I wanted to write a post about my hamstring tendinopathy experience.
This might be fully pre-empting things but I feel somewhat confident I can write this post and that I’m mostly out of the woods).
The affected area was the top of my hamstring, right below my bum cheek. It wasn’t sharp or stabbing pain, more like a throbbing, dull ache. At the beginning I could feel this while walking, while lying down and especially when sitting. Sometimes I would feel an ache in my lower back and down my hamstring.
Running made it feel uncomfortable so at first I avoided this to let it calm down. Though I saw a very good physio who I heartily recommend (South Physiotherapy), it didn’t really help. I had acupuncture, massages, ultrasound… I still felt the discomfort.
I wanted to write this post because during my hamstring tendinopathy injury I read a lot online which was very negative and without solutions. I realise the spirit of the Internet and forums for health issues is not like a diary whereby people write about their issues, solve them and then go back to update people. When you’re fixed, you don’t go back. You just carry on with life. But I wanted something to put out there that might be helpful to someone like me. I know I’d have found this helpful.
Here are some sources that were useful though and hugely helped my recovery –> this journal article and this blog post.
Obviously I’ll preface this saying that I’m not a physio, doctor, coach or any sort of professional who has more than half a brain. I’m merely explaining how I overcame my issue. Whether it’s the full-on correct way or if it’s just something that works for me, I don’t know. But if you can take away anything from this post (if you have this injury) is that there is hope!
Though there appears to be minimal research out there for hamstring tendionopathy, what the two sources above agree is having a three step approach. The first step is to let the hamstring settle a bit. You don’t want to be doing hardcore leg strength workouts and you should probably stop running, especially avoid any sort of speedwork or hills which will aggravate the hamstring directly.
The not running part I was really good at. I stopped running completely for seven weeks. In hindsight, I don’t believe I needed to take this much time off had I not aggravating things further with trying to do too much strengthening and rehab at the gym in the early stages. But I read too much online, got carried away and attacked my hamstring with all manners of strengthening, from hamstring curls, Swiss ball bridges, sledge pushes and glute kickbacks. All of which I felt directly in my top hamstring but believed this was it “working” only to find the next few days it was far more niggly and nothing was improving. I also tried to replace running with using the elliptical machine, but this aggravated things too.
What I should have done at the beginning was focused primarily on isometric exercises. These are when you hold your muscle tightly. Nothing moves, but you’re squeezing the muscle. We’re talking static bridge holds. Eventually once I got past my over-enthusiastic gym endeavours and took a step back and focused on the bridge hold, things got calmer. The niggle was still there, but now it wasn’t getting worse or bugging me all the time and the isometric exercises were providing relief.
So, stage one: only do isometric exercises for the hamstring. The best example of this is literally the bridge hold (with a long lever base so it’s your hamstring working not your glute – so push your feet out further from your bum). Increase how long you can hold. Then when you’re solid with that, move to single leg and push the time on that. You can do this just lying on the floor, or you can do (as well as) putting your feet on a raised platform, like a coffee table.
Avoid at all costs: squats, lunges, glute kickbacks, hamstring curls (lying or sitting) and anything that makes the hamstring feel worse the next day. Tendons are a funny thing – it can take 24 hours before you realise you’ve screwed it up. Try and avoid long periods of sitting; get up and move around frequently. DO NOT STRETCH the hamstring. Don’t be tempted. It won’t feel better, it’ll aggravate it. It is literally the worst thing you can do to it.
Stage two is now where you can do a bit more. I found using the lying hamstring curl machine on the affected leg worked wonders. At first I aimed for high reps low weight but actually what really changed the game for me was low reps higher weight SLOWLY (heavy slow resistance).
What you should aim for is a weight that becomes challenging on the 8th rep. Aim for 8-10 reps. Don’t push through pain though! Pain is NOT a good thing. 3/10 discomfort is your marker. Your hamstring should feel tired afterwards but not painful at the time or later.
This is also when you can start to add a bit of running back in (again, no speedwork or hills though). It will still feel uncomfortable but if you have sharp pain, avoid and go back to stage 1. Mild discomfort that doesn’t get worse and that disappears after 24 hours is OK.
During this stage I also focused a lot on improving my adductor strength. I wanted the surrounding muscles to be strong. I used the adductor machine at the gym (that awful machine that people a few years ago used thinking it would zap inner thigh fat). I also laid down, put a medicine ball between my knees and gently straightened my legs out, then drew them back to my chest while all the time SQUEEZING the ball. This is a killer for the adductors and the core.
I still avoided squats and lunges but ramped up my glute work with resistance band walking, clams and heavy hip thrusts. Basically I was gently rehabbing my hamstring while super-powering everything else.
Running was frustrating (for me and everyone around me who had to hear me moan). It was still uncomfortable. Having a physio “re-align” my hips helped unlock me and changing my trainers definitely helped but it was more of a case of being sensible with when I did the rehab and when I ran. And keeping things easy and short – building up gradually. And trusting the process.
So many times after a run I was lost in my negativity and ready to give it all up. I’m very lucky to have such a patient and loving network of support around me. Even my mum, who’s a big supporter of my running but in general doesn’t care for the details, would ask more questions after every run, worrying for me and wanting things to be better. Kyle of course was a pillar of strength for me during this time.
But gradually things got better. My hamstring would niggle less, become uncomfortable later and later during a run. Afterwards it would feel better. I remember when I ran eight miles and that night I felt my hamstring gently throbbing while I laid in bed and I worried and worried. The isometric exercises helped calm things down and acted as a good pain relief. And taking bigger gaps between each run helped. Then long runs stopped bugging me during the night. My body was healing quicker as it adapted.
Stage three is adding back in things like squats and deadlifts. I’m not quite there yet. I think I could add them back in but with Chicago literally round the corner I want to avoid anything that aggrevates my hamstring.
I’ve ramped my long runs up (two 15 milers under my belt) and feel confident I’m heading in the right direction and not putting my hamstring at risk of regression. Obviously 26.2 miles in a few weeks is really going to test things but my plan is to be sensible. Realistically I am terrified and worried of going back to square one. If this wasn’t Chicago I would have canned it.
Basically my advice for this injury is: it will take time to recover. There is no magic pill, no trainers, no massage technique, no amount of icing or medication, no stretching or foam roll battering that will make everything better.
Rest is also not best. During my injury I had friends and family, who were enduring my continual frustrations, saying I should stop everything I was doing. Stop going to the gym. While I will fully admit that there were a number of weeks I shouldn’t have gone quite as ham on the rehab as I did and should not have tried to replicate my running on the elliptical machine, rest would not have solved my issue either. This injury requires rehab which involves strengthening and monitoring. Gently getting into a position where you can actually build your hamstring back up without reaggravating things. It’s a delicate balance.
In terms of cross training, I found the stair machine to be the best thing. Cycling (including spin – which was horrendous for it), the rowing machine and the elliptical machine really didn’t work. But ultimately it’s the strengthening of the hamstring that is the way forward.
Sorry for such a waffle but I wanted to write down my findings for this. If this helps just one other person, then I’m happy.
Good luck!