focused on getting my pelvic position right, and working on my pivot point, this has just about disappeared. Sometimes I will get fatigue in my lower back, but this is quickly rectified with a self adjustment (do a back bridge on the leg where the back is tight, then push as hard as you can on the opposing knee, while opposing this force with your knee).
Fixing the hip position, has also alleviated a lot of the other issues and lets me concentrate on fixing the cause, not the result.
The one thing that I still cannot do is the one legged hip pivot. Standing with weights in each hand, you stand on one leg, with the other moving straight out behind you as you pivot at the hip. When you move back up, it should be the hip muscle doing all the work. (the straighter the knee, the harder it is to prevent the hammie from helping)
I can do this no problem on my left leg, the right with the attachment issue, the hammie always wants to join the party.
FisH20-
I’m in the Chicago area as well and I have been seeing Dr. Michael Chin @ The Running Institute for an Achilles problem for the last year. (Long story…subject for another thread).
Anyway, you may wanna give him a call. I have been impressed with him and his knowledge of new practices, etc.
Well TTC, thanks for the info you’ve posted (and others - all good to hear). I’m trying your program and going to see how it goes for the next few months. I’ve had a high hamstring tendonosis for probably coming up four years now and am thoroughly sick of it. I’ve tried before to get rid of it with an exercise program but so far no luck. Don’t think any were this comprehensive though so going to give it a try.
I’ve been given so much conflicting advice that it’s doing my head in. I have chronically tight hammys and hips and this is probably what caused the injury in the first place (along with overtraining for sprinting etc), so the most frustrating advice has been around whether or not to stretch.
Anywho, I’m hoping for the best this time - I haven’t had any luck finding a good sports doc so far (have seen 3 though), and I don’t think PRP injections are common here in New Zealand as I’ve never had it mentioned before - so sticking with the eccentric exercise program.
Just some quick thoughts and questions on the program provided:
The Hamstring ball curls (well, the whole lot combined really) was too much to start with, so I’m taking that one out (as it’s the hardest). Felt a good ache in the butt/high hamstring after the first 2 sessions, so going to start a little slower. Will reintroduce those again (as I think they are an awesome exercise) later in week 2 or 3.
Thanks again, good luck to the rest of you suffering from this.
@Jsmith - how is your rehab coming?
Cheers,
Simon.
Saw this thread come up again and decided to add a quick summary of my positive (so far) experience with a similar injury.
Now the only issue that remains is I get some aching when I sit for prolonged periods. But that seems to be (slowly) improving too.
Most importantly, I’m finally at the point where my mileage and pace are limited by other issues (sore calves!) rather than my hip/hamstring attachment.
I too have suffered through this for 8 months with no running. Followed the therapy plan found here the eccentrics were the key. I concentrated on the exercise with the stability ball and did one legged hamstring curls with very light weight using both legs to pull up and one leg to very slowly let the weight down. It took 8-10 weeks but I am able to run now about 95%. I had tried everything PT, ART, chiro, massage.
I am a sprinter/mid-distance runner who happened to see this site a month ago after failed rehab over 9 months. I have had MRI that showed proximal hamstring tendon tear. PT with needling and eccentric strengthening, chiro with ART and graston and two rounds of PRP, the last 1.5 months ago. Then 2nd MRI 1.5 months ago showed healed tear. After each round of treatment I tried to start running or biking and I had an exacerbation of the injury with spasm through my left glut. (MRI also showed a normal lower spine without any nerve entrapment.) I started TTC’s regimen three weeks ago, giving the PRP 3 weeks to do its work, and felt great progress. I did not do chiro over the last 3 weeks but I did do dry needling alongside the exercises. Yesterday I got in the pool to do 5 minutes of deep end jogging and my glut med/piriformis went into spasm after that and hamstring became diffusely sore. I can minimize the glute/piriformis spasm by rolling the proximal hamstring aggressively but now I am set back by a couple of days, it seems. Can someone speak to what sort of progression I should expect. I can do the face plants 5 times in a row without proximal hamstring pain but any rapid movement of the hamstring sets off a diffuse tenderness in most of the hamstring and the aforementioned glute/piriformis burn/spasm. Any thoughts would be greatly appreciated.
Thanks so much for your post. I have the same issue you once had. I am following your protocol carefully and just started dry needling. I am curious to know if you had any pain or sensations down your leg when you had this issue. When I stretch the hamstring my calves flutter due to nerve compression in the hamstring attachment. I hope you have put this injury far in your past.
Best,
Dustin
TTC- I am desperate! My left HS is torturing me!
Can you please let me know where the doctor you spoke of is located? I live in So. California and have seen an Ortho and PT but unsuccessful! I really need an exact protocol so I can work with someone regularly. I was so encouraged to read about your success… Hoping I am able to get done relief. Hurts most of the day,
Thank you for your help!
Grace
I have had a summer of activity- none running- but I keep re-inflaming the proximal hamstring tendon and then I have tingling in the gluts and some spasm in the medial/lateral hamstrings. Now that the activities are behind me, I have a block of time to actually get this behind me.
I gave the hamstring a week of icing and rest and proceeded to PT and chiropractic.
I do occasionally have some twinges of pain down my lateral thigh and to my toes from some entrapment of my sciatic,but I think it is sufficiently transient that I hopefully won’t have long term sciatic nerve tethering with scar tissue to the healing tendon.
I am aggressively doing PT with therapeutic ultrasound to start then dry needling and some gentle stretching, tissue mobilization, pelvic alignment and baby steps of eccentric loading. Now that the tendon seems calmer, I am introducing the yellow theraband at home attached to a couch leg or my heel on the third step pulling with a slightly bent knee to do a quasi-isometric and sometimes eccentric load on the hamstring. Concurrently, I am following the protocol that TTC described. The article below gives a good description of how to progress:
http://runnersconnect.net/running-injury-prevention/high-hamstring-tendinopathy-injuries-a-pain-in-the-butt/
My chiropractor performs several rounds of ART on my gluts and then she does ten minutes of class 4 laser therapy on the hamstring tendon area then does a couple of rounds of ART on the hamstring.
I am trying to alternate chiropractor and PT. I have not done any reading that suggests that u/s and laser one day apart is harmful. If anything, daily treatment is supposed to be helpful. I also have found that my hamstring resists any progess without either laser or U/S. (So I’m doing both!)
My stretching is 4 times a day with gentle stretching of the hamstring laterally, medially, directly forward and some transition to the adductors. Most of this is done with my foot on the second or third step and some lean in with the pelvis and not a lot of lean of the head toward the foot. I have a tendency to overstretch so I have to double think every step of my exercises.
This week I have two PT appointments for Tuesday and Thursday. Tuesday will probably be mostly dry needling. Thursday will be continued eccentrics. Hopefully I can get chiropractic for Wednesday. I will likely decrease the amount of ART now that I am at a generally low inflammation state in order to focus on the eccentric strengthening phase.
All of my discussion above focuses on the hamstring with just a touch on the gluts, but I have been performing all of the core exercises extensively for glut/piriformis strength. Hopefully in the next week I will introduce some stationary squats and gentle lunges. Walking lunges inflamed me last month.
Gradualism is the key! I am not wired to do things gradually, so this is quite a process.
What were the wobble board exercises?
@ jsmith
I’m a mountain biker suffering from what I think is the same thing you did back in 2010: Exquisite tenderness over both proximal hamstring tendons (at insertion point) when palpated, sitting at the office, riding, running, etc. Pain came on gradually last May (2013) and has been gradually increasing in intensity ever since. Pelvic MRI shows fluid buildup in both hips and both ischial tuberosities (sit bones), which could indicate partial tearing of proximal hamstring tendons. I’ve seen countless doctors, have done months of physical therapy, had steroid injections, stopped running and have cut way back on my riding. Nothing seems to be helping. I’ve never had anything so frustrating and so difficult to overcome.
My ortho recommends surgery. I’ve read about PRP and it sounds promising. Not sure what my next move is … how are you feeling today and what did your recovery program / protocol look like? How long did it take before you were pain free and able to resume activity?
Any thoughts or advice you might have would be greatly appreciated!