high hamstring tendinopathy vs. Piriformis syndrome: please disguish

found this thread while trying to diagnose my 14 month injury.

how did the cortisone treatment work out in the long run?

sounds like an answer for my problem. thanks

I had a ultrasound guided cortisone shot for high hamstring tendinopathy. It had an immediate analgesic effect, which induced a sense of euphoria. Don't mistake the analgesia for a cure. The shot should reduce inflammation and let you do the PT you need to get better - that is the point of it.

good luck

Bumping this thread- here's the original good article on high hamstring tendonopathy:

http://classic-web.archive.org/web/20080621111334/http://www.physsportsmed.com/issues/2005/0505/fredericson.htm

I've been struggling with "pain in the butt" for 1 1/2 yrs. Originally I felt a "pull" in the belly of my hamstring. I stopped my strength training for almost a full yr. to let it heal. Tried adding it back in last summer-- that side was very sore/tight/crunchy/weak. I've gone through bouts of doing the ~eccentric type exercises (bridging, planking, squatting, RDLs, ham ball curls), and yet the problem persists- the supine plank test brings out major pain/weakness, despite all the strengthening I've tried to do.

I've gone to a massage therapist the past 3 weeks, and she says my piriformis is tight and has some trigger points. She also feels a knot in my hamstring, and there's some pelvic malalignment issues, moreso on the opposite side. I'm going to a chiropractor who does ART and acupuncture on Monday. I've thought this whole time the problem was my hamstring, but now I wonder if it's ~piriformis/sciatica, with referred pain to my butt? It's hard to palpate the pain, but I definitely feel it on the sit bone (not high at the piriformis). I haven't gotten an MRI, but I appreciate feedback if I need to get this done. We'll see how the chiropractic visit goes.

bumping this thread in hopes that someone who originally posted is cured.

Questions:

1) Was complete time off from running the only way to finally nip this? I'm doing a lot of strengthening but i continue to run every other day or so. After initially starting to feel like i was improving, progress stopped and i'm stiff after 30 mins of easy running.

2) I've been doing eccentrics and many of the exercises previously posted for several weeks. my hams are always sore but feel stronger when running. but i still have hamstring pain after 30 mins or so of running. Am i on the right track?

3) How would you rate ART? i read that you should not dig into the area that is sore but you should dig into the area that is sore.

thanks

Quite honestly, the best cure for these ailments is to run the Western States 100 miler. It is coming up, so that actually might work out for you if you are currently having these problems.

deadlegged wrote:

bumping this thread in hopes that someone who originally posted is cured.

Questions:

1) Was complete time off from running the only way to finally nip this? I'm doing a lot of strengthening but i continue to run every other day or so. After initially starting to feel like i was improving, progress stopped and i'm stiff after 30 mins of easy running.

2) I've been doing eccentrics and many of the exercises previously posted for several weeks. my hams are always sore but feel stronger when running. but i still have hamstring pain after 30 mins or so of running. Am i on the right track?

3) How would you rate ART? i read that you should not dig into the area that is sore but you should dig into the area that is sore.

thanks

a dude who runs slow wrote:

Quite honestly, the best cure for these ailments is to run the Western States 100 miler. It is coming up, so that actually might work out for you if you are currently having these problems.

dude, if i could run past 30 mins without hamstring discomfort, i would give that nutty race a try. but distance is not my friend right now. neither is speed. short and slow is all this injury allows. it sucks.

This is a great article and has helped to give me some insight into my own injury which I have suffered with for over 2 months now.

Mine was first diagnosed as a proximal high hamstring tendonopathy. Initially the pain was quite localised at the connection point to the bone. Now this pain has subsided and the pain is more referred in the low back, buttock and hamstring. I also have a really tight psoas muscle on one side.

Usually I don't feel any pain during everyday activities, just some mild low back tension and pain.

When I run I can do about 10mins before my hamstring and groin tightens up and my leg won't swing through properly.

I think my injury is coming from SI joint mis-alignment, I've noticed I have really bad anterior pelvic tilt as well.

I haven't found any exercises yet that make the discomfort subside enough when I'm running. For now I will more agressively stretch the psoas and do some bridging to strengthen the glutes.

I struggled with upper hamstring tendinopathy for 18 months. Of course, I started conservative with treatment (i.e. no running, stretching, icing, etc). I then went dry needling. None of these things "cured" me, but seemed to keep the injury from progressing. I could still run, but anything much faster than 10k pace aggravated the issue severely. Approximately 1 1/2 months ago, I began cycling some to correct some muscle imbalances. Just prior to this, I had platelet rich plasma(PRP)therapy injection into the upper hamstring and, again, took 3 weeks off from running. Upon my return, I'm feeling better than ever.

The frustrating issue right now is that i can run. I followed this:

http://www.runnersworld.com/injury-treatment/pain-rear-high-hamstring-tendinitis

for 2-3 months and got to the point where my stride was pretty back to normal. but after 30 mins, i start getting uncomfortable.

then someone posted these eccentric exercises:

https://www.youtube.com/watch?v=AS9eqB_hZqo

and i started doing these for the past 3 weeks. My stride feels even better and i am so optimistic every time i head out the door. but 30 mins or so into it, i start tightening up again.

i have hips, abs, and glutes of steel after doing so much strengthening but i just can't seem to get rid of the irritation.

i've been doing a bunch of biking, swimming, and the elliptical and none of this hurts it. i am just not sure what the next thing to try is to get to progress to the next level where i get beyond 30 minutes of easy running.

i'm tempted to start taking Nsaids but then i read that thsi can slow the healing even more. Do i have someone dig in there or will that just irritate it?

thanks.

I've been advised by my physio to do hydrotherapy exercises to correct the muscle imbalance caused by this injury.

Has anyone had success with this approach?

I had it in my right leg for about 2 months. USA car, live in the USA. Drive 30min + 30min to & from work. Work has me driving between job sites. Both cars no cruise control. Cut way back on my driving at work and with weekend workouts. Focused on entire foot-to-hips tendons linkage stretching. Problem gone.

hydrotherapy didn't work

next i was advised to do a 'pillaring' exercise to strengthen the hamstring. this was like bridging but raising the knee to the chest on each side. along with that i have been streching the hip flexor muscles.

the stretches help to ease the tightness/pain but are not curing the problem

I am a receptionist and I have swam all my life. I recently started running and after a year of training, I felt a tug one day, while running, right in the glute/hamstring area. I haven't been able to run since. I swim to stay active, but it's not the same. I have tried ice, compress, massage, stretch, and strength training, but nothing seems to work. Pain medication won't even take the pain away.

I have done some research and found that many of these injuries come to people who have jobs that require them to sit for long periods of time making your hip muscles sit in a 90 degree (Hyper-extended) angle, which our bodies are not built for. I just read this thread and will be trying your suggestions.

Has anyone had any improvement?

Interesting to see an old thread and my postings on it from earlier this summer.

I started PT 6 weeks ago and have made great progress. Here's the thing, they have me doing stuff that i would not have considered.

1) Rope stretching - so many of the posted articles out there say don't stretch it. - every day

2) Eccentric 1-legged ham curls on the machine 3 x week

3) Lay on back, both legs straight up in the air, bring one leg down to the floor and back up, now the other. repeat 20 times - every day

4) Lay on back in a door frame like this guy: - every day

http://www.youtube.com/watch?v=YJ9MjdWC2aE

now bring the leg on the floor up and down.

5) one legged seated leg press - 3x week

after 4 weeks added in:

6) 1 legged dead lifts - 3 x week

7) 1 legged squats - every day

The problem is that my flexibility in my hams was so bad that all the strengthening i had been doing from the phys and sports med article and the RT article were working only in a limited range of motion.

ART made it worse. It came down to getting some flexibility back. now i can run slowly but feel really weak going up hills because i hadn't been using that part of my hams for so long.

Jackster wrote:

Has anyone had any improvement?

Also forgot to mention that i started using a stand up desk in late june. i'd been sitting on my butt for 20+ years. now i alternate between sitting and standing.

while i am standing and typing this, i am stretching my hip flexors by putting my knee on the seat of the chair and my foot on the back. it feels really good :-)

It's good to see my old thread resuscitated.

As it turns out, I was out of commission for 10-12 weeks altogether. I saw a terrific ART (Active Release Therapy) guy in Memphis, Dr. Jeremy Jessop, and he put me back together. I started running in mid-April 2007 and by July I was able to race again. Everything was normal by early fall. Between April 2008 and January 2009 I ran 50-55 PRs in 10K, 10 mile, and half marathon. I did NO additional strength work; just saw the ART guy 6-10 times and began stretching my hams more. 100% success.

I've had hamstring issues once or twice since then--not quite as bad as the January 2007 injury, but still something that tamped down my training and resulted in off days. I've returned to Dr. Jessop every time. (His brother, Darrin Jessop, is also a chiro/ART practitioner in Memphis and does a great job as well.)

If I had any high-hamstring advice, it would be distilled as follows:

1) Stretch your hams daily. Don't overdo it; just find stretches--by experimenting--that feel good and work various angles. Go slow at first!

2) When you're working into faster paces that you haven't touched for a while, go slow! This is especially true as you age.

3) Assess leg length and address leg-length issues. Pay attention to the camber on roads.

4) Learn the piriformis stretch. I rarely do it, but learning HOW to do it and doing it daily was a part of what helped heal me.

A couple more points:

5) When you feel your hamstring begin to tweak, back off. Run 3-5 mile recovery runs for a couple of days. Stay away from the hard, fast stuff for a week. I've done that several times and saved my road racing season as a result

6) When injured, track down an ART practitioner. You won't be instantly cured, but my guy has a 100% success rate: he's cured me of hamstring problems four times in seven years. This past spring, after the lastest round, I was able to run 20:36 in a 5K, which in age-graded terms is a 17:08--as fast as I've ever gone. So there IS hope, no matter how badly you've tweaked the dang thing. Healing is a process. Give it time, keep hope alive, and when you come back, take it slow. You'll get to where you want to go.

These are outstanding exercises for the hamstring! This can be a tough injury. Check out this article; it has a pretty good take on this:

http://marsblackandgesso.com/post/97128629884/an-18-month-relationship-with-high-hamstring-tendinitis