High hamstring tendinopthy
I injured my right upper hamstring in late April and (very stupidly) kept running on it because I had a 1/2 IM in June and a full IM in August. Finally got an MRI a few weeks ago and the good news was no tear in the hamstring or labrum but I have this inflammation where the hamstring attaches to the pelvis. It apparently can take a long time to recover (maybe several months) mostly because of poor blood flow there. I was wondering if anyone had experience with this, treatments, recovery etc. I'm having shock wave treatments now to break up adhesions and increase blood flow.
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Safe trip Al, thanks!!
Turby, I have the same struggle. I trigger it with high intensity exercise, which means I really have to pay attention with the coming OS. "Rest", which for me means a couple weeks off, has not helped one bit. I've tried massage therapy, chiropractic treatment, estim, PT exercises (clams, bridges, etc.) and dry needling. Combine the high ham pain with an occasional tight IT band and you have one nasty combination for running. It seems to never completely go away. But, for me, dry needling with electric current was the key. It's a little uncomfortable, but I've felt worse and look forward to it now just to be able to run "pain free." I'm not sure if it got the blood flow there or loosened up the remainder of the ham to take some tension off the attachment. But, it gets me through my needed training and racing until the next time it flares up. I suspect my hamstring is compensating for another weak muscle, but until I find time for strength training in addition to all the other training, I may not know for sure.
Yep, this is a bad one guys! I would take 2-3 weeks off from running then jog 3-4 miles at 10 min pace or slower and it would be there just as bad! Rob, I remember you were fighting a ham injury forever, didn't realize it was this. I'm switching mental gears to being a swimmer/cyclist till further notice. ZERO running! Also going to get started with the PT/strength this week. Thanks for your help guys!
Turby, I'm going to share my own experience with this over the past 14 months, not to tell anyone what to do, but to document what worked for me, and maybe provide some ideas.
Last year, starting back into training for Kona after Lake Placid, after my first set of TP run intervals, I developed pain on the right side, lower part of my butt, worst when I pressed in under the glute max muscle near the greater trochanter of the femur. Besides the pain, the other key symptom to me was pain when I would "paw" at the ground with the ball of my foot - that became important, as I used that sign (the disappearance of it) to help guide me back to running again. Since I wasn't going to skip Kona unless I literally fell apart, I looked for ways to train through it. On the training side, I stopped doing speed/interval/high intensity work, and long runs, for a month. All of my running began to be at a faster cadence than previous, with shorter stride length. During August, I was running 5 days a week, 4-6 miles mostly, with a 9 mile and 10 mile run, all @ TRP. In September, I tried two attempt at "TP Intervals", but ended up managing more like a half marathon pace for 2 x 1 mile. I dropped to 3 x/ week, with two runs of two hours. While my pain never went away - it hurt every step I ran - it also was not getting worse, so I trudged on.
The exercise program I developed during this time was focused on improving lower core strength and flexibility, with an eye towards long-term prevention as well as short term recovery. I played with several different exercise programs, but this is where I ended up, based on what I felt comfortable doings and what I felt was working. Stretching included the Yoga "good morning" pose, standard hamstring stretches, and holding my knee up to my chest while standing. Core work included crunches with my knees up, arms crossed on chest; front plank x 90 seconds; pelvic bridge static x 90 seconds; and pelvic thrusts (slow, emphasizing gluteal contraction) x 30. I did 30 side leg lifts, 30 clam shells, and 30 "reverse clams" (lying on the side, lower leg with knee bent, upper knee stationary close to lower knee, and rotating the upper leg so the foot went up and down). All of these were focused on feeling effort and strength in the hip flexors and small and large muscles of the gluteal area. In addition, I did side leg thrusts, front leg thrusts, and single leg knee bends, aimed at patellar stability. I tried to do these every day, usually managed 5 per week. One thing I should note is that for some stupid reason I had stopped doing most weight room and core work for about a year. Since I'd never really gotten any significant training injuries, I thought I must be immune, and stopped following my own advice to OFs to not give up on weight work, ever. So I decided maybe a part of the recovery should be a return to better strength, emphasis on helping the poor hamstring do its work.
While I was able to finish Kona, I only ran about 13 miles total, due to the pain. Since I had hernia surgery scheduled three weeks later, I shut down my running from that point forward, continuing with weight lifting (leg presses, seated quad lifts, no hamstring work) and the above stretching and core work. I had the surgery, & thus enforced rest from running. I started back up running after two months after Kona. In Dec, I ran 15 times/45 mi; Jan, 15 x/65 miles; Feb 11x/55 miles, working up to max 7 miles. Then, Feb 27, I broke my R great toe, and stopped running until May 10th, By the time I started back up, I was totally pain free, but very slow.
I did a standard IM build up from May 10-Oct 1 of 20 weeks, and while I got no faster (like 30 seconds per mile slower than before the injury), I remained pain free, which was my major goal. i did IM MD (at a very slow, but persistent 10-11 min/mile), 10 days later, I tried an interval treadmill set which went OK, and two days later tried an 80 minute treadmill progressive run. (It literally rained non-stop for seven days, which is why I was on the treadmill.) That was Sunday; on Monday, my left hamstring hurt worse than the right ever did the year before - the injury before Kona had been on the right. That scared me almost out of my mind, since I had my A race for the year coming up on Nov 13th. Like Kona, I was going to do that event unless I was in the hospital or a cast. So I took two days totally off from running, but kept up with my stretching and core work. then gingerly tried to go back to running. It hurt, but I persisted. Within a week, I was able to do some interval work, and managed three "long" (for HIM training) runs at reasonable pace. By race day, pain was not on the radar screen.
I had a respectable run in terms of HR, but my pace was a minute/mile slower than I anticipated. Probably a combination of the temps being 85F (this was Miami), and my training being inadequate. Two days after the race, I remain pain free.
So my personal conclusions:
@ Al, first, big congratulations on your 4th place in Miami!! Well done, you still got it baby!! The common thread seems to be that we older people all seem to quit the strength/ flexibility part and there are consequences. I'm doing yoga twice per week, am back to strength work, and am going for some PT to get more ideas. I'm also in the "shut it down for several months in the off season" camp. Thanks to all for your help!
2013 was my first IM year and did WI, month later a half, and month later a stand alone marathon. Felt great and excelled in all 3. Shortly after that however I started to get pain in the upper hamstring...it felt like where the led connects to the leg...and very deep inside. After seeing many doctors and several MRI, concluded it was a tear in the tendon, due to overuse. I think I just did to much at the end of 2013 and it didn't like it.
2014 I really tried to train. It had to give up on my race and decided not to even start. My recommendation To you is make sure you take a "good" amount of time for it to recover. I kept trying to come back...and it always failed on me.
Focus on other things...I became a very good swimmer that winter, and PRd my swim the following year so there are upsides to not "having to" run.
In terms of therapy....I did ART, PT, shock wave, PRP. In the end , the only thing I actually think made a difference is many sessions of PRP. I had a fantastic dr which makes a difference. The first one was just poking around and don't think it helped. The second was fantastic.
I would also agree with Al that core and strength is super critical. I personally hate doing these things but it's if you target that area and get surrounding muscles strong it will help. It's a big deal to ensure you are NOT using your hamstring for power...you are using glutes. I did a lot of eccentric exercises, one of which I think helped was to kneel on your knees, feet or ankles fixed under something and lean forward as far as you can go (not causing pain), and the lean back. You keep body straight from knee to head, i.e. Not bending at the waist. I found this to really target the area and when I am having any twinges now, I go back to them.
One dr opinion I got was surgery...he said I would not race at 100% with the state I was in. I try to avoid surgery if at all possible so went over the top on rest at the time, PRP, and exercises. I don't do the exercises as much as I should now but after a successful IM last September and MT with you this year, I am happy to say I don't think that surgery is required.
I will say that I think this thing is with me for the long term. I still have problems today and just know to listen to my body. I am very careful on training and try to keep up with exercises.
I guess if we were couch potatoes this wouldn't be a problem...but then again we would have other issues far worse to contend with!
Hope it helps and let us know how you progress.
Thanks Dawn! Yup it's swim/bike/strength for me until this gets better. That glute/ ham raise you mention is a great one to target the area. I'm glad to hear yours is kind of staying away but as you say I think this is one that is always lurking! Hope you guys are great!