Hi all,
Have had persistent hamstring hypothesitis ( adolescent equivelent of tendonitis) for the last 7 months and have seeked treatment on numerous occasions to no avail. X-rays reveal persistent hamstring apophysis but there is no evidence of chronic bone changes. I have tried improving flexibility, strengthening the hamstring/glutes with both an open close kenetic chain, 4 months rest and deep tissue therapy but have had no success. The pain originates at the right ischial tuberosity and the tendon is aggravated when foot is at full external rotation and is loaded. I am a chronic duck-footer during acceleration / maximum application and have found acceleration work to aggravate the injury. I suspect the injury could be a result of overuse due to an imbalance between the biceps femoris and the semi-ten/semi-mem rather than stress being placed on semi-fused apophysis’ on the ischial tuberosity as it has been explained to be.
Anyone on CF who can help me out?
Do you mean apophysitis? No one that I work with and I have never heard of hypothestis. The apophysis is where the tendon forms a junction with the bone, and aposhysitis is when the apophysis becomes irritated and inflammed.
Firebird, I understand hypothesitis to refer to tendonitis in adolescents. I am not qualified in this area and I must admit it would not be the first time I have become confused with terms.
Basically, growth plates on the ischial tuberosity are yet to completely fuse and this is leading to tendonitis. I have been informed of instances where this can lead to chronic bone changes however this is not the case in my situation. Apparantly the injury will clear once the growth plate is fully fused, however treatment + strengthening should produce a rapid recovery. No such luck.
Obviously dealing with the muscle imbalances is primary.
Also there are natural anti-inflamatory supplements that can help.
If you are competing soon or in future, CF has a system(s) of running routines that provide sprinting fitness while not overstressing the injury (personal consultation).
I havent done any track work since April, where the injury flared up after one session. But I have been playing weekly games of soccer for the last 6 weeks without any trouble. I did a light hurdles session of mostly drills last Tuesday, and finished with 6 x 100m @ 75% with walk back recovery. Did the session on grass and hamstring was fine. I’m starting training over the next couple of weeks with some more hurdling drills, and some light speed work. I plan on doing three weeks of intensive long sprint training beggining around the 18th June. We shall see how it holds up.
I must admit, I have had a number of experiences with physiotherapists and I have completely given up on them. Of the ones I have seen, all of them have been unexperienced, to proud to admit they can’t isolate a problem and obsessed with treating symtoms, rather than attempting to find a cause for a continuing injury. Unless the injury is textbook they become lost, and rather than admitting their confusion, they insist you entirely rest your whole body, ice the injury… and come back to see them. From my experience, they are over qualified masseuses, lost in a profession where they have to think for themselves, rather than recite figures from books, exactly how the majority of them got there.
As far as I know hypothesitis is not a scientific term, etimologically it has nothing to do with anatomy anyway.
Also, apophysis is a “structure”, thus “persistent hamstring apophysis” does not describe a pathological condition.
I would do MRI for the low back and see if there is a nerve compression somewhere along the lumbar spine.
Thanks for the input sprinter, what would your best guess be as to the origin of the problem? The pain is isolated to tendon of the upper hamstring, close to the bone ( ischial tuberosity). The first problem I had with the injury was shortly after running a 100, and the injury continued to be aggravated by anything involving maximum acceleration. It deteriorated over a period of 6 weeks to a point where I couldn’t run on it at all. The pain can be isolated when my right foot is rotated externally, and the hamstring is activated. Interestingly, when I accelerate my feet turn outwards, the right one more so than the left. I figure this is why accelerating aggravates the injury?
As stated before, I guess it’s a sciatic nerve compression at lumbar spine level. Do a MRI to confirm it.
Also, get a myofascial release treatment on your glutes and piriformis, that might alleviate the symptoms.
Thanks sprinter, your advice is greatly appreciated. I have made an appointment to get an MRI and will keep you posted. Would you mind expanding on what sciatic nerve compression is, and how it can affect the hamstring? I have extremely reduced spinal flexion in the lower part of the lumber spine - it doesn’t cause me any difficulties other than not being able to straight my back when im in the set position, could this be related in any way? Also what does myofascial release mean? - I have made a decision to visit a sports massuese fortnightly now that I am starting to train again, will she be able to perform this for me?
Thanks again.
As scheduled, did my first track session of the season today.
Started off with a long, active warm up - plenty of dynamic stretches.
Then,
- 4 x 200 @ <30s with 3 minutes, 2 minutes, 1 minutes recovery. ( Ran 29, 26, 28, 29)
- 15 Minute Recovery
- 4 x 40m @ 100% (standing start) with 1-2 minutes recovery
Low and behold the hamstring has pulled up fine! Calves are both sore, and stomach is a little worse for wear, but no problems what so ever with the hammys - I have a smile to my eyebrows. 
Will keep up the stretching and gym work however - don’t want to get complacent.
I will keep my progess updated in my training journal from now on. Thanks all for your contribution.