High hamstring tendinitis / -osis / -opathy... am I done forever?

bummedHamstring wrote:

I’m 29, and I suspect the next few years will be it for me in terms of PRing anything, but it's looking grim for getting fully healthy.

Given the time you took off for injury, your peak will probably come much later than other people. So you might have another decade to chase PB, especially in marathon.

Had/have similar issues. Dont really know what to tell you that you dont know. Doing nothing did nothing for me either. Have you tried dry needling? If its way up high though I don't even know if thats appropriate. It has helped others I know.

Ive improved by dedicated rolling/massage/manipulation and maybe just time but I havent really pushed the pace yet so I'm unsure how recovered I really am.

Has surgery been suggested or discussed as a possibility?

I too had this issue for over 2 years...I was running 70 mpw and racing. I tired taking time off/massage/chiro but that didn't seem to help. I then stuck with low mileage for 6 ish months and started riding my road bike a lot. Then started to train for a long distance triathlon and had no hamstring problems....and have actually regained full hamstring flexibility and haven't had pain since. I assume the increase in the strength of my hamstring (road bikes engage hamstrings well) is what did it, but I am just happy that I can run again with no pain.

I had this for a year or two. Hated it. Couldn't run fast. Was always sore.

Ended up switching to cycling just out of laziness (running was a lot work as I got older). About three years later ce back to running with no hamstring issues.

So no, you are not done.

That said, I am now old and slow and have tendinitis in my knee. Awesome.

I had it in both of the legs at different times in a period of two years. At one point both were barking at the same time. 8 weeks is not a very long time off , but I took much more and still had it later and worked through it running/exercising eventually. I learned to be very careful with stretching , totally avoiding putting strain on that area. You have certainly seen all the guidelines for this by now. I still stretch and think it helps, making sure the stretch is mainly on the big parts of the hamstring muscles.

I stopped doing deep squats except with body weight. I do squats and dead lifts but the squats with weights are to parallel. I think overstriding with fast running , and too hard of running workouts not recovered enough(monster work outs relative to my ability, really) , stretches that pulled on the tendon bone attachment and weights were all either doing damage or blocking recovery, or both. Never went to PT or doctor BTW.

I also changed to getting a more of my stride from behind my body and going more to a mid -foot than fore-foot strike for regular runs. I incorporated these changes gradually by starting over at easy running a couple of times . You can see all kinds of stuff on this on web, including youtube I think. I ended up having much better foot and ankle action. Definitely more of a "glute"runner. Anyway, I think what people say about our injuries being our teachers is right. You might not need to do the same things or worry about the same things , but it's working for me. Side benefit is that I no longer have constant calf problems that I had before.

I sit on my foam roller when I spend too much time at the computer. Sometimes the weight bearing is on my hamstrings and sometimes on my butt. You can roll around on it a little here and there, stretch quads and hip flexors one time while sitting . Not sure if this stuff helps , but it feels like it might. It also reminds me I am spendng too much time sitting , so that's good.

I had something similar to what you describe, although perhaps not identical. It hit me out of the blue after a hard hill run two months after I had qualified for the 1992 Olympic Trials with a 2:42:50 (female). I was 33 at the time, and I pretty much lost the next 9 years trying to get over this injury. The various sports medicine docs and physical therapists I saw could mostly find nothing wrong with me except for an appalling lack of flexibility, so they prescribed various stretches. None helped and some made me much worse. Like you, I would go through periods when I could run a fair amount of mileage as long as I never went too hard, but then there were periods when I literally didn't run a step for many months at a time, using my bike to stay in decent aerobic shape. I gained weight and pretty much gave up hope of ever being able to run normally.

At age 42, something I heard gave me the idea that perhaps my problems were caused by sleeping in a bad position. I usually slept with my legs extended, either on my back or 3/4 on my stomach. So I began trying to sleep on my side in a fetal position, with my legs pulled forward and everything in the butt area stretched out. It took many months for me to learn to sleep this way, but I saw gradual improvement and finally I trained myself to wake up and change position whenever I flopped onto my back. The more I slept with my legs pulled forward the better I got, and within a year I was back to running almost normally, although I had lost a tremendous amount of fitness. For a few years the problem would still sneak back sometimes after a particularly hard run, but it never got bad again.

Now, at age 58, I have been completely trouble-free in this area for well over ten years. I'm still careful to never sleep on my back. I'm way, way slower than I used to be, and I still get other injuries including an Achilles tendon problem that is currently hobbling me, but I've solved the butt problem. It worked for me--you might give it a try.

Good luck!

I have had the same problem 2-3 times over the last 15 years. An cortison/inflamation injection has always took care of the problem.

Wow. If it is sympathy you want, you've got mine.

I am dealing with a lower hamstring issue in my biceps femoris. I've done a round of PT and recently had it come back when I stepped in a ditch and stepped awkwardly trying to regain my balance. Trying to knock it out for this round on my own has been tough, and I've not been successful so far.

Every suggestion I would have had for you you already tried. Your diligence with PT is admirable.

Hamstrings are so fickle. My PT (a college track athlete) told me that they are among the touchiest and most unpredictable of all body parts regarding reinjury.

I can sympathize with you that hamstring issues just don't seem to play by the rules of other injuries. Time off, stretching, strengthening, icing, ibuprofen… You can try it all and it seems like voodoo. There is no rhyme or reason to what seems to help at a given time, and when a given practice will stop helping.

lkj wrote:

I have had the same problem 2-3 times over the last 15 years. An cortison/inflamation injection has always took care of the problem.

Reminds me that I did a cortisone shot. Helped but was not a total cure.

I don't know what will help you, but I wish you all the best

I've dealt with the same issue for about 5 years.

I've done probably everything you've tried.

About 3 months ago I STOPPED stretching the hamstrings 100% and maintained the strengthening protocol.

I'm now running 50-60 mpw with 1 track session. My stride is a bit altered (shorter with a quicker cadence) but the hamstring issue is now very manageable and I can race.

Granted, I won't try sprinting a 100m or such, but I'm able to enjoy the sport again. I still won't stretch the hams.

Good luck!

I have had similar issues. The biggest improvement came from a standing desk. If I sit, I use a stool. It positions the hip much better than the closed position in a standard chair.

Igy

Hi. I have to take the opportunity to weigh in on this. I too had this bitch of an injury back in 1988 Ischial tuberosity tendonitis sustained first lap of a one mile race I talked myself into racing. Finished race with feeling like my right leg had gone numb. Was in considerable pain & discomfort for months later. What you described is so similar to what I endured - for near two years. It would be, back to some running, some racing but like 2 plus minutes SLOWER for 10 km time and just unable to push to even keep up with an ornery noon hour bunch whom I would have to have been able to smoke. Humiliation as well as prolonged discomfort while at work (sitting) and driving. Yup, pool runs, a course of 2x a week exercising on a kin com machine (Kinetex exercisor) two summers on my bike. I was then all of 41 yr. old and was still hoping to continue to be competitive. Well time fortunately is the greatest healer. Presently am free from it, but, age does catch up with all of us. A slow minimum mileage fitness guy these days.

This does eventually get better. You are relatively young. Don't give up hope!!!

Are you positive it is tendonosis/itis? I struggled with pain in both hamstrings for almost a year and was diagnosed with tendonosis and prescribed the usual eccentric stuff. However, it turned out that what I really had was over excited nerves running through the hamstring area that were getting caught on fascia or something like that. I did nerve flossing and very light progressive eccentric strengthening over a few months and was able to kick it. However, about the time I fixed it my hamstrings my IT bands both flared up and became a source of chronic pain...

In my experience, all of the lower limb (and low back) injuries are interconnected. Therefore, I think it's crucial to holistic approach rather than fix the specific area that hurts at the moment. Easier said than done of course.

- strengthen your calves

- keep your calves stretched and loose. this is critical

- stretch your IT band and butt

- strengthen hamstrings. bridges, curls etc etc - look up exercises

be very careful introducing sprints and speedwork

- be conscious of how you sit at work

most important:

- strengthen and loosen your hips. i bet your problem starts with a hip weakness/tightness/imbalance

i address those things weekly and my hamstring problem goes away. maybe 2 days of 20 minutes each day just for those things and calf and hip stretching after each run (10-15 minutes) and during the workday

good luck

Funny, I realized just now that I haven't had this problem at all this season. The last two seasons it was really bothering me and held me back in training for a few stretches when it got worse for a few weeks.

It just kind of went away without me even noticing. I'm 31, so it bothered me from about 28 to 30. I'm glad to have it behind me (hopefully for good). But now I'm dealing with achilles tendonitis that slowly crept up on me over the course of this past track season.

In case you haven't seen this article. Follow it like the RY believers and you will get some improvement.

http://www.runnersworld.com/web-exclusive/high-hamstring-tendinitis

FWIW, I believe that longstanding injuries like this are the result of something off in your gait, both walking and running. They'll linger for years until you figure out what's off, and correct that. And then poof - it clears up. I lost about a year to a similar injury.

The causes of my injury, I eventually figured out, were a habit of overstriding with my left leg, due to an old tear in my right groin, plus an SI joint that had loose ligaments and liked to pop out of place. I got the groin repaired, and got the SI joint tightened with prolotherary, and I've been mostly good ever since. About every 14 months or so, the SI joint gets loose again, so I do another round of prolotherapy in the SI joint, and I'm good. (I also have to continually work at keeping my gait correct - single leg deadlifts are my religion, and I do them before every run to get stuff firing correctly).

I'm not saying that those are necessarily the causes and fixes for you - it may be something else. My broader point is the issue is NOT with your hamstring, if it's persisted this long, especially with rest. The issue is elsewhere, and you need to play detective.

PT is great and can be helpful; but at this point I'd be getting second and third and fourth opinions. Not because the first PT is bad, but because every PT will have a slightly different approach. It took me two PTs, two Chiropractors, an Egoscue Therapist, and two Orthopedists to finally decypher the underlying cause of my injury. Each of those professionals contributed a facet of the overall answer, and not a single one of those visits was wasted. However, I had to put the pieces together myself.

I'd also start doing lots of single leg exercises - single leg deadlifts, step-ups, etc. And pay attention to your alignment during them. My problem was my left high hammy - and yup - my right side is by far my tougher one for balancing. Doing those exercises slowly and paying attention to HOW and WHERE you struggle can give you some solid feedback as what it is in your particular stride that triggers the injury.

Good luck!

Thank you, each one of you, for these thoughtful responses. So many wonderful insights here. I'm sorry to hear many of you have had similar experiences, but grateful for your advice and anecdotes.

>> "Have you tried dry needling? ... Has surgery been suggested or discussed as a possibility?"

Yes! And ART, graston, positive thinking, meditating the injury away... :) no surgery discussions yet. I'd be hesitant to take things that far.

>> "something I heard gave me the idea that perhaps my problems were caused by sleeping in a bad position." ... & ... "The biggest improvement came from a standing desk." ...&... "In my experience, all of the lower limb (and low back) injuries are interconnected. Therefore, I think it's crucial to holistic approach rather than fix the specific area that hurts at the moment." ... & ... "I believe that longstanding injuries like this are the result of something off in your gait, both walking and running. They'll linger for years until you figure out what's off, and correct that. And then poof - it clears up."

Nodding my head along with each of these posts -- completely agree. In the past decade, I've had hip and other leg issues all down the chain that would evaporate after a few visits to my trusted chiropractor (who has since left the profession). I haven't been able to find a new one who can help me yet, so either she was some kind of spine sorcerer, or these other chiros have been just fine and the issue is that there are other puzzle pieces I've yet to sort. It seems like something like alignment correction, plus PT, plus targeted lifestyle changes (standing desk, better sleeping position, etc.) should solve this, but I haven't quite found the recipe yet.

>> "- strengthen and loosen your hips. i bet your problem starts with a hip weakness/tightness/imbalance"

Absolutely. I've had hip issues since high school and am honestly surprised it took me over a year into the injury before I figured out this piece of the puzzle! The deep hip/groin stretches & glute med exercises I've been doing have been keeping me out of major trouble... for a little while, I thought they were going to be the solution to problem entirely, but not quite.

>> "My broader point is the issue is NOT with your hamstring, if it's persisted this long, especially with rest. The issue is elsewhere, and you need to play detective... It took me two PTs, two Chiropractors, an Egoscue Therapist, and two Orthopedists to finally decypher the underlying cause of my injury. Each of those professionals contributed a facet of the overall answer, and not a single one of those visits was wasted. However, I had to put the pieces together myself."

Agreed. What a great post. I've proven a poor Sherlock Holmes so far, and it is becoming a mental and emotional drain to keep thinking I've found the culprit, or a solution, or another puzzle piece, only to let myself down again. How does one stay optimistic through this process? I'm becoming such an Eeyore about it!

My health insurance is not great, and playing detective is getting expensive. I cringe every time I think about how much dough I've dropped on this hobby injury and am feeling skittish about restarting that process. I'm chuckling a little because I've actually also seen two different PTs, two chiros, and two orthos! Maybe an Egoscue Therapist will be the tipping point that helps me pull this dang puzzle together. :)

Another component is that it is difficult to know how long to stick with something before concluding that it doesn't seem to be helping, particularly where health insurance coverage is concerned. I'm really good about sticking to a PT regimen or anything I can do at home, but am hard pressed to continue spending money on things like, e.g., dry needling that don't seem to help after several visits.

>> "You can try it all and it seems like voodoo. There is no rhyme or reason to what seems to help at a given time, and when a given practice will stop helping."

No kidding. What a perfect summary of how this injury has gone so far!

>> "Then started to train for a long distance triathlon and had no hamstring problems....and have actually regained full hamstring flexibility and haven't had pain since" ...& ... "Ended up switching to cycling just out of laziness (running was a lot work as I got older). About three years later back to running with no hamstring issues."

I think the "get a new hobby, forget about running for awhile, and maybe magically find myself healed in a few years" route sounds like the best case scenario for my mental health at this point! These stories are heartening to hear.

Thanks again for all the great responses. I'll probably be feeling mentally better about this all soon and go back to "playing detective" with gusto once I get out of this funk. The upside to this strange, stubborn injury is that it really isn't debilitating unless I'm trying to run fast... there are so many other wonderful athletic things I can still pursue.