James Dunn, Sports Rehabilitation Specialist, Ex Pro Rugby Player and Marathon Runner’s Complete Guide to PHT
Your upper body weight pushes through your hamstring tendons. However, your semimembranosus hamstring tendon is copping most of the pressure due to it’s position.
There’s three tendon parts attaching the three hamstring muscles to the ischial tuberosity (area of the pelvis).
My semimembranosus tendons (my case was bi-lateral) were the affected parts. I had a paperless desk job. So no reason to get up and walk about. 10 Hours of sitting a day plus driving to and from work equalled 12 hours of sitting.
After 3 months of the paperless job, my proximal hamstring tendons were a 7 – 8/10 on the VAS scale and I could hardly sit. I continued to drive to work for another 6 months and stood at my desk all day.
Standing for long periods of time is not a good idea. Too much of any activity will put a strain on groups of muscles and tendons, potentially causing more injuries.
I asked for a better chair and an up down desk which wasn’t forthcoming so had no option but to go off sick as I was unable to continue.
The next two years were spent standing as I could no longer sit down at all and having exhausted treatments available in the UK, after hours and hours of research, I flew to Finland and had a bi-lateral proximal hamstring tenotomy.
Don’t despair, most people recover before surgery becomes an option. Surgery is the absolute last resort.
My surgery was successful. Just a side note, Finland is a wonderful country and so too it’s people. We had a great time and want to go back and see some more of it.
However, my re-hab at home was not so good so I’m still recovering…. forever hopeful.
Sit on a thick spongy, pillow or cushion. Carry this about with you. Take it to work and use it for driving. Heads-up here, obviously it puts you in a different driving position so take it easy to start with. Take time to adjust.
You can buy a cushion/seat pad on Amazon designed for PHT. There’s holes cut out for the sit bones (ischial tuberosities). However, people have said it’s chance if the holes line up in the right position for your bone structure and it’s quite pricey. On the flip side, others have found it helped with their recovery and rated it highly.
As an alternative, people buy gardening kneeling cushions, measure up and cut their own holes. This apparently has worked very well and is a cheaper option.
Another pain reliever is the Wondergel seat pad. Community member recommeded:
Don’t sit for longer than 15 – 20 mins without getting up and walking about. This takes practice, especially at work. You get into what you’re doing and before you realise, an hour or more has gone by.
Standing takes the pressure off your tendons, allowing blood through and walking about causes the blood to flow quicker, taking oxygen and nutrients to the injured area and toxins away. However, standing all day isn’t good for you either so mix sitting, standing and walking about if you can.
Ask for or purchase an up/down desk.
This one has been recommended by a member of the Facebook PHT community:
Price £79.99 UK
If you want something ergonomic, portable and are concerned about the environment, try these natural products made by carpenters and cabinet makers and sold by Deskstand, Cape Town. This company also comes recommended by a PHT member so tried and tested!
I noticed an improvement in the quality of my tendons after using a pillow. They felt less ropy so these measures can help with recovery.
I also used a simple pacing and grading Word table after I hadn’t sat for two years. If you don’t sit on your tendons, they become deconditioned. So I started at 30 seconds on a soft surface, then a minute and increased the time every two days by 30 seconds, until I reached 10 minutes. Then I went up by a minute every two days and brought in a slightly harder surface alongside starting at 30 seconds with that. If you don’t want this hassle, don’t stop sitting completely.
Keep your water levels up and don’t skip meals…. more reasons to get up.
Talk to other people with PHT to understand how they manage sitting: https://www.facebook.com/ProximalHamstringTendinopathy
Hope this helps with improving your pain levels and your recovery.
This directory was created following a request from a PHT community member.
Every clinician listed has been recommended by a PHT community member who’s received treatment from that clinician. The only criteria for the directory is a PHT community member recommends them.
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.
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
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.
If you’ve tried most treatments for proximal hamstring tendinopathy and there’s nothing else left that sounds sane, it could be your nutrition blocking your recovery. Nutrition is fundamental to tendon repair.
If you think you are low or deficient, consider blood testing.
Red blood cell and plasma blood tests show what’s happening inside your cells and serum whole blood tests show what’s happening outside your cells, in your whole blood, as it says.
Symptoms of deficiencies include muscle tics, tight muscles, numbness, tingling, headaches, insomnia, fatigue, muscle weakness, hair loss, dry scaly skin, palpitations and more.
It’s not ideal to pop into your local high street health food shop and pick something up, as a stab in the dark, to fix a health problem without blood testing first. There’s a lot of great advice on the internet but using it to work out if you are low on something and trying to fix it yourself, without testing, may cause nutritional imbalances.
For example, magnesium and calcium work together to relax and contract muscles. If you are low in magnesium and top heavy in calcium, your muscles contract causing pulling on your tendons.
Excess vitamin C is eliminated by the body by attaching itself to another mineral which is excreted, resulting in mineral loss.
Whatever supplements you take, they will deplete or impede something else and so it goes on. Plus there are only so many binding sites and if there’s nowhere to bind to, the vitamin or mineral is lost.
If blood testing shows a deficiency, talk to your doctor first before taking supplements and take them temporarily, until blood tests show your levels are optimum, then stop when your doctor advises.
I still see posters on the London Underground advertising multi vitamins with a famous actor (in his 40’s) saying he’s been on them since his twenties.
Low or deficient vitamin D also impacts your musculoskeletal system. Here’s what the UK Government have to say about it via the NHS.
“The government says it has issued new vitamin D recommendations “to ensure that the majority of the UK population has satisfactory vitamin D blood levels throughout the year, in order to protect musculoskeletal health”.
Read the full advice from the NHS using UK government guidelines here: www.nhs.uk/news/food-and-diet/the-new-guidelines-on-vitamin-d-what-you-need-to-know
Obviously, this applies to the geographical position of the UK but gives a good indication on how important vitamin D is for everyone’s musculoskeletal health.
About Dr. Alison Grimaldi
Exert from Dr. Alison Grimaldi’s Website
With 25 years of clinical experience and particular expertise in the management of hip, groin and lumbo-pelvic pain and dysfunction, Alison is Principal Physiotherapist at Physiotec and an Adjunct Research Fellow at the University of Queensland. Alison also has a special interest in the assessment and optimisation of lumbo-pelvic and lower limb biomechanics for running, change of direction and all weightbearing sports, aiming to maximize an athlete’s performance outcomes and minimize risks of injury or re-injury.
Dr. Alison Grimaldi’s ebook series:
Tendinopathies of the hip and pelvis represent a large burden on both the sporting and ageing populations. Growing evidence is shaping contemporary conservative management of tendinopathy.
This e-book series aims to provide readers with guidance towards a deeper understanding of tendinopathies of the hip and pelvis and more effective clinical management based on an emerging evidence base derived from scientific studies on structure and mechanobiological mechanisms, risk factors, impairments and the available information on effects of intervention.
Link to her recently published books including book 3 Proximal Hamstring Tendinopathy:
All information on Proximalhamstringtendinopathy.org is based on the experience of the author who suffers from PHT and is not provided by a qualified medical professional.
The information is intended to motivate readers to make their own health decisions after consulting with their health care professional. The author is not medically qualified and takes no responsibility for others decisions about their health.
The information on this website is not intended to replace a one to one relationship with a qualified health care professional and is not intended as medical advice.
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