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High Hamstring Tendinopathy

renasrenas
in General Training Discussions

  Hi all,

I've been struggling with this injury for 4 months now. I did lots of PT sessions (ultrasound, tens, massage, stretches and strengthening), this sessions are helping but the pain are still there. I'm considering  PRP, but my doctor is reluctant and prefer to keep the more conservative treatment. It's working but is very slow and with lots of highs and lows.

I went to 2 doctors and 2 differents physiotherapists, and really don't know what to do.

Anyone here successfully healed this injury?

I'm from Brazil and will be in San Francisco and New York during the next couple of weeks maybe I could look for an doctor or a PT that really knows how to deal with this specific injury in US, anyone can help?

Thanks.

Comments

  • ghernandghernand

    hello Renato,

    how was your diagnosis determined?  was there any MRI imaging or simply physical exam?

    what was the incident that caused the injury 4 months ago?

    was there bruising at anytime?

    answer these questions when you can and maybe it will help me and others make some recommendations.

    DrGH

     

  • Leigh BoyleLeigh Boyle

    what kind of hands on treatment have you had?? massage and stuff like that?? or has all the treatment been you physically doing stuff like exercises?

  • renasrenas
    Hi Gilberto, I did a MRI in the beginning of October and was diagnosed with High Hamstring Tendinopathy associate with Peritendinitis.

    It was after 14 weeks of OS training and there was no specific incident during training sessions, at least none that I had noted.

    The trigger was a flight to Las Vegas in September, that I did right after this 14 weeks. I started to feel a pain in my right buttock, that was getting progressively worse during the 14hs flight. I tried to do some run in Vegas, but it was very very painful, so I took that week off.

    The return flight was only possible with ibopufren, and since the my hamstring/buttocks never been the same. At first I couldn't sit for more than 10 minutes without feeling the pain. I couldn't run, bike or kick on swim.

    When I came back from this one week trip, I went to a sports doctor, hip specialized, and he asked for a MRI, I got a diprospan shot and started the PT.

    Now I am better, it's not a problem to sit anymore and I can kick (easy) during the swim. I tried to resume biking and running sometimes, but the pain got worse when I did, so I just kept the swim sessions.


    Renato.
  • renasrenas
    Hi Leigh,

    The kind of hands on treatment are Massage, Trigger Point and some Myofascial Release.

    During the sessions I also do lots of light stretches and some light Pilates, the focus of this sessions is to do all the exercises without triggering the pain.
  • Leigh BoyleLeigh Boyle
    Did anyone ever use any tools on it?? (graston, astym, etc). Once you get to the tendinopathy part, the tendon itself has changed so to kick it you really need to get in there and dig at it. Usually while you are laying down at rest and then some more while moving the hammie to make sure the adhesions break up. If it was down lower in the muscle itself, then you could get away with regular massage and the like, but tendons like to stick and can be pretty stubborn.

    Ever hear of those down your way??
  • renasrenas

    Yes, but I am not sure if it is the same thing.

    My new physiotherapist uses the head of the ultrasound probe to do the massage, it's not  like a regular ultrasound session, it's more like a strong massage session. 

  • ghernandghernand

    thanks for the info, Renato.

    good that this was supported by an MRI, since there are other conditions that could produce such symptoms.

    here are my suggestions:

    -4months out and with your described gradual improvement is well within normal limits.  so, stick with the therapy and be disciplined about not doing too much too soon.  until this gets resolved, dedicate yourself to the rehabilitation, since it will take time.

    -try to avoid further steroid injections for now.  stick to the therapies that are designed to not illicit too much stressat the attachment of the tendon.  steroids can help acutely, but there is also risk of atrophy with repeated use or too high a dosage.  similarly, any needle in the region, even ultrasound guided has the potential to cause damage if not done correctly.  non-traditional injections of substances other than steroid have no molecular evidence for working, only empirical evidence.  therefore, in my opinion, better to wait until there are no further improvements.  4 months out is still too early in the recovery process.

    -surgery should be a final option and only after another MRI and even more complex imaging studies have confirmed that there are things that the surgery will help improve, like worsened tendon thickening or evidence of chronic damage to the surrounding tissues and blood supply, or in the worst case irritation to the sciatic nerve.  this being said, surgical results tend to be more beneficial than detrimental, so if it comes to this you have some positive evidence on your side.

    -perhaps the physiotherapists in the EN forum can comment on this, but I would even recommend an upper thigh compression stocking, like that of the austrailian company Compress Sport for Quad.  this would support the muscle of the hamstring and help relieve excessive strain on the tendon attachment both at rest and during minimal activities.

    I hope this helps for short term and long term planning of your recovery. 

    This is a tough injury to have since it takes so long to heal, but it's still early and you are improving, so you are doing great.

    Sincerely,

    DrGH

     

     

     

     

     

     

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  • Leigh BoyleLeigh Boyle
    nope this is different. it's tool assisted meaning it's usually a scary looking piece of plastic or metal. the two big groups are graston and ASTYM (both have websites if you google them). You can also check their sites to see who is in the areas you'll be traveling to state side. You could easily hook up with an A.R.T/graston chiro in most areas and get a few quality sessions for short money. image may even have some people in your neck of the woods!
  • renasrenas

      Leigh / DrGh,

    Thanks for the advices, I did some research and is kind of easy to  find the treatmens in SF and NY.

    I guess it's just a matter to have more patience.

    It's tough because this injury ruined my season, but I will just start from the scratch when I healed.

    Renato.

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