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Hamstring Tendinopothy

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  • CT Hamstring Tendinopothy

    A post collegiate sprinter who often writes insights at our bearpowered forum recently commented on his approach to a serious hamstring injury.

    I thought his comments were certainly worth sharing with members here. Some of his insights I think you will find interesting--like the "brain matters."

    "I started the thread last year as I was the one suffering from this annoying setback. I first noticed the aching pain in my butt in January of 2015, and it was only this fall that it finally seemed to be gone for good. The last year and a half has been more of a lesson in what not to do than what to do to recover from proximal hamstring tendinopathy. I'll share what I learned through trial-and-error. In the end it, the true answer might just be "it takes time," so my advice might end up being along the lines of how not to make matters worse.

    Quick background on my story. I hit all PRs in 2014 (7.06 and 22.42 indoor; 10.81 and 21.69 outdoor). I became a dad in the fall of 2014 and tried training at the same intensity as the year before. High Load + Lack of Sleep --> over-training. Everything blew up on me in the second indoor meet of the 2015 season. I still felt pain throughout the 2016 season with horrible times of 7.34 and 23.74 indoors followed by 11.29 and 22.86 outdoors. I called it a season early to focus on recovery. I ran a 7.16 a couple weeks ago in a preseason meet and am finally racing pain-free. It's been a long process, but I'm back within 1% of my best training times.

    I learned to cut out anything that created irritation to the area. The more I did something that elicited pain, the more the disability was reinforced in my motor patterns. I almost got to the point of feeling pain just thinking about contracting my posterior chain. Even when pain wasn't present, this resulted in some sort of neural inhibition. It was as if I had an internal governor stopping me from going beyond a certain speed. I eventually realized that I needed to teach my body and brain that it's ok to sprint again. To do so, a long progression of positive training experiences was necessary.

    What I Cut Out (most are contracting while hip is in flexion--especially when in a fatigued state)

    Running A's
    · Rowing
    · Tempo Running
    · Skips for Distance
    · Skips for Height
    · Hip Extension Machine
    · Hill Sprints
    · Falling Starts
    · Specific Rehabbing of Injured Area
    Contrary to a lot of the advice I received, I ended up abandoning a focused rehab protocol. I found that working the injured area specifically just created more irritation and led to disability reinforcement. Rather, I eventually settled on a general approach of getting stronger on the whole at manageable intensities. For the first time in many years, I actually ran intensive tempo to increase the body's and brain's exposure to progressively increasing intensities. I did this throughout the summer of 2016. Once the intensity got high enough, I transitioned back into a true speed / ext tempo split. But it took a while.

    My key takeaways were as follows:

    Treat the leg and body as a single unit. Don't spend too much time focusing on the actual injured area.

    · The brain matters! You have to avoid sending negative feedback to it when training. The more you run injured and with worry, the deeper the hole you'll dig for yourself.
    · The best rehab takes place in the environment of the end goal. I've never found a connection between some hamstring-specific strength exercise and sprint readiness. Do what you can on the track and lift in a general manner.
    · There may be something to training the healthy leg. The crossover effect appears to be a real thing. If you're set on specificity, start there to create a positive feedback loop with the brain ("contracting these muscles is ok").

    Some of my advice may contradict that of others. I, in no way, believe my words are the gospel. They're simply one set of empirical data.

  • #2
    I would add to this, stay in touch with training partners and do what you can. Members of the judo squads I worked with turned up to squad training with un united fractures, they were supported and encouraged and they gave support to team mates along with joining in any activity that was appropriate.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi


    • #3
      Nice insight, thanks for sharing.

      It will shock many that a mention of foam rolling, dry needling, manipulations, releasing structures....was absent I found it refreshing!


      • #4
        I read this a while back.
        I view this as a very sensible, reasoned out rehab program. I wish this was taught in schools and to some very experienced rehab professionals. Thats a biased approach as his story mimics what I do with athletes and non-athletes alike. Isolating irritated structures is a good way to irritate those structures.

        Self exploration, active coping, modifications, flexibly persisting, regression to the mean, time is your friend, trial and error. Looks good to me.

        For what its worth, his self treatment for proximal tendinopathy mimics what the researchers would recommend for proximal tendinopathy.
        "The views expressed here are my own and do not reflect the views of my employer."


        • #5
          I'll throw this out:

          Is this not a sensible rehabilitation approach?

          Why would anything else be required, necessary or covered by someone else's money (insurance)?
          "The views expressed here are my own and do not reflect the views of my employer."


          • #6

            The emphasis on time, self treatment and general strengthening makes sense to me too.

            No wonder you're dead. Of course, I appreciate that.

            The scene described by a trainer (now deceased) at The Ohio State University when I was there (many years ago) was of Woody Hayes running out to the field after a player was down and the trainer was attending to him:

            "Can he play?" Woody would ask.

            There's a lot in that question and the amount of time required for healing (an unknown) required that the trainer (or team physician) "handle" the coach, player, situation and several other things in a particular way. When many aspects of the player's complaint of pain were invisible imaging was enhanced. That has taught us a lot. Some of it good, some of it bad and some of it mysterious.

            Athletic trainers have a hard job. I would have lasted about five minutes in that position.

            What is offered is a rational and defensible way to treat pain arising from mechanical deformation of the nervous tissue supporting the leg.

            No wonder it is rejected by many who "know" something "better." This would include, of course, Woody Hayes.
            Last edited by Barrett Dorko; 29-12-2016, 07:22 PM.
            Barrett L. Dorko


            • #7
              Hi Josh!

              It will shock many that a mention of foam rolling, dry needling, manipulations, releasing structures....was absent I found it refreshing!
              I very much agree with this. But I'm sure there are many who would suggest he was delaying his return to competitive racing and risking a potential re-injury by not considering the protocols you've mentioned.

              Here are a few images from the time Pete raced here in Lisle at Benedictine University.
              Attached Files