Proximal Hamstring Tendinopathy: My 6-Year Battle and Triumph

Introduction

In today’s episode, we dive into my personal journey of overcoming six years of tendinopathy, specifically proximal hamstring tendinopathy. Welcome to this podcast, dedicated to helping you understand this condition, learn the most effective evidence-based treatments, and dispel common misconceptions. My name is Brodie Sharp, an online physiotherapist and recreational athlete, and in this blog article, I’m going to share my detailed journey of battling proximal hamstring tendinopathy and the strategies that helped me overcome it.

My Background

I’ve always been an active individual, primarily a recreational runner, but my history is marred with various injuries, including calf issues, hamstring problems, plantar fasciitis, high hamstring tendinopathy, calf strains, and hip flexor strains. However, my most persistent issue was proximal hamstring tendinopathy (PHT), a condition that nagged me for six years without causing severe pain but was always present in the background.

The Origin of My PHT

The interesting thing about my PHT is that I couldn’t pinpoint the exact moment or activity that led to its development. PHT occurs at the point where the hamstring, adductor, and sartorius muscles converge, near the inside of the knee. In my case, both sides of my pes anserinus tendons would subluxate, shifting across the bone during certain movements, leading to irritation and eventual tendinopathy.

Taking Advantage of Lockdown

When Melbourne went into lockdown in March, I saw it as an opportunity to focus on overcoming my PHT. The condition had become increasingly irritating, especially after my triathlon season, which involved fast and intense work. My usual trigger for pain was running just 2-3 kilometers at a pace around 5 minutes per kilometer. While it didn’t hurt during the run, I knew it wasn’t right, and I decided it was finally time to address it.

Setting Expectations

Before embarking on my journey, I set some crucial expectations. I knew that with chronic tendons, there might be minor flare-ups along the way. I also understood that being completely pain-free might not be achievable, and that was okay. As long as the pain stayed around my baseline and didn’t escalate, I considered it a win. Patience was another key expectation. I knew this would be a long process, and I set a three-month goal, allowing for fluctuations in the timeline.

Four Key Steps

I approached my PHT recovery with a four-step strategy:

1. Creating a Running Program

I utilized the Nike Run app to design a program that would help me gradually build up my mileage over time. I started with just 2K runs in the beginning.

2. Isometrics and Pre-Activation

Before, during, and after my runs, I implemented isometric exercises, particularly the “tricep dip” style movement, to pre-activate my hamstring and reduce pain during the run.

3. Gait Adjustments

I made adjustments to my running technique, including a wider step width and a lower cadence to reduce the stress on my hamstring.

4. Strengthening

I incorporated a strength training program with exercises like theraband hamstring curls, squats, and deadlifts, aimed at improving the strength and resilience of my hamstrings.

Early Weeks

In the initial weeks, I didn’t immediately start the running program but began with short 2K runs with alternating jogging and walking intervals. This allowed me to assess how my hamstring would react the next day. When I was ready to start the program, I began with two to three runs a week.

Stumbling Blocks and Adjustments

After two weeks on a four-to-five-days-a-week schedule, I realized my hamstring needed more recovery time. I scaled back to two to three days a week, adjusting the program accordingly.

Incorporating Cross-Training

To maintain fitness while running less, I introduced cycling into my routine. I often combined a bike ride with a shorter run to substitute for longer runs.

Responding to Speed Work

I discovered that shorter, faster runs caused less discomfort for my hamstring. Intervals and faster-paced workouts were more manageable than steady long-distance running.

Nutrition and Recovery

During this journey, I experimented with my diet. I cut out sugar for three weeks, which appeared to have a positive impact on my overall recovery. My readiness scores improved significantly during this sugar-free period.

Progress and Challenges

As the weeks progressed, my symptoms started to stabilize. I gradually increased my long runs by 1K each week. However, there were setbacks, including a flare-up during a 5K run, which led me to reevaluate and adapt my approach.

The Hurdles

Around the two-month mark, I faced a new challenge. My calves started to experience delayed onset muscle soreness (DOMS) due to the increase in distance and reduced support from my light running shoes. I began using heavier, more supportive shoes to alleviate calf discomfort.

A Slight Setback

As I transitioned to heavier shoes, my right hamstring started to tighten. Although it remained bearable, I chose to prioritize caution and stopped the run. In the following days, I experienced DOMS in both hamstrings but resumed running after a few days of rest.

A Turning Point

Around week 10, my long runs reached the 10K mark. This was a significant milestone, as it demonstrated the progress I had made in my journey to overcome PHT. My hamstring began to tolerate the longer distances and the discomfort was well within my expectations.

Conclusion

My journey to overcome proximal hamstring tendinopathy has been a gradual but ultimately successful one. By setting realistic expectations, carefully adjusting my training program, and being open to various strategies, I was able to make significant progress and reduce the impact of this persistent condition. It’s important to remember that each person’s experience with tendinopathy is unique, and finding the right approach may require patience and adaptability. The key is to keep moving forward, make smart decisions, and prioritize your long-term health and well-being.