This clinical paper is written by four of the worlds top tendon specialists: Tom S.H. Goom, Dr. Peter Malliaris, Michael P. Reiman and Craig R Purdam.
https://www.jospt.org/doi/10.2519/jospt.2016.5986
https://www.lasselempainen.fi/category/about-injuries/rehabilitation/?lang=en
A little give away – the changed pathology remains but the tendon grows more good tissue until there is more good tissue than a tendon with normal pathology! Recently termed the donut effect.
Many people say the hardest part of being injured is the impact on their mental health. On top of that lots of people take up sport to improve their mental health or as a coping mechanism. Many sporting events are social events. People make friends through sport so when you’re injured you feel losses in many ways.
Maryke Louw of Sports Injury Physio helps you make sense of why you feel grief and how you can help manage these feelings. Click the link below.
https://www.sports-injury-physio.com/post/how-to-deal-with-the-mental-side-of-injury
https://www.surveymonkey.com/results/SM-8HX6PL377/
This website is dedicated to proximal hamstring tendinopathy. There’s a link to a global Facebook community where people share their experiences and support each other. You are not alone with this. Talk to people who have successfully recovered from proximal hamstring tendinopathy and returned to running, sitting and a pain free life.
Proximal hamstring tendinopathy is a long name for a group of pathologies where changes have occurred to your proximal hamstring tendons, also known as high hamstring tendons. These changes can either be inflammatory or degenerative and often both. Partial tears are included in PHT.
The hamstring tendons connect the hamstrings to the ischial tuberosity part of the pelvis. PHT causes a deep aching pain just under the glutes, where you sit.
I’ve had this injury for some time and have created this website to share my experiences of PHT.
I’ll be talking about the treatments I’ve had, to help you recover faster and give you support along the way.
The road to recovery can be frustrating and testing to say the least. It can take anything up to 2 years to recover.
Although we could all do without pain, the position of this particular tendinopathy can restrict your daily activities, especially sitting and bending. It’s thought of as a runners injury but certainly isn’t exclusive to running.
Sitting, stretching and running tend to aggravate the tendons making them more painful.
Generally, this injury comes on slowly, presenting as mild pain at the top of the posterior thigh. So good news – there’s an early warning to take action.
Sometimes, PHT can also be caused by a sudden acute injury.
If you’re feeling at your wits end, this can be fixed.
To connect with people with PHT, to find answers, feel supported and read recovery stories, visit the PHT Facebook page here .
This directory was created following a request from a PHT community member.
Every clinician listed has been recommended by a member who’s received treatment from that clinician. The only criteria for the directory is a community member makes the recommendation.
The directory is designed as a starting place and in no way takes the place of you researching who to see before you see them. The author takes no responsibility for other’s decisions and their outcomes.
Click Directory at the top right of the homepage screen.
To manage proximal hamstring tendinopathy, start by cutting back on the activity that’s aggravating your tendon. It’s thought, tendinopathy (tendinosis) is partly an overuse injury. The tendon cannot keep up with the amount of activity and the repair process so degenerates.
Tight, weak hamstring muscles cause pulling on tendons and restrict blood flow which causes degeneration.
Weak glutes are another factor. Glutes should be powerful to propel you along. If your glutes are weak, the hamstrings take over and they aren’t designed for this type of work.
Have a full examination of the kinetic chain by a qualified, registered physiotherapist. If you have access to an MRI, have this done early on. This should rule out other injuries.
Once you have confirmation of your diagnosis, your physiotherapist can prescribe an eccentric strengthening exercise programme. A good physio will advise you on how much of what type of activity is right for you .
Everyone’s PHT is different. Different stages of severity and recovery. The programme and advice should be tailored to you.
There’s several treatments for PHT. Follow posts and discussions with people on the PHT Facebook page. (www.facebook.com/ProximalHamstringTendinopathy)
The treatment that produces results, is an eccentric strengthening programme.
Tom Goom of The Physio Rooms and creator of RunningPhysio.com describes the onset of his proximal hamstring tendinopathy. Tom also talks about his gradual loading programme here. www.running-physio.com/pht-rehab
In Brief:
Prolotherapy involves injecting a natural solution directly into the injury site to cause an inflammatory reaction. This is to create new healthy tissue, strengthening the tendon.
From what people have reported, the best results come from having lots of areas of the tendon injected instead of the solution going into one place.
PRP (platelet rich plasma) is a form of prolotherapy. Platelet rich plasma, from the same patient, is injected into the tendon to promote healing.
Printed in Muscles, Ligaments and Tendons Journal.
Platelet Rich Plasma Treatment Improves Outcomes for Chronic Proximal Hamstring Injuries in an Athletic Population. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327356/
Dry needling (IMS – intramuscular stimulation) is inserting dry needles (not injecting anything) into shortened, tight muscles and tendons to create micro tears. This induces the bodies’ inflammatory reaction and repair process. Also, when needles are inserted, trigger points (knots) cramp around the needle. When the needle is removed, the trigger point relaxes.
IMS was developed by Dr. Chan Gunn. Find out more here: http://www.istop.org/
Steroid injections are generally considered not worthwhile. If you are lucky, you get approximately six weeks of pain relief but an extended period of recovery time. It’s also thought steroid injections are deleterious to tendons.
If you and your doctor decide steroid injections are appropriate, make sure it’s ultrasound guided. The injection should NOT go into the tendon but should go into the tendon sheath space around the tendon.
ESWT (Shockwave therapy) breaks up calcification within tendons. It also causes micro tears that the body repairs. This generates new tissue and reduces inflammation. Although it is somewhat painful, it is tolerable for the short period of time it’s administered. Do not have more than six sessions.
The practitioner should use different heads depending on the anatomy he/she is working on and adjust the intensity during treatment.
The protocol for shockwave therapy is six sessions. It seems healthcare professionals give three sessions, one a week for three consecutive weeks. The patient then has a break for a month to see how they improve while following an eccentric exercise programme.
The Biological Effects of ESWT on Tendons, The Muscles, Ligaments and Tendons Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666498/
If all else fails and the effects of PHT are too great on your day to day life, surgery can be an option as a last resort. I had a bi-lateral proximal hamstring tenotomy after having PHT for five years. There are different types of surgery for this condition.
One third of my semimembranosus tendon was cut off my pelvis and stitched lower down to the bicep femoris tendon. This lengthened my hamstrings by 3.5cm.
I was given a gradual eccentric strengthening exercise programme to do at the appropriate time following surgery.
I also had a build-up of scar tissue cut away.
However, I wish I’d had my bloods done when my PHT first appeared. Having a mineral profile done may save a lot of hassle and money in the long run.
Nutritional deficiencies and imbalances can be the cause of tight muscles and tendons.
Plasma and RBC blood tests give a more in-depth picture than serum whole blood tests. See the nutrition for PHT post: https://proximalhamstringtendinopathy.org/nutritionforpht
Plasma and RBC mineral profile blood testing may find the underlying cause of your PHT.
If you’re taking supplements without blood testing, they may be causing a nutritional imbalance. This imbalance can cause tight and weak muscles that pull on your tendons.
You can check the registration of a physiotherapist here: http://www.hpc-uk.org/check/
As stated on this site’s home page, I’m not medically qualified in any way, I’m merely a patient with long-term experience of PHT and it’s treatments. All decisions you make, are entirely your own. Always seek professional advice.
