high hamstring tendinopathy vs. Piriformis syndrome: please disguish

Boy, I can relate! I have had this pain-in-the-butt for over a year now, and all my countless physical therapy, massage, rest, chiro and ortho visits have NOT pinpointed the cause of the issue or even what it is, exactly. I am basically now a non-runner. Any new input from the Let's Runners would be of interest!

Thanks-

RB

ditto...i've been doing all of the exercises in the article from physician and sports medicine that i suspect you have read, *not* doing the ham curl machine, doing squats and 'mini' seated leg presses one leg at a time. i call them mini because it hurts the ham/butt to bring the knee to a right angle so i only do a short range of motion.

i've also just started getting serious about doing the pretzel stretch, other piriformis stretches, and very light ham stretching.

am i prefectly better? no...but, since starting this routine, i've been able to up the training.

I have been having this problem since march of 06 and then in may 06 I had a very stressful 10K for the 1st run of the nats du champs. This effort totally exploded this injury and I have had to really just take alot of time off. I was doing all of the exercises listed above. I was able to run a little but any time I went up hill, got faster than 6:45, or went over 6 miles it would start to irritate me. It seemed nothing was working. I had a few MRIs and these showed nothing. So they tried telling me it was lower lumbar and nerve issues that was casing my pain. I knew my body well enough that this couldn't be the case. I couldn't even sit or drive without pain.

I did more research and found a case study of an olympic 800/1500 runner that has had the same problems I had. They finally got it diagnosed correctly and did the following:

1st -cortisone shot to the ischial area ...very precise and guided by CT.

2nd -ten to 15 days off after shot. Do absolutely nothing for those 10-15 days. Easy stretching, strength training, and easy base running for 2-3 months.

3rd -start workouts again after 3 months from time of shot.

4th -back to succesful international racing at 6 months with no issues.

I went back to my orthopedic with this info and we ordered new MRIs. They did "comparative" MRIs on both sides to compare for slight deviations. Finally, they found some imflamation and we moved forward with the above treatment. Got the shot 3 weeks ago, took 12 days off from doing anything to my hamstring, just finished last week running only 5 miles per/day. Feels great. I can actually sit at my desk and drive without being in agony. My plan is to be at 70 miles per/week by the end of March and maybe start workouts in april.

I have the article somewhere and will post when I find it.

I think we're all talking about the same syndrome, whatever you call it. Not a mid-hamstring tear or strain, but something awry in the upper-leg/butt-bone area, where muscles thin to tendons, circulation is much less active, and any swelling is potentially exacerbated by a circle of bone.

I did a little on-line research and found this link:

http://forums.runnersworld.com/eve/forums/a/tpc/f/678106477/m/540100718

I've never tried ART (Active Release Therapy) but I will probably seek that out. A constant of various treatment modalities seems to be the forceful application of pressure to the painful spot--using hands, a tennis ball, or a "log" (a roller) of some synthetic substance. I tried this last time around and it did seem to help. That might be considered a kind of home-remedy ART.

Am I the only one who has had good luck with Naproxin sodium (Aleve)? That has really helped clear this syndrome up in the past.

For the past year, I've kept any high hamstring problem entirely in check by taking an Aleve (one 220 mg tablet) after each of my two midlength runs and my Sunday long run. Three tablets a week. When I failed to do that--and when I only took tablets on the weekend--hamstring pain would immediately begin to accrue. But once I stumbled on the three-tabs-a-week regimen, ALL high hamstring pain disappeared and I was able to train hard with absolutely no problem.

Now this! There is hope, in any case. Both other times I've had this syndrome, I self-treated and was ultimately fine. Once I took two weeks off.

I find that sticking to flat paved surfaces helps. (Usually I run on uneven off-road stuff.) Also being very conscious of what sort of chair I'm sitting in all day. (Shift around; get up AT LEAST once every hour for a couple of minutes.)

Here it is.

http://www.physsportsmed.com/issues/2005/0505/fredericson.htm

i totally had alot of luck with aleve. i actually forgot i had the problem. then, i decided to go drug free and realized that it was still there. i feared that i was masking the pain and making it worse so i didn't go back on it. but, after hard workouts i take a couple and i feel great for a couple of days.

i agree with the foam roller guy - this is something else i forgot to mention. i can feel pinpoint pain in my butt when i use this. i wore out my old white one and just ordered a new one that is supposed to be harder that the old ones.

an aside...does anyone also have pain in the adductor/groin/pubic area in addition? i had to stop doing anything in pushup position and can't do any ab work where i have to lift my legs cause of pain in the groin/pubic area. i suspect that this is associated with the piriformis/ham.

greenbeer,

I have had issues in the groin/pubic area and what helps me is to do elevated situps with my feet tucked under the cushion. I guess you could do regular sit-ups with your feet tucked under the couch. Doing them this way you are also strengthening the groin/pubic muscles (hip flexer) as well. Start doing them very litely and increase slowly.

Thanks ischial...i've been hesitant to even try any ab work in a while. this sounds like a good way to start back up without irritating the groin.

ischial tendinopathy wrote:

Here it is.

http://www.physsportsmed.com/issues/2005/0505/fredericson.htm

My friend, that is an absolutely mind-blowing article. It is comprehensive in a way that only an injured running nerd (like me, for example) would appreciate. Incredibly useful. This article should be prescribed reading for any runner who ever suffers from this sort of thing.

Cheers. And thanks. You're a prince.

no problem

I have the same symptoms but not as bad. When I first felt it, I focused on low intensity running but kept the distance and it got better.

I would go for ART. Regular physical therapy seems to just treat the symptoms, but every time I have had ART the chiro pinpoints the cause and works it all out to eliminate the problem.

I had the same problem about 5 years ago and tried physical therapy, ultrasound and massage and nothing worked. I eventually went for ART treatment and that fixed the problem after two visits. In two weeks the injury I had for 12 months was cured.

About 6 months ago the injury came back. I no longer live near the person I previously saw for ART, so I went to a new doctor and after 6 treatments the injury is still there. The treatments helped a little but it was only temporary. I've since moved on to another ART doctor and after my first visit, my range of motion improved dramatically, but the pain is still there. I have another visit scheduled for this week. So far the results from the new doctor are promising and similar to what I experienced with my original doctor 5 years ago. I think after a couple more visits, I should be pain free.

Just seeing a doctor who practices ART may not work. You need to find one who knows how to treat your specific injury.

PS, I also used the foam roller and it didn't do much because the injury was very high up and isolated to a small area. I ended up getting a softball and it worked much better. You can really pinpoint the injured area.

Hey,

I've been out of running for nearly 3 months due to a femoral stress fracture. My leg started to hurt in September, but I ran on it for nearly 2 more months because I was told it was a muscular problem. I thought that it might be hamstring tendiopathy or piriformis syndrome. I had x-rays taken in late November and those along with three different doctors confirmed the stress fracture. I am seeing the doctor on Friday to see if I can run, but there is still some tightness and slight pain in the injured leg.

I have a chronic tightness that runs along the inside of my groin/hamstring area and down to my knee.Is it possible that there was an initial hamstring injury that left my leg vulnerable to further injury and the sprinting and bounding drills only exacerbated the condition.? I know a femoral stress fracture is different than a tibial stress fracture, but I think there is more going on than just the stress fracture itself. Hopefully the doctors will listen to me this time when I see them next Friday.

Here are two very good case studies on hamstring pain that Active Release Therapy seemed to clear up. I am thinking I might need this treatment. Any thoughts?

http://www.sportsperformancecentres.com/assets/articles/Scientific%20Review%20Articles/Treatment%20of%20Proximal%20Hamstring%20Pain

http://www.sportsperformancecentres.com/assets/articles/Scientific%20Review%20Articles/Treating%20Snapping%20Hip%20Syndrome.pdf

i have what sounds like the same problem for the last 2 years. it's an upper hamstring/piriformis/sciatica/butt/whatever problem.

been through everything including taking last nov. and dec. completely off.

all with no relief.

now i have hope again.

Binderdundat!

Back in June, 1988. A one mile on the track with no proper track training. It took over two years to get better but it probably altered the rest of my runnning career regarding my gait..too bad I had just entered the Masters Cat.

Was able to mount mini-comebacks but was a real pain.

To previous posters thanks for those links.

I can so empathasize with the rest of you on this thread.

i had the smae thing. it came on after i returned to training much too quickly after a severe ankle sprain (my gait was altered). MRI came up negative. It took me about 4 months to get over it. ART, PT (including CORRECTING THE SOURCE OF THE PROBLEM, my ankle biomechanics), antiinflammatories, and a very gradual ease back into running ended up being the "cure". I would suggest you try to find out why one side is more stressed than the other and try to correct it. In my case it was fairly apparent - yours may not be but i think that is the key to shaking it for good.

I'm bringing up this old thread as I have been diagnosed with a high hamstring tendinopathy. In my case, it was very much a specific event that caused the injury - I missed a hurdle with my right toe and literally heard the left tendon "snap" as I flailed through the air.

Conventional therapy to date has been relatively ineffective, so I need to get more active in finding a fix (I've been sitting for just 15 minutes now, and already my butt is throbbing).

Any way, I'm wondering if anyone has a new link to the article referenced above. Or, if you've got it saved off-line and could forward, I'll be happy to share my e-mail.

Had to do some google gymnastics:

http://www.physsportsmed.com/index.php?article=89

if you have been diagnosed with high ham tendiopathy via imaging, ask your doctor about shock wave therapy (ESWT). i was at the american college of sports medicine conference in june. one researcher did a lit review on this and found that ESWT was successful for high ham tendonopathy if it were done in a specific manner. my notes are shaky but someone with experiences should be able look up the information. one of the points of his talk was that only when it was done in a specific manner i.e. shock intensity, number of shocks, and number of treatments, was it found successful. he pointed out studies with different protocols and the outcomes weren't as successful.