Help with Hamstring Tendonitis?

[arbo]

So I just got back from going over the results of my latest ultrasound, and it appears I have hamstring tendonitis.

 

I am concerned, as this injury has been nagging me for almost 2 years very severely,  yet after 2 mri's, ultrasound etc, it seems this is indeed the diagnnosis.

 

So now, the suggestion? Go to physical therapy. However,  I have went to physical therapy before and did not get the results I wanted. Sigh.

 

Wondering if Stretch Therapy has anything to say about this. Wondering if a ST approach can deal with this problem or help me somehow

[Dexter]

I had a similar hamstring issue which lasted for months stopping me from bending forward comfortably. Strengthening the hamstrings and also stretching it and surrounding structures fixed my issue. A trip to the physio also helped as he released some nasty trigger points along the sides of the quad. Piriformis stretching also seemed to directly help. I think the key is to continue working on what you can, and in time it will be gone.

I believe @Kit_L had a hamstring issue himself which he dealt for years which he mentioned at the workshop I attended and even on the forums here itself. He would be able to offer better advice .

 

[dannyg]

Due to the long timescale you're working with I'd imagine it's more 'Tendonosis' that 'Tendonitis'. More info here if interested: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/

(The article may be useful if you've suffered this long - Tendonitis shouldn't last more than 6 weeks really)

In the article there are points 1-8 about things that should help.

In my opinion number 5, which is 'apply ice' isn't useful at all unless the injury is at a very superficial level.

 

The best clinical evidence is to perform Eccentric Strengthening Exercises. They can be performed on a swiss ball or with resistance bands.

Currently there is big hype & research about Isometric strengthening which I use a lot with people. ( I can dig up some citations and research if you would like!) 

I'd image positions like a isometrically held single leg deadlift position: https://www.youtube.com/watch?v=34saz57cxjs (In which the end position is very similar to Kit's 'T-Pose') would be useful. 

And some of the positions for hamstring stretches, with longer held contractions might help. 

 

If you have any questions please ask - I'm sure some others might have varying viewpoints.

 

Also, this might be an interesting read: http://www.tendinopathyrehab.com/blog/tendinopathy-updates/just-load-it-guest-blog-by-erik-meira

 

Edit. I'm saying all this due to the fact that frequently 'Tendonosis' is frequently misdiagnosed as 'Tendonitis'. It's getting better than it was, but there are still many practitioners out there who aren't aware of the difference. With ST's approach of isometric contractions, it would be a really good method to encourage tendon repair.

[arbo]

On 9/27/2017 at 4:41 AM, dannyg said:

Due to the long timescale you're working with I'd imagine it's more 'Tendonosis' that 'Tendonitis'. More info here if interested: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/

(The article may be useful if you've suffered this long - Tendonitis shouldn't last more than 6 weeks really)

In the article there are points 1-8 about things that should help.

In my opinion number 5, which is 'apply ice' isn't useful at all unless the injury is at a very superficial level.

 

The best clinical evidence is to perform Eccentric Strengthening Exercises. They can be performed on a swiss ball or with resistance bands.

Currently there is big hype & research about Isometric strengthening which I use a lot with people. ( I can dig up some citations and research if you would like!) 

I'd image positions like a isometrically held single leg deadlift position: https://www.youtube.com/watch?v=34saz57cxjs (In which the end position is very similar to Kit's 'T-Pose') would be useful. 

And some of the positions for hamstring stretches, with longer held contractions might help. 

 

If you have any questions please ask - I'm sure some others might have varying viewpoints.

 

Also, this might be an interesting read: http://www.tendinopathyrehab.com/blog/tendinopathy-updates/just-load-it-guest-blog-by-erik-meira

 

Edit. I'm saying all this due to the fact that frequently 'Tendonosis' is frequently misdiagnosed as 'Tendonitis'. It's getting better than it was, but there are still many practitioners out there who aren't aware of the difference. With ST's approach of isometric contractions, it would be a really good method to encourage tendon repair.

This is very concerning. Tendonosis sounds a bit more serious than tendonitis. Thank you for the information! I'll read it and get back to you

[arbo]

On 9/27/2017 at 1:33 AM, Dexter said:

I had a similar hamstring issue which lasted for months stopping me from bending forward comfortably. Strengthening the hamstrings and also stretching it and surrounding structures fixed my issue. A trip to the physio also helped as he released some nasty trigger points along the sides of the quad. Piriformis stretching also seemed to directly help. I think the key is to continue working on what you can, and in time it will be gone.

I believe @Kit_L had a hamstring issue himself which he dealt for years which he mentioned at the workshop I attended and even on the forums here itself. He would be able to offer better advice .

I'm still unsure about how to go forward, strengthening or stretching. Seems like the consensus I've seen online suggests stretching. Sigh. Thanks for the input, a bit overwhelming of course because of all of the possible causes/treatments, but thank you for the feedback!

[dannyg]

14 hours ago, arbo said:

This is very concerning. Tendonosis sounds a bit more serious than tendonitis. Thank you for the information! I'll read it and get back to you

Actually, although it sounds more concerning - it is very manageable. Remember that the sensation of pain doesn't necessarily correlate with any 'damage'. Pain is part of you 'alarm system', it isn't the feeling of 'damage being done'. There are lots of discussions about it on the forum with links to pain research & pain science. 

 

Being concerned is normal, and it can be frustrating to face injuries. Your body is strong and adaptable. Pain does not equal damage. And carefully and mindfully exploring and working with discomfort can be helpful.

 

An exercise I use when incorporating mindfulness with chronic pain (part of the OsteoMAP project) is to explore the movements and sensations and notice the difference between the 'hard edge' of the pain (which is the actual pain) and the 'soft edge' - which is the anxiety, tension, fear, worry etc as you approach the hard edge. Noticing how much of your experience is 'soft edge' and how much is 'hard edge'. 

 

I advise reading/watching things in this thread: 

https://kitlaughlin.com/forums/index.php?/topic/1337-intriguing-research-on-the-perception-of-back-pain/&tab=comments#comment-16986

I can suggest lots of further reading if you want - 'Explain Pain' by David Butler and Lorimer Mosely is a good start to understanding what 'pain' might actually be.

 

[arbo]

On 10/5/2017 at 7:58 AM, dannyg said:

Actually, although it sounds more concerning - it is very manageable. Remember that the sensation of pain doesn't necessarily correlate with any 'damage'. Pain is part of you 'alarm system', it isn't the feeling of 'damage being done'. There are lots of discussions about it on the forum with links to pain research & pain science. 

 

Being concerned is normal, and it can be frustrating to face injuries. Your body is strong and adaptable. Pain does not equal damage. And carefully and mindfully exploring and working with discomfort can be helpful.

 

An exercise I use when incorporating mindfulness with chronic pain (part of the OsteoMAP project) is to explore the movements and sensations and notice the difference between the 'hard edge' of the pain (which is the actual pain) and the 'soft edge' - which is the anxiety, tension, fear, worry etc as you approach the hard edge. Noticing how much of your experience is 'soft edge' and how much is 'hard edge'. 

 

I advise reading/watching things in this thread: 

https://kitlaughlin.com/forums/index.php?/topic/1337-intriguing-research-on-the-perception-of-back-pain/&tab=comments#comment-16986

I can suggest lots of further reading if you want - 'Explain Pain' by David Butler and Lorimer Mosely is a good start to understanding what 'pain' might actually be.

 

Hi there Dannyg, thank you for the great post

 

So, I am curious about something here -- What is the different treatment for tendonosis vs tendonitis? Am I right in thinking that I need to sort of 'revive' the muscle by stimulating it with exercise/strengthening? I'm not sure if I should do a stretch or strengthen approach here basically(the issue btw is behind the knee, so I guess from what I've read online, it would be 'lower hamstring tendonitis -- or tendonisis)

 

I also know what you're talking about with the edge of pain. So, is it good to stay on the edge of pain or go 'all in' and get the sharp pain/the sensation of damage? 

 

[dannyg]

Just a note at the start. This is not 'advice', this is just my opinion. I do suggest, if you can, find a good physio or Medical practitioner who actually knows about tendonopathies. It is common for medical practitioners to not know the differences of different tendonopathies. 

Quote

 So, is it good to stay on the edge of pain or go 'all in' and get the sharp pain/the sensation of damage?

Please read the previous post and do research into this. 'Sensation of damage' is exactly what might NOT be occurring. Pain sensation is not linked to tissue damage levels. Please please read/watch. I know there is a lot of material in the other thread I linked to - but check out the videos.

http://www.bodyinmind.org/what-is-pain/

https://www.painscience.com/articles/pain-is-weird.php

 

 

 

- The '-itis' suffix describes inflammation. 

 

- The '-osis' suffix describes a chronic condition

 

- In this instance the '-osis' suffix could be thought to mean 'Collagen degeneration without inflammation'. 

 

- Usually it can be thought to be either tendon overuse or, most likely in this case, failed healing. 

 

- Vitamin C is needed to collage repair (among other things like vitamin E)

 

- Eccentric loading exercises (which means 'lengthening muscular contractions') are considered to be the best rehab at the moment

 

- There is promising research in isometric loading exercises

 

- Some stretching exercises can also be strengthening exercises. 

 

I'm on a time window right now so post is a bit lacking in detail. Might update later.

 

Hope that helps a little.

 

 

[arbo]

On 10/7/2017 at 9:11 PM, dannyg said:

Just a note at the start. This is not 'advice', this is just my opinion. I do suggest, if you can, find a good physio or Medical practitioner who actually knows about tendonopathies. It is common for medical practitioners to not know the differences of different tendonopathies. 

Please read the previous post and do research into this. 'Sensation of damage' is exactly what might NOT be occurring. Pain sensation is not linked to tissue damage levels. Please please read/watch. I know there is a lot of material in the other thread I linked to - but check out the videos.

http://www.bodyinmind.org/what-is-pain/

https://www.painscience.com/articles/pain-is-weird.php

 

 

 

- The '-itis' suffix describes inflammation. 

 

- The '-osis' suffix describes a chronic condition

 

- In this instance the '-osis' suffix could be thought to mean 'Collagen degeneration without inflammation'. 

 

- Usually it can be thought to be either tendon overuse or, most likely in this case, failed healing. 

 

- Vitamin C is needed to collage repair (among other things like vitamin E)

 

- Eccentric loading exercises (which means 'lengthening muscular contractions') are considered to be the best rehab at the moment

 

- There is promising research in isometric loading exercises

 

- Some stretching exercises can also be strengthening exercises. 

 

I'm on a time window right now so post is a bit lacking in detail. Might update later.

 

Hope that helps a little.

 

 

Helps very much! Since the PT sessions are pretty short, I'm trying to add a few exercises to my home PT and the eccentric loading information is a very good point. I once read an article about some eccentric hamstring movement that was supposed to limit hamstring tears, but don't think I have nowhere near the strength to do it unassisted(the 'Nordic Curl' I think it was called)

I guess some background for you and anyone else who's reading this thread and wants to help : I did PT earlier in the year and the problem did not resolve. The emphasis seemed to be on strengthening the quads and hips and stretching the hamstring. The PT place I went too was very 'third rate' compared to the PT that my mom experienced for her PCL tear and from the brief PT at this new place, so we're not even sure at this point if the PT was effective enough so I can say, "PT didn't work".

 

What I do recall is that stretching the hamstring provided some pain relief. Is it possible that my hamstring in my problem leg has become shortened? I guess in the back of my mind, my concern is that some of these problems are a response to an injury and really can't be fixed without treating the injury(surgically). However, only way to find out.... Is to throw everything non-surgical at the leg and see if it helps!

 

That's my approach now. Currently have a home PT session that consists of  the following exercises(feel free to add any exercises/stretches) (and note, my insurance allows me 12 PT sessions per year, any more requires an extension, so we are waiting for my insurance to grant an extension which they probably will this week, but until then I'm on my own)

 

Current Routine:

*Extend leg fully and rest heel on a folded up towel for 30 secs. Let leg fall into towel/try to let leg 'fall' into straight position. x4

 

*Extend leg and rest on folded towel. Press heel into bottom of towel, toward floor. Hold contraction for 3 seconds. x4

 

*Heel slides, sets of 12. x4

*Squats with Theraband around area above knee(bodyweight). x4 sets, reps vary between sets

 

*Clams with theraband around knees for glute medius

 

*Bird dogs, x4. Sets vary

*'Donkey kicks' or some exercise where I try to raise my leg behind me, kicking out, and activating my inner/top glute, feeling squeeze there. Exercise really hurts/stresses the injured lower hamstring

 

Feels like I'm missing something, or a lot. I'm trying to treat this like a meniscus injury or something. Doesn't feel like much work on the actual affected hamstring, but at this point I'm not sure if I need to try to fix lower body dysfunction and the 'other' issues and that somehow that will help the hamstring injury!

[dannyg]

Examples of Eccentric Strengthening for Hamstrings:

 

https://www.youtube.com/watch?v=AS9eqB_hZqo

https://www.youtube.com/watch?v=jVq7wFhaqyk

https://www.youtube.com/watch?v=0C9ACBt3Tqs&list=PLdEMNTv3EQU08os5Hs5-6hgMgSEg9pN0K

 

I know one is for 'high hamstring', but the movements are basically the same.

Using a bridging movement as an example: Use support/two legs for concentric portion and one leg for eccentric portion.

 

 'Loading' of tendonosis is essential to recovery. 

 

I urge you to read everything I've linked you to, and google things like 'hamstring tendonosis eccentric strengthening' or 'hamstring tendonopathy eccentric strengthening' or 'hamstring tendonopathy isometric strengthening'. Read 'explain pain', or find a copy online. 

I can't give you detailed advice or a program to follow as it is essential you take agency and have the courage to use your body (slowly, and with mindfulness) and explore movements. If you were my patient/client I would say find one or two exercises that you can do for your hamstrings, and do up to 10 repetitions, 3 sets every day. (up to 10 reps, not 'must do 10').

 

I'm unsure the rationale for all of the exercises they are making you do. Gluteal exercises and band squats are useful, but don't seem to match your diagnosis (well, my diagnosis). Can you ask about tendonosis/tendonopathy, and if they have a different plan for that? If they aren't loading the muscle, they aren't doing much to help it in my opinion .

I also don't believe (unless you have something like muscular dystrophy) that you're muscles are 'shortened'.

 

Kit has written about the 'apprehension reflex' and in the thread I linked you to (again, https://kitlaughlin.com/forums/index.php?/topic/1337-intriguing-research-on-the-perception-of-back-pain/&tab=comments#comment-16986) there are some videos exploring perceptions of pain.

 

I think of pain like an alarm system or fire alarm. If you're cooking something, you're kitchen doesn't have to be on fire for you alarm to go off. In fact, in my old flat in London - the fire alarm went off if I cooked anything in a frying pan. There was no fire! But the alarm wouldn't stop going off. The problem is, when all we hear is the alarm (pain) we assume there is fire (damage). If we are patient and are willing to put up with the alarm, and explore what is going on, we might find there is no fire (damage). Just a very sensitive alarm. I hope that makes sense.

 

It is okay to explore and use your leg. Your body is not falling apart. It is strong and adaptable. Your alarm system is likely very sensitive, approaching movements and exploring the leg with a sense of curiosity and non-judgement. Don't listen to your internal narrative about 'tendon injury' or worries about the future, in your head. Take a few minutes and allow yourself to experience without any preconceived notions. 

Edited October 11, 2017 by dannyg
Spelling

[Tones]

Tackle inflammation (good diet, quality water, quality sleep and QUALITY supplementation.. Thorne/Animal and Usana are the only decent brands in Australia), then get behind the route of the issue, retain the body.

Easiest way to find a good physio is to go to an osteo (haha) or find a physio that works with a lot of sport teams/clubs.

The video is a simple exercise that cuts through a lot of the bull plop out there. Massages the hammies, activates the core and hip, decompresses the spine, strengthens posture muscles.

 

[arbo]

On 10/10/2017 at 11:32 PM, dannyg said:

Examples of Eccentric Strengthening for Hamstrings:

 

https://www.youtube.com/watch?v=AS9eqB_hZqo

https://www.youtube.com/watch?v=jVq7wFhaqyk

https://www.youtube.com/watch?v=0C9ACBt3Tqs&list=PLdEMNTv3EQU08os5Hs5-6hgMgSEg9pN0K

 

I know one is for 'high hamstring', but the movements are basically the same.

Using a bridging movement as an example: Use support/two legs for concentric portion and one leg for eccentric portion.

 

 'Loading' of tendonosis is essential to recovery. 

 

I urge you to read everything I've linked you to, and google things like 'hamstring tendonosis eccentric strengthening' or 'hamstring tendonopathy eccentric strengthening' or 'hamstring tendonopathy isometric strengthening'. Read 'explain pain', or find a copy online. 

I can't give you detailed advice or a program to follow as it is essential you take agency and have the courage to use your body (slowly, and with mindfulness) and explore movements. If you were my patient/client I would say find one or two exercises that you can do for your hamstrings, and do up to 10 repetitions, 3 sets every day. (up to 10 reps, not 'must do 10').

 

I'm unsure the rationale for all of the exercises they are making you do. Gluteal exercises and band squats are useful, but don't seem to match your diagnosis (well, my diagnosis). Can you ask about tendonosis/tendonopathy, and if they have a different plan for that? If they aren't loading the muscle, they aren't doing much to help it in my opinion .

I also don't believe (unless you have something like muscular dystrophy) that you're muscles are 'shortened'.

 

Kit has written about the 'apprehension reflex' and in the thread I linked you to (again, https://kitlaughlin.com/forums/index.php?/topic/1337-intriguing-research-on-the-perception-of-back-pain/&tab=comments#comment-16986) there are some videos exploring perceptions of pain.

 

I think of pain like an alarm system or fire alarm. If you're cooking something, you're kitchen doesn't have to be on fire for you alarm to go off. In fact, in my old flat in London - the fire alarm went off if I cooked anything in a frying pan. There was no fire! But the alarm wouldn't stop going off. The problem is, when all we hear is the alarm (pain) we assume there is fire (damage). If we are patient and are willing to put up with the alarm, and explore what is going on, we might find there is no fire (damage). Just a very sensitive alarm. I hope that makes sense.

 

It is okay to explore and use your leg. Your body is not falling apart. It is strong and adaptable. Your alarm system is likely very sensitive, approaching movements and exploring the leg with a sense of curiosity and non-judgement. Don't listen to your internal narrative about 'tendon injury' or worries about the future, in your head. Take a few minutes and allow yourself to experience without any preconceived notions. 

Hi there Danny, just wanted to update you and the people in the thread about my progress so far

 

So, I have ordered a theraband door jam to do one of the eccentric hamstring exercises. I have a DB, so I can do the single leg DB one -- and I need to order a large exercise ball today, then I should have access to three of those eccentric exercises(so far have only been doing the one with the band)

 

So loading the muscle is essential for recovery from tendinosis. Hm. I guess I can proceed forward as if this is a low hamstring tendinopathy problem, and then see if the problem resolves! The orthopedic is cool with me waiting a month to try more PT, then it's gonna be injection time(though I'll fight for a new diagnosis if I feel that this isn't a hamstring tendon problem only...)

 

In the back of my mind is some notion that other lower body problems are contributing to the tendon problem. I could be wrong. But my lower body is a bit of a mess since this injury. Very tight HF's, weak and inactive glutes, etc. Wish me luck!

 

And thanks for the info! Within the next month I should be able to figure out if the hamstring tendonpathy protocol works

[dannyg]

Hello! I was wondering how you are getting on with your Hamstrings? 

I saw this video and thought you might find it insightful: https://www.facebook.com/RethinkingPhysiotherapy/videos/1737383212958914/?hc_ref=ARTo5-dipylIOiAayXQJ4Cl6theQq7P5_sqWHj5SUWTPEsuhIGqUUG6tTNX4HZ0Knbo

 

 

D

 

[arbo]

On 12/17/2017 at 9:10 PM, dannyg said:

Hello! I was wondering how you are getting on with your Hamstrings? 

I saw this video and thought you might find it insightful: https://www.facebook.com/RethinkingPhysiotherapy/videos/1737383212958914/?hc_ref=ARTo5-dipylIOiAayXQJ4Cl6theQq7P5_sqWHj5SUWTPEsuhIGqUUG6tTNX4HZ0Knbo

 

 

D

 

Hey D, good lecture there. Watched it, got the take away that therapists should seek to improve function over all -- treating pain is not enough, and restoring the old structure is not possible

 

The update on my situation:I just got back from seeing an ortho this morning who ordered a new MRI. He's talking steroid injections if it's still a hamstring problem. I myself am leaning towards some kind of ligament issue just because the pain is quite severe and even after doing a very gentle rehab program, I still can't get the leg to begin to get the leg straight repeatedly with no pain

 

There's probably some other problem going on and the hamstring tendonitis is just... a minor accompaniment? 

 

I will say this though... Today, the ortho when evaluating my knee said that my IT band is EXTREMELY tight. Does this mean tight hip flexors? I ask because one protocol for treating hamstring tendonitis involved fixing any pelvic tilt as they thought that(I'm guessing anterior?) pelvic tilt increased the strain on the hamstrings? 

 

Also, one reason why I'm not sure if it's tendinosis, is because the presence of swelling in the knee. Tendinosis(sp?) is associated with no swelling, from what I've seen. So if I have inflamed hamstrings, then... well, I think it literally is hamstring tendonitis(inflamed hamstring tendon)?

 

Last thing -- I'm having a problem here btw. To rehab the tissue, it seems loading is necessary, yes? Well, to load the hamstrings, I have about 3-4 options from what I've seen, yet each one tends to induce pain. IE, bridges on the ground, if I lock out my knee at the top -- pain(and the pain isn't 'healthy' pain, it's the pain that gets worse and feels like 'danger zone' if I do this for 3-4 days and ignore the pain)

 

Single leg deadlifts -- Something I thought I invented, just doing the bar, yet learned that Kit used these in his own rehab of a hamstring issue. I guess mine aren't Romanian though, because I'm doing mostly a regular deadlift though on one leg

 

Hamstring curls with physio ball - Pain. Bad pain. Feels like somethings gonna break when doing this

 

Glute bridges from floor -- This, I can't get a full lockout. I'm like completing the movement 90% but not locking my hips. Like my uninjured leg, I can kind of thrust up until I'm in a locked position, with my injured leg, can't do this. So I can do like 80% ROM of these and experience little pain, but cannot bring the movement to completion

 

Hip thrust on coach -- using Bret Conteras bodyweight hip thrust on my couch with cushions pulled off. Again, leg locking problem, can't really get the complete ROM

 

This all brings up the fear that as I rehab, I'm basically doing poor ROM and not loading the injured hamstring(specifically the lower area behind the knee). To avoid pain/injury, I'm going to do all the movements in an altered fashion, recruiting different muscles and not completing the movements(if I do complete it, it hurts and feels numb/tingling and kind of stretched, like it doesn't feel good and strong and healthy)

 

Basically, all I do either results in either immediate  pain -- dull pain if I don't straighten the leg fully, if I do partial ROM, and sharp pain if I complete it with normal ROM -- and delayed pain. The delayed pain, if it feels like a vague aching, I'm cool with. I've learned from reading about this not to freak out about it, and that rehab of the leg I may have some soreness. However, if the pain is sharp, then I can't help but think that's time to avoid it. To use your phrase, I am comfortable going to the edge of pain. Walking for rehab, I believe I noticed this, just a dull ache, was fine with it. Sharp pain, it seems to me it's my brain saying damage/you're worsening the problem(esp if it lasts a long time)

 

Which brings up one other point -- I can walk with this injury. If I walk, and do no other activity, I can basically walk and manage the pain. This gets me some exercise and gives me a bit of extra energy. But, here's my question : Should I? When I'm walking, I know that I have mastered some kind of gait pattern that is taking the strain off of the lower hamstring. Maybe walking with a bent leg? Maybe using some kind of back muscles and glute medius more? I think this is true, because as I walk for a long period of time, I can feel kind of the form change and then the hamstring starts getting 'hit' in some way. It's almost as if I'm walking and protecting my injured body part, but if I go for 30 minutes or more, the body can't maintain the weird form and the leg starts falling more naturally underneath me, the hips are looser and the injured area starts receiving more force, with accompanying pain

 

Anyhow, any thoughts? Any criticisms? Any insults?(jk) -- But really, what do you recommend I do here? 

 

 

[Florian]

Hello.

I feel with you. I don't have any good idea how to help you with this, but just concerning your problem of "it seems loading is necessary" but the ways you know to do that aren't possible in your situation. Have you tried just to sit on the floor? Can you straighten your legs in this position? Maybe you could try to load your hamstrings for example in a pancake position, which should be possible in a very safe and controlled manner. It is possible to do this with the legs bent too if necessary.

Another idea are shoulder bridges. You talk about glute bridges, where your legs are bent and you try to extend the hip. The same is possible with the legs straight (the hip extension then is not as far "away" as with bent legs). You can put your arms at your side and help a bit with the movement. And you could experiment with this, without to actually lift yourself up. Instead of pushing so hard that your butt comes off the ground, you could try just to assume a posterior pelvic tilt on the floor (then you have your hip extension already) and push a bit with your heels into the ground. So you can start with very gentle force on your heels and control the amount of strength you use. If you want to load them, you don't need to actually perform any specific movement, just to load them a little bit according to your actual possibilities without experiencing (much) pain. You can try to sit on a chair with your feet firm on the ground and push your heels a bit backwards into the ground. You can lie on your belly, bent your leg to 90°, then raise your knee off the ground or just experiment whether you can do a contraction in this direction. Have you tried to do something with resistant bands?

[ edit: Just saw that you already do resistant band stuff. Sorry, I haven't read everything yet; I will read everything later. ]

And what is with unloaded movements? Can you do them? You can promote blood flow by this too. What do others think on that? I don't know, if there is much pain involved by completely unloaded motions, it is a good idea to load it yet?

Other than that, concerning the IT-Band. I am just curious. Have you tried to work on this? I would be interested in your feet (is there a pronation or something?), in the way you walk, the external and internal rotation of your hip on both sides and differences there and your hip flexors. There could be so much things involved in your hamstring problem. Therefore, maybe find a good Osteopath? If they are good, they really look at everything in context, which problem could possibly cause another etc.

I hope you get well soon. Would like to hear how its going.

[arbo]

1 hour ago, Florian said:

Hello.

I feel with you. I don't have any good idea how to help you with this, but just concerning your problem of "it seems loading is necessary" but the ways you know to do that aren't possible in your situation. Have you tried just to sit on the floor? Can you straighten your legs in this position? Maybe you could try to load your hamstrings for example in a pancake position, which should be possible in a very safe and controlled manner. It is possible to do this with the legs bent too if necessary.

Another idea are shoulder bridges. You talk about glute bridges, where your legs are bent and you try to extend the hip. The same is possible with the legs straight (the hip extension then is not as far "away" as with bent legs). You can put your arms at your side and help a bit with the movement. And you could experiment with this, without to actually lift yourself up. Instead of pushing so hard that your butt comes off the ground, you could try just to assume a posterior pelvic tilt on the floor (then you have your hip extension already) and push a bit with your heels into the ground. So you can start with very gentle force on your heels and control the amount of strength you use. If you want to load them, you don't need to actually perform any specific movement, just to load them a little bit according to your actual possibilities without experiencing (much) pain. You can try to sit on a chair with your feet firm on the ground and push your heels a bit backwards into the ground. You can lie on your belly, bent your leg to 90°, then raise your knee off the ground or just experiment whether you can do a contraction in this direction. Have you tried to do something with resistant bands?

[ edit: Just saw that you already do resistant band stuff. Sorry, I haven't read everything yet; I will read everything later. ]

And what is with unloaded movements? Can you do them? You can promote blood flow by this too. What do others think on that? I don't know, if there is much pain involved by completely unloaded motions, it is a good idea to load it yet?

Other than that, concerning the IT-Band. I am just curious. Have you tried to work on this? I would be interested in your feet (is there a pronation or something?), in the way you walk, the external and internal rotation of your hip on both sides and differences there and your hip flexors. There could be so much things involved in your hamstring problem. Therefore, maybe find a good Osteopath? If they are good, they really look at everything in context, which problem could possibly cause another etc.

I hope you get well soon. Would like to hear how its going.

Well, I guess here is my concern... My upper hamstring is fine, most of the hamstring is fine.. There's a small area behind the knee, that is the problem area

 

So that means I could do some gentle loading and what not, and continue doing partial ROM exercises like it seems you're suggesting -- With the bridge on the floor you mention -- But, I worry that this will not actually be addressing the problem area. So I wonder:

a) If I do partial ROM, I'm not really hitting the behind the knee hamstring area(lower hamstring), yet could somhow I do this enough that I gently, gently ease into full ROM eventually? I don't think so, because the strength in the hamstring is so low that even just completing a single leg deadlift maneuver with no weight, seems to put a strain on the injured muscle

 

If I do full ROM, what happens? Pain, that worsens.

 

Anyhow, on the IT band, how would you suggest fixing it? I know that the hips are very, very tight, though I often wonder if this is a type of protection measure to stop my leg from fully extending. Like either it's contributing to the injury or it's actually my body trying to adapt so I can walk with a bent leg

[dannyg]

11 hours ago, arbo said:

Well, I guess here is my concern... My upper hamstring is fine, most of the hamstring is fine.. There's a small area behind the knee, that is the problem area

 

I worry you might be falling into a reductive trap. I can't really offer any clinical advice over the internet, but I can give you ideas so you might better look at your problem. 

 

The problem seems to be reduction in function. Muscle and joints work together - and I'd suggest rather than focussing on 'the bit behind your knee', focus on improving knee and hip function.

 

I'd also suggest also improving gluteal strength and foot strength - if training the hamstring directly is too uncomfortable. 

Pain behind the knee can also be Popliteus though, not necessarily hamstring. Especially is straightening the leg is an issue! 

 

Ligament problems would more likely make your leg unstable not really restrict movement so much. 

 

Swelling could indicate something like a bakers cyst or effusion. Or perhaps bursitis or something similar. 

 

Perhaps have a read about popliteus function and see if it matches your symptoms.

 

 

[MattS]

Hi mate,

You've been diagnosed with hamstring tendinopathy?  I suggest you check out Prof Jill Cook of La Trobe Uni and her work on tendinopathies. This should get you going: http://semrc.blogs.latrobe.edu.au/10-things-not-to-do-if-you-have-lower-limb-tendon-pain/

I can't speak for the hamstring as I have patellar tendinopathy, but I can offer some general advice on it as both my patellar tendons are injured - I am simply regurgitating what Jill Cook has put forward and what has assisted me from being unable to walk without pain to sprinting (i'm still rehabbing the injury btw. it's a long process)

Tendon rehab is 1. load through the tendon and 2. speed of loading - in that order. At some point in time the load you put through your tendon surpassed it's capacity. As such, you'll need to rebuild that capacity by progressively overloading it and using your pain feedback immediately post workout and the next morning. If there's no pain, increase the intensity of the movement. Try and load it every day in some way or another, whether it just be isometrics - resting is the worst you can do for tendinopathies.

1. The tendon needs to be loaded directly, starting with isometrics, progressing to isotonics and then progressing to plyos/energy storage movements (sport specific training)

2. Speed of loading comes in close second. Keep it as slow and controlled as possible, but don't sacrifice load in favour of speed.

3. Strengthen the surrounding muscles to take away as much of the load as possible from the tendon.

Note that strengthening the surrounding muscles is different to loading the tendon (for instance, for my patellar tendon, a barbell back squat will load the musculature and tendon, whereas the first 1/4 of a leg ext will favour the tendon only). You might want to also address any biomechanical issues which contributed to the initial inflammation? Also, work to discomfort, but not pain. 3/10 on the pain scale appears to be the maximum in most of the current research.

I'll give you an example of my patellar tendinopathy rehab over the last few months and hopefully it can assist you in developing your own plan for your hamstrings:
- daily wall sits for 45 seconds. I had to do these for about 2 weeks until my tendon adapted to the loads and I could do these pain free. I started with one minor painful set and built up to 5 pain free sets twice a day. Once I was pain free (minor discomfort during loading is acceptable) I progressed to isotonic movements
- bulgarian split squats. Starting with bodyweight and progressing the reps and sets daily (based on my pain feedback during/post/next morning)
- moved on to barbell box squats, starting with the bar and progressing up to 120kg for reps. at the same time I was doing bodyweight loading (split squats, lunges etc) as often as possible.
- full barbell squats (front/back)
- moved on to plyometrics, and that's where I am now. Jumping, sprinting, acceleration, deceleration, changing direction etc.
- next step for me is return to sport - however, i have biomechanical issues which need working out, so this will be a lot longer than normal

Eventually you'll be able to judge what is negative discomfort and positive discomfort during your workout. You can 'tell' if you have pushed it too far, and if that's the case, regress the weight and overload slower. I've jumped the gun on 3 separate occasions and progressed too quickly and woken up with fire in my tendons (foolish mistake wanting to return to sport too quickly). Once the pain subsides and my ego deflates, I continue where I left off.

If you have tendinopathy, it's slow and frustrating process, but it's relatively simple: if it hurts, back off. if it doesn't hurt, do more.

[Kit_L]

https://kitlaughlin.com/forums/index.php?/topic/1408-getting-over-hamstring-injuries-tear-pull-strain-weakness/&tab=comments#comment-18062

Sorry to quote myself here, but this is the succinct version.