Chronic Hamstring Tendinopathy

Been dealing with this for 10 years now. Constant cycle of rehab + start feeling good + increased pain + rehab. Here's what has recently helped:

Increased heel to toe drop in my shoes.

Moving foot-strike away from forefoot and more toward midfoot/heel

Not running faster than 7:45 for first 20 minutes of every run.

confusedmalem wrote:

Been dealing with this for 10 years now. Constant cycle of rehab + start feeling good + increased pain + rehab. Here's what has recently helped:

Increased heel to toe drop in my shoes.

Moving foot-strike away from forefoot and more toward midfoot/heel

Not running faster than 7:45 for first 20 minutes of every run.

Thanks mate. 7:45 is probably about my easy run pace (long stuff included), I've a mix of drops in my running rotation and I'd like to know more about my foot strike; I'm quite confident I'd be heel/midfoot.

I've got a desk job, do you think it'd be worthwhile standing at the desk as opposed to sitting? Sitting on your arse for prolonged periods may hinder more than I'd expect. I'll ask this stuff at the physio, but it's nice to get some insight prior to my visit.

Welcome to the club. I've probably experienced every injury under the sun and have been able to eventually clear them. Proximal Hamstring Tendinopathy is definitely the toughest nut to crack.

I was able to recover from my first bout with it through mainly eccentric loading of the tendon...the exercises seem to force the fibers to re-align/heal at the insertion at the ischial tuberosity (sit bone). I lasted a couple of years, but it is now back with a vengeance. I've had no success with total rest (6 months) and have since read that total rest may not be the answer because continued blood flow to the area is crucial for healing. So I now jog 8-9 minute pace for 45 - 80 minutes 6 days per week. Anything faster requiring an open stride seems to exacerbate the problem.

As stated by the previous poster, I believe a greater heel-to-toe drop in a shoe helps.

Three physical therapists and two ortho surgeons have been little help. There are several blogs available on the condition and apparently a surgeon in Sweden who can fix the issue for good. Neither of my ortho surgeons felt confident they could fix it, and besides, they're breaking the bank with hip and knee replacements.

Please keep us posted an good luck!

Treatment with EPAT machine really helped get me over the hump, but it can be expensive if insurance won’t cover it.

Yes, you want to strengthen the hamstring with eccentric loading, but often tight and short hip muscles pull on the hamstring and leave it vulnerable, so getting work on the hip can help. ART can be a helpful manual treatment. I had success with a very good accupuncturist too.

As others said, rest does nothing once you are beyond the acute injury phase. You need blood flow.

Sit bone wrote:

I was able to recover from my first bout with it through mainly eccentric loading of the tendon...the exercises seem to force the fibers to re-align/heal at the insertion at the ischial tuberosity (sit bone).

What eccentric exercises did you do? Nordic drops?

Also, how can you tell if it's high hamstring or piriformis?

If you stretch your hamstrings, probably should stop until clear of the issue. When and if you start stretching them again , always with bent knees. I probably kept stretching some, but I know I was aware it was risky.

I go over mine, both legs at different times and both at the same time once by walking a lot , hamstring curl variations, including nordic and straight leg eccentric stuff with bands. I corrected /avoided over striding when i did go back to running. Got more disciplined with keeping easy / hard days in the right variations. I remember kneeling or lying down when I could instead of sitting . When I sat, I would vary how a lot. Also, did a lot of soft tissue work in my hamstrings , not sure what that was worth.

Suffered 2 years. Tried everything except surgery. I *think* frequent and intense massage, rolling, j cane, etc finally did it. Get someone to really get their thumbs in there, knead, twist, whatever. If it's not uncomfortable, its not hitting the right spot. I imagine it was breaking up scar tissue but I really don't know. For all I know, it just randomly healed, and ymmv.

Thanks. I'm never sure about digging into it. It seems to make it worse. I also have pain in my butt so it's possible it stems from piriformis syndrome.

It comes and goes. When it's gone, i never feel like it's coming back but when it's there. it feels like there is nothing i can do to make it go away.

I know one thing i will not do is have a cortisone shot. Even it was considered a treatment, read the "cortisone shot for the labral tear" thread. It convinced me that i'm never getting cortisone in any body part.

I had it for one year and was successful beating it by 1) careful massaging everyday; 2) stop static stretching and do slow warmup; 3) run on grass if you can and don’t do any significant hill running till it starts to feel almost normal.

My PT said piriformis is unlikely for most athletes, and tends to develop more in sedentary older people. At first I though I might had piriformis issue but it was HHT.

Good luck...

I have had a hamstring injury for 2 years tearing it twice in same place, a few things i have found to really help and fix is a deep tissue massage, doing those nordic ham curls, can use a medicine ball to make it easier to start, also strengthening my glutes and hip flexors, and trying to even out my leg strength by doing one legged squats etc because my injured hamstring was on my much stronger dominant right side

happykat wrote:

Thanks. I'm never sure about digging into it. It seems to make it worse. I also have pain in my butt so it's possible it stems from piriformis syndrome.

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I thought it helped. I finally just had my wife work on it every damn day. I agree with the others advocating against stretching. Also I think I re-aggravated mine in the middle of that mess by biking once, so maybe use caution there. I did some eccentric strength work and backward running. It didn't hurt, and may also have helped. I did reverse curls with ankle weights for example. I would avoid squats until you are really on the mend. I did add them and continue to do them...body weight, a little more at times, but regularly now.

Mine would just get achy after a half mile and soon I'd feel like I had a piece of soggy fettuccine back there instead of a hamstring. I was basically carrying a useless leg on my run..Next day upper and mid HS would be sore. And I did not run through this, I tried at first but I barely ran for long periods, only testing it. I tried to "let it heal".

Toward the end, the soreness changed from bad to good if that makes sense. Day after a run it would be painful to massage but it felt strong, not weak. Thats when I knew it was finally over.

Summary..pound on it and carefully strengthen it. Then go slooow until you are sure it on the mend.

Not chronic and just level 1 but your case is interesting. I'm older than you and problems have been multiplying like rabbits. It's also so damned unpredictable, one day I went out with pretty bad pain in my hamstrings, ran hard and felt immensely better and it didn't come back.

Looks like you are on the right track. Fix your running form (maybe gait analysis), make sure muscle groups are even so there is no strain and to that I'd add a little more caution in adopting new regimens or while training. I tend to spread my effort over time more now, so as an example I'll try to start kicking with about 800 to go in a 5k instead of a wild sprint in the last 100. Body seems to like gradual progression, maybe we are like new cars and have to be treated with kid gloves when getting older.

Have your wife steadily push your bent leg (on your stomach) down while you moderately resist. Don’t battle each other, your ability to resist changes as the angle of flexion changes, and so should her pushing. Work each hamstring band this way (about 10 reps each way) - 1) the foot in line with the leg, 2) turned out, and 3) turned in. Rest the leg by alternating with the same exercises on the other leg.

You can do these three times a day, 3 sets with each band would be plenty.

After you get healed (within a week is possible), switch to maintenance 2-3 times per week, maybe only 2-3 sets.

DC Wonk wrote:

I had it for one year and was successful beating it by 1) careful massaging everyday; 2) stop static stretching and do slow warmup; 3) run on grass if you can and don’t do any significant hill running till it starts to feel almost normal.

My PT said piriformis is unlikely for most athletes, and tends to develop more in sedentary older people. At first I though I might had piriformis issue but it was HHT.

Good luck...

Thanks DC; the irony of part of your statement (the bit about running on grass) gives me a chuckle. I think the reaggravation occurred when I decided to take my shoes off and do barefoot intervals (90 seconds with 75 jogging recovery) on a local cricket/soccer oval. I reckon I overstride, too, but when I'm in the position to be able to run again I'll look actively into that.

DC Wonk wrote:

I had it for one year and was successful beating it by 1) careful massaging everyday; 2) stop static stretching and do slow warmup; 3) run on grass if you can and don’t do any significant hill running till it starts to feel almost normal.

My PT said piriformis is unlikely for most athletes, and tends to develop more in sedentary older people. At first I though I might had piriformis issue but it was HHT.

Good luck...

Thanks. never heard that about piriformis not being common in athletes. lots of runners seem to think they have it.

I haven’t had to deal will a full blown tear, but I’ve been able to rehab strains using much of the advice mentioned above.

1. Nordic drops. Plenty of videos online if you’re not familiar. If you don’t have a person to hold your ankles down, you can rig something up by hooking your heels under some furniture. You’ll likely want a yoga ball to ease the fall/drop eccentric part at first.

2. Glutes: strengthen with a variety of exercises. A specific one I recommend involves: use a yoga ball to get in a bridge position with the ball between your shoulders. Alternate twisting your torso side to side USING YOUR GLUTES. This helps you “activate” your glutes so you can “steer” with your hips. I recommend the Running Rewired book if you want to try diagnose and fix your form.

3. Once I’m back to running, I progress the rehab exercises. I do things like single-leg deadlifts while holding ~20lb dumbbells, back bridge hamstring curls using a yoga ball with the eccentric portion switching to a single leg, and single leg back bridge/pelvic thrust with my foot on a yoga ball.

Again, thanks for all your responses. I have a physiotherapist appointment on Thursday (next week) and their advice, along with the snippets of advice here, should keep me going whilst not running. Unless you're all bored s**tless by this, I'll post back with the outcome.

Cheers.

Roger Murdoch wrote:

Again, thanks for all your responses. I have a physiotherapist appointment on Thursday (next week) and their advice, along with the snippets of advice here, should keep me going whilst not running. Unless you're all bored s**tless by this, I'll post back with the outcome.

Cheers.

How did the appointment go? Anything we haven't heard before from the Physio?