Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management

The Most Comprehensive Clinical Paper On Proximal Hamstring Tendinopathy

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

 

 

 

James Dunne’s Complete Guide to PHT

James Dunn, Sports Rehabilitation Specialist, Ex Pro Rugby Player and Marathon Runner’s Complete Guide to PHT

 

Survey of PHT Community Members Voting For The Most Helpful Treatments

Survey of PHT Community Members Voting For The Most Helpful Treatments

 

https://www.surveymonkey.com/results/SM-8HX6PL377/

 

The Directory

The Recommended Clinicians Directory

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.

 

Collagen Supplements

Collagen Supplements – Do They Work?

When you’ve a long history of tendon injury and nothing seems to fix it, you put a lot of energy into considering ways you can. Ways you can get back to living your life pre PHT.

Collagen supplements are one of the more easily obtained potential treatments for PHT or any musculoskeletal injury. There’s been a lot of interest in these over the last few years and you can see why. Pop into a health food shop on the high street, pick some up for a few pounds and start taking them that day. Far more accessible than waiting for a medical appointment, scans, follow-up and a lot cheaper if you don’t have access to a state run health service. You feel like your doing something positive towards your recovery. You sometimes pin your hopes on them. So are they worthwhile and what does the research say?

The Research

Most collagen studies have been of small sample groups and industry funded so the question to ask is can you trust an industry funded study? Nearly all existing research has focused on supplements and not food so can you get the same collagen production from a healthy balanced diet? Libby Mills – Spokesperson for The Academy of Nutrition and Dietetics, Chicago and Washington says “Maybe if people consumed adequate protein, they would get the same benefit.” The body breaks down both food and collagen supplements into amino acids in the same way to produce collagen. Libby Mills talks about collagen supplements verses food sources in Jamie Santa Cruz’s article for Today’s Dietitian Magazine, March 2019. https://www.todaysdietitian.com/newarchives/0319p26.shtml

What Nutrients Are Needed To Make Collagen

Apart from collagen (a protein found in meat, fish, eggs, dairy and spirulina) vitamin C is the main co-factor in collagen synthesis. Vitamin C is also an antioxidant which helps reduce oxidative stresses that degrade collagen. The outcome of a study for the use of vitamin c, following musculoskeletal injuries, was favourable. The study appeared in The Orthopaedic Journal of Sport, Oct 2018 titled “The Efficiency of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injury.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204628/

Libby Mills says “Zinc and sulphur are also co-factors in collagen production.” Vitamin A is also involved and an antioxidant. This article, written by Jamie Santa Cruz, in Today’s Dietitian Magazine, states what to eat to get all you need. https://www.todaysdietitian.com/newarchives/0319p26.shtml

What Impacts Collagen Production

One of the world’s favourites – sugar! “Sugar molecules bind to collagen fibres which results in the formation of advanced glycation end products.” Writes Jamie Santa Cruz. Patricia Ferris MD, Clinical Associate Professor of Dermatology at Tulane University School of Medicine says “These bindings cause an irreversible loss of strength and flexibility in collagen fibres.” As well as sugar’s impact on collagen synthesis, alcohol inhibits the absorption of vitamins and minerals impeding collagen production while smoking causes irregular fibril organisation and fibroblast degeneration in tendons. Read about cigarette smoking and the effects on tendons here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711704/

Conclusion

Although these small studies have had good results supporting collagen supplementation, Libby Mills makes a valid point “Spending money on supplements doesn’t seem to be necessary because there are many food sources and if you are eating a balanced diet, you should have the nutrients you need.” So perhaps an improved diet and lifestyle is all it takes while we wait for larger non industry funded studies.

 

PHT Recovery Success Stories

Proximal Hamstring Tendinopathy Recovery Stories

Posted by Corina Barbaza Weber

After fighting for almost one year PHT, just completed now a pain free, injury free half marathon in 1h37min, beating my 2016 PB. For everyone out there who is exasperated of not being able to sit without pain, let alone bend forward or run, I tell you: don’t lose hope. Stay focused, wrap yourselves in KT tape and don’t miss your boring Physio, massages and gym sessions with eccentric hamstring exercise and planks. God bless you and give you the strength to fight until you’ll get healed!

Image may contain: Corina Barbaza Weber, smiling, standing, child, outdoor and text

Posted by Mary Bourne-Marth

After 2 years of fighting, PT + dry needling + lots and lots of support from friends and family led me back to race running – this is the 10k Blue Bell fun run in Brenham, TX. Please don’t give up. Get a good Ortho and good PT (if there is anyone out there in Houston, I have recommendations for both after suffering through several bad experiences). I have been running 7 miles every Saturday with my buddies, riding horses again, and sitting through Broadway plays and movies with the help of a special pillow. I am not 100%, but at least 90% healed. Hang in there, I am cheering for all of you! (especially Vicki)

Image may contain: 2 people, people smiling, people standing

Sam’s Story

Almost 5 years ago I started to develop HHT.  It started appearing while running, during a football pre-season.  A sort of tugging feeling.  I’ve never had a muscle/tendon injury before so I just assumed I’d run through it and it would get better.

It slowly got worse through tennis and football and before I knew it, I could barely kick off my shoe.

Over the next two years, I went to two chiropractors, one physio, one sports doctor and a deep tissue massage therapist.

Nothing seemed to work.

I just thought it would get better but I would always do something to hurt it …… like running or kicking without warming up etc.

The annoying thing about my injury, was if you did injure it further, you couldn’t feel the result until at least 1 – 2 days later.

I ended up going to another physio over a year ago.  She recommended I started resistance training on my hamstrings and build up my glutes.

Slowly, I built up the strength in my hammy and was able to run at footy.

I had a lot of set-backs and had to restart again if I pushed it too hard running or kicking, if I didn’t warm up properly or did too much weight with exercises.

It’s been about a year now, I’ve been at 100% with sport.  I still have to be smart and warm up but it’s good.

The key thing for me were:

Don’t do static stretches.

Do some dynamic stretches.

Glute and hamstring resistance training.

A good warm up before sport.

This is not an injury that can be fixed with rest.  You must work at it using paced and graded exercises.

Most importantly, you gotta know your limits, don’t push too far because it might set you back.

Sam

Anonymous

I’d suffered with HHT for about 12 months (49 yrs old with a marathon / ultra marathon running background) and then thought I had gotten over it but had a really bad set back (after a 50km training run) that saw it flare up for another 4 months.

Have been 99% pain free for about 6 months now and have completed the Tokyo marathon and 2 x 100km trail races pain free during this time. Clams and more clams (daily) seemed to really help me along with continuing to load the tendon up to a tolerable point but being cautious not to over do it. I never really stopped running, but my speed definitely suffered.

By far the worst injury I’ve ever had, and I still feel like I’m not absolutely over it, despite how good the hammy feels. I’ve learned the pain signs that tell me when to back off, and also how important it is to keep exercising, keep running and avoid stretching and icing (at least for me). Good luck to everyone and definitely hang in, there is light at the end of a long tunnel.

Anonymous

To talk to people who have recovered, visit the PHT Facebook page:

https://www.facebook.com/ProximalHamstringTendinopathy