Dealing With High Hamstring Tendinopathy – A Practical Guide

High hamstring tendinopathy forced me out of running for about five months. That’s a really long time for someone who usually runs at least seven times a week.  Only now am I slowly getting back into it.

Unfortunately, there is little information about high hamstring tendinopathy out there.  If you google it, you will find a good, but very academica-ey paper and a bunch of (mostly) useless stuff on message boards.

I’m no doctor, but I have some first hand experiences that, hopefully, can be of use to others. This injury is fairly rare, so some of the things that worked me for were discovered purely through experimentation.

Symptoms

First off, how do you know you have high hamstring tendinopathy?  I initially was misdiagnosed with a simple hamstring “pull”, an injury that lasts 4-6 weeks, I think.  Here were my symptoms

• Pain in the upper hamstring area, most notably where the hamstring connects with the sitz bone
• The pain is deep in the muscle, not at the surface
• Pain came on slowly over time (as opposed to suddenly due to a traumatic movement of some sort)
• Pain while driving a car
• Pain when sitting a long time, especially at a desk or on hard surfaces
• Pain when sitting on an airplane
• When trying the ‘touch your toe’ stretch, I could get my knuckles down to my knees (uh oh!)
• Pain at the outset of a run, but going away once ‘warmed up’…then coming back later on
• Numbing of entire leg while running (this is when I realized I had to go see someone to get this fixed)
• Occasional glut pain
• It hurts most when getting out of bed in the morning

It hurt right there

(Note: I do not recommend self-diagnosis, but finding the best sports physician possible to help you figure out what you really have)

Causes

I’m not sure what the actual cause of my injury was.  My best guess: Running 10,000 miles on mostly mountainous terrain for over four years and never stretching.  That’s the kind of thing you can do in your 20s, but not, as it turns out, in your 30s.

There may be other causes, but I’m going with the above.

How to Get Better

Essentially, you’re trying to heal an inflamed muscle, so rest is your best friend.  I committed early on to not patch up my injury and come back quickly but to take as much time as necessary to heal.  My main goal is to run into my 70s and 80s and not to run as soon as possible with a high likelihood of re-injury.

Loosen Your Hamstring, in particular, and leg muscles in general – I have a foam roller (black; the color indicates how hard the roller is) and would roll out my hamstrings, quads, IT bands and glutes every single day for the first two or three months. (I mean: every. single. day.) I hated this.  Watching the Mavs win and listening to Western States podcasts made it a bit more bearable (yes, that’s how along ago all this started).

Eventually, I started stretching – lightly – and increasing my flexibility.  I can now touch my toes at any point in the day, which is a huge accomplishment considering where I started.  Eventually, I was able to start doing yoga (after about 4 months), which I consider invaluable in my recovery (more on that later).

Also, the wonderful Mrs. Golden Trails would massage my hamstrings two to three times a week during months two and three.  If you have someone who can do this for you on a regular basis, I would highly recommend taking advantage of that.  (We started this about 4-6 weeks in and maybe should have done it sooner).

Ice - I didn’t think this would work, but icing did help quite a bit at the beginning to calm down the inflamed muscle.

Strengthen Your Core – My PT insisted on this.  I would (still) argue that my core was pretty strong to begin with.  I passed all strength tests with flying colors.  Doing several 60 second planks should be *very* easy.  Anyways, just mentioning it, because it may help the reader.

Compression - I own one pair of compression shorts.  For a while, I wore those to bed which helped alleviate some of the pain I felt in the mornings.

Everyday Issues and How to Solve Them

Rest. Rest. Rest. – At first, my hamstring hurt all the time.  After a few weeks (4-6 weeks), I got to the point where I would have a few pain free hours during the day and could even walk a few steps without pain.  Avoid walking, standing and sitting on a desk (or other hard) chair for long periods of time. Easier said than done, I know.  “Avoid” = “minimize as much as you can”.

Do what you can.  I used to live half a mile from the subway and Mrs Golden Trails would sometimes drop me off/pick me up from there.  It’s pretty sad for me to even think about, but any walking would re-aggravate the injury.  Also, Mrs. Golden Trails rocks.

Sit On a Pillow While Driving - I don’t know how I figured this out, but after weeks of bad pain any time I drove, discovering this was an absolute game changer.  I would also bring something soft to sit on airplanes, at sporting events, etc.  Sitting on soft surfaces puts less pressure on your hamstrings, so that made me feel better.

Get a Standing Set Up at Work (if possible) – I realize, this is not possible for most, but if your employer pays for such perks – take advantage.  Regularly being able to switch between sitting and standing is gold.  Also, if you get a really fancy chair (Herman Miller!), you can bend the chair bottom (the part you sit on) forward.  Again, less pressure on your hamstrings = happier hamstrings.

Helpful Exercises

Bridges - I don’t like this exercise, but I did it anyways.  It helped.  Here is an example.

If that’s boring, try doing it with a stability ball.

Swimming – After a while (6 weeks or so), I started swimming.  At the beginning, all I did could do was pulling.  Swimming is boring to me, but was great for getting my heart rate up on a regular basis.

Bikram Yoga (the hot kind) – OK, so you may have done yoga before.  Forget all about it.  This is not the same.  This is no granola, “ommmmmm” yoga you may imagine or have done before: this is a *workout*.  I’ve been doing it for two months now, and it’s changing my body in a hurry.  If I had to name one single thing that helped towards recovery, it’s Bikram.

Let me tell you: it’s hard.  Most newbies I’ve seen, don’t make it through the first class (count me as one of them).  Even my mother-in-law, who had been practicing yoga for 10 years before I took her for the first time, ended up throwing up 25 minutes into her first class. She also came back and finished out the session.  Sound a bit like ultra-running?  It’s not too different.  It’s extreme and pushes your body to a place you likely haven’t been before.  Try it.

If you have additional questions about my experience, please ask in the comments.  I will try my best to get back to you.

Get well soon!

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