Do you have any specific questions regarding therapy?
Interestingly, some of the papers you linked recommend the exact same treatment approach (eccentrics and stretching) you are critising. There is a lot of literature showing that for tendinopathy, which is NOT an inflammatory condition, some degree of discomfort can be tolerated during rehab as long as it doesn’t make things worse.
I agree, and stated numerous times, that you should NOT stimulate the area to the point where it hurts the next day. You should see what you can do without causing this kind of exacerbation. If something you do does cause increased pain the next day you back off and go back to what you have previously done that did not exacerbate things.
Load progression over time is vital to stimulate tendon healing. As you progress the load you may progress too quickly sometimes, and how you feel the next day will tell you that this was the case.
Therapy is a nice adjunct if you can afford it, but the gold standard rehab protocols for tendinopathy involve exercises you can do at home for free.
Interestingly stretching has been shown as a form of tests and NOT actual treatment especially in the first stages of the protocols. Also some paper have shown that what you called ([SIZE=2]eccentrics and stretching) which I am criticising led to no changes in patients and actually some of patients opted for surgery after 6-12months of traditional treatment. [/SIZE]
So to your (eccentrics and stretching) thank you but …
The first study you linked stated this:
“Abstract: High hamstring tendinopathy is an uncommon overuse injury seen in running athletes. Patients typically report deep buttock or thigh pain. A detailed physical examination and, occasionally, imaging studies are necessary to confirm the diagnosis. Rehabilitation involves soft-tissue mobilization, frequent stretching, and progressive eccentric hamstring strengthening and core stabilization exercises…” They used stretches in the early phases and then moved on to eccentrics.
The third study you linked also successfully used eccentric strengthening. For the actual tendon, stretching and eccentrics is basically the same: the tendon is being stretched which stimulates tenocytes.
The second study only used a very lacklustre exercise protocol for one of their control groups: three times per week for three weeks without much details as to what exactly was done. They wanted to show that shockwave therapy works, so using the most effective rehab protocol (ie. daily eccentrics and/or stretching for 12 weeks) as a control to compare to would not have helped their cause.
The last link is not a study at all. Its just a website that gives a definition of hamstring tendinopathy and suggests treatment protocols that are lagging behind what we now know about this condition by about two decades.
Hi Angela! As I read your comments and questions (along with those from others), I am starting to realize how nice it would be to have a coach. I need someone like James to ask me how I’m feeling today; I need someone like you to remind me to take care of the basic needs; and most importantly, I need someone to tell me when to stop! My practice times started to go the wrong direction during the second month of fatherhood. You’d think that this was a pretty clear sign that I needed rest and/or therapy. But what did I do? Try harder of course, only to injure myself a month later.
- A new baby! Congratulations are in order. You mentioned that as far as you knew nothing had changed. LOL. ( male perspective I guess . This is your acute event. Loss of sleep could be the single factor that changes everything and especially something that is under lying as James has pointed out.
Thank you! Being a dad truly is the best. As the track results deteriorated, I often said, “I’m still winning.” Yes, this was definitely a change. But while frustrating, it has been well worth it.
- It never hurts to have photos (MRI) but don’t wait on this. Get it if you can but move ahead now as there is lots you can do.
I am going to continue forward with the recommendations and guiding principles in this thread. The fact that I still raced at 95% of PB level makes me believe that I probably don’t have something requiring medical attention (e.g., surgery). If things aren’t getting better in 2-3 months, I’ll revisit this point.
- How is your water intake? What about your nutrition. If you can improve them do so NOW and if you don’t need improving good work but I bet you could benefit from a reminder on healing 101. Hydration and fuel are two things we tend to take for granted in our routines.
You are calling me out. With the lack of sleep came an increase in coffee consumption to the point of feeling worse after each subsequent cup. I wasn’t making a point of being well-hydrated. I’ve swapped tea for coffee over the last few months and am constantly filling my water bottle. As for nutrition, I aim to eat a large variety of quality foods, so I feel good there. I’m currently supplementing with beef gelatin, creatine, and ZMA.
- Tissue and tendons have compromised blood flow due to the density of the tissue. Any promotion of overall circulation benefits the entire organism. Training in the water accelerates circulation as you are promoting blood flow greater than normal as you are exercising without compression. Water heals.
I would absolutely love if I had regular access to a pool. I have a couple week-long vacations coming up over the next two months, where I will be able to be in a pool every day. Is there any benefit to being in a simple bath? Maybe performing manually therapy there?
- Tempo must continue as it’s circulatory, it helps vascularize muscle and tendons and it promotes overall recovery and mobility. Run in the pool or do laps with push ups and sit ups out of the pool alternation the same way you might out of the pool. Are you able to do bike?
Yes, I have access to a bike. I haven’t done a bike workout in years, so that would be a new stimulus for my body. How do you and others feel about tempo via running given my current state? Should I let pain be the guide here, as well? If I can run extensively and feel no pain the next day, all is well?
- Contrast baths heal and regenerate the nervous system. Soft tissue work and or acupuncture are amazing but choose what you can perform daily and at home for best results. Having a baby, life’s inevitable ups and downs are stressful even when they are good and more so when things go wrong. The nervous system must be in tact routinely for daily healing and repair.
I hate and love contrast showers. I need to make these a daily occurrence. I’ve recently begun to experiment with breathing exercises to promote the parasympathic response. Calm is good.
- You do not need volumes of exercises to replace speed. You do need to replace speed. Mock and or replicate drills or exercises in ways that mimic the exercise without creating pain. Use the guidelines you already have that are discussed but don’t stop thinking yourself as you are doing the feeling and your situation is unique to you.
I am going to roll with the James Smith drills progression and CLIMBON’s strength progression, while keeping intensities within tolerance.
What you are describing is perfectly normal and natural. Your inability to coach yourself is not abnormal. I know something about stressful events and how they impact the balance so as soon as I read your thread I knew this was a big part of your issue. Many people ignore and forget that body has to be looked after in more ways than just the training. We take the healing aspect for granted until something goes wrong and when it does go wrong we wonder why? It will get better but you do need to work much harder to stay where you are. It will take even more work to return to where you were. But it can happen.
I was looking at Marion’s Facebook page and was unable to find a way to contact her directly but on her page she said she was most blessed to have children. With all that she has gone through I am not surprised. Both Charlie and I felt that same way.
love this thread!
writing this with one hand, my 3 day old daughter in the other…and pain in my right hammy from overwork this season.
Is it possible to have proximal hamstring tendinopathy and have no pain doing drills like a skip, high knee, butt kick, and even alternate leg bounding, straight leg bounding and one leg bounding?
This happened after one meet where I ran with extremely bad posture having no frontside all backside. Felt it hours later, not immediately after. Never made me limp. No bruise or anything, which makes me doubt it’s a hamstring muscle strain.
No pain doing 1 leg glute bridge.
The site of discomfort is shown in the picture attached.
When running and aggravated, it feels like a dull ache, when I bend over like and Romanian Deadlift (hip hinge) it feels like extremely sore muscle.
Sometimes it is at site A, slightly below tendon, more medial, usually feels more like a sore muscle, sometimes it is at site B where it feels more like dull ache.
However, there’s pain when striding and sprinting. It is worst during a start. It is surprising since I would think bounding will involve more force and range of motion (though less frequency) than easy warmup strides…
Reverse plank and one leg reverse plank can be done, but it does bother me and I have hard time activating glutes (which I don’t have problem of during bridges)
I’m pretty confused as to what it is that I have and what I can do to minimize loss in fitness and maximize the rehabilitation…I don’t have time to just sit and be sedentary for weeks and months. Though I may need to start with no running initially, I must find things I can do that won’t aggravate the injury and things that will help strengthen and accelerate the recovery as soon as possible.
Tried a few methods to test it as I don’t have money for MRI. Done Puranen-Orava test, no pain, Bent knee stretch test was fine, slight discomfort with modified bent knee stretch test, where the knee is extended rapidly.
Though I’m starting to think this is unfortunately a unique form of tendinopathy, I’m hoping it is just a sort of spasm or minor adhesions or something that can be resolved soon with good therapy…
How long have you had these symptoms for?
It was since 3/11 so since a little less than 3 weeks ago.
Have you been getting therapy? How is your lower back? are your hips out of wack? WHen I hurt my back a few months back, once I was able to run again, my ham started to have a dull sore ache. I would have to keep it worm to sprint. But my hips and low back where way out of alignment. right side was higher than the other causing my left ham to be sore. Ive been going every two weeks for therapy and I feel much better. See if you can find a chiro that works with athletes or someone who does soft tissue manipulation
I will be getting a therapy tomorrow. My lower back feels fine, and don’t notice anything. Whenever I go in to my therapy session, my therapist tells me my hips are well aligned. However, that could have changed temporarily after that bad race from 3/11, as I now have a little more difficulty activating my glutes on left(bad) side since then (was good with glute activation before). My chiropractor does have more of specialty working with athletes with soft tissue manipulation. I’ve had no back injury in the past few years.
I’m really hoping this is not that tendinopathy and it is something that I can recover from soon, especially with the therapy.
How did therapy go?
What are you doing on your own?
Has the therapist given you things to do on your own?
What is the frequency you are seeing the therapist?
Let me know what the answers to this are before I make further suggestions.
I’ve been doing foam rolling, contrast showers, sauna, steam room, and jacuzzis on my own.
During my appointment, I was actually told that this is unlikely a hamstring tendinopathy based on manual tests, palpation, and my description of symptoms. He told me it was probably a mild nerve irritation either at the lower back or hips. I usually get therapy about once every 2-4 weeks but if conditions get really bad I may have to try to go in more often.
I was told that some stretching can help release tight muscles that can irritate the nerves and to avoid overexertion that can aggravate it.
Start micro stretching every night
Deal with nerve pain by elevating natural levels of B vitamins. Calves liver is number one by far in terms of how much B12 you get compared to the other foods second to liver it’s not even a contest.
You need to make sure you are training around the injury.
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bike workouts
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pool workouts
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have you started 1 x per week doing depletion push ups?
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likely you can warm up on bike, do drills with skipping or impact but walking drills the same way you would if there were a hamstring injury.
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stopping exercises is not usually a good idea but careful selection of eccentric exercises to manage careful training.
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its not what you are doing necessarily it’s how methodical you are doing things and how frequent.
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The question needs to be asked "Why has the nerve been aggregated? What did you do to cause it? The bigger priority aside from why is who cares just make sure you are doing anything, all things needed to overwhelm the system to heal.
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If you have not ever done yoga there is a good reason why this form of wellness activity has lasted thousands of years. Remember , reinvention of the wheel is not required. The best way to grow a tree was 20 years ago, the next best time is NOW.
Thank you for such a comprehensive guidance. I’ve done some pool and bike workouts throughout when I thought I had hamstring tendinopathy, and will probably have to depend on those for a little more. I need to focus on being more smooth with my movement and progressive smart while taking care of my health to promote recovery.
I’ve mentioned this to each person who is injured. Injuries can be an invitation to work on things you might not be working on when you are 100 percent healthy.
First question. Get as fit as you possibly can via bike and pool workouts. Go get what ever it is you can get and promote recovery on all fronts and over time you lose nothing and learn more and prevent yourself from doom and gloom attitude that often accompanies injuries.
Thank you. I will have to continue working on the recovery. I’m hoping that I don’t lose much as you said through continuous work on the fitness side of things.
I am in the middle of recovering from high hamstring tendonopothy and in the absence of running have taken to Hi Intensity bike sessions. 8 x 30 secs on a high level as hard as I can with 90 secs rest. This has taken me to a new fitness level that I would not have developed without being injured. So I agree with Ange, where you can get positives and take aways from an injury that can be used when returning to the track.