PHT Treatments

Managing Proximal Hamstring Tendinopathy

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.

Getting A Diagnosis

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.

PHT Treatments Available

There’s several treatments for PHT.  Follow posts and discussions with people on the PHT Facebook page. (www.facebook.com/ProximalHamstringTendinopathy)

Eccentric Strengthening Exercise Programmes

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

If Eccentric Exercise Hasn’t Worked, The Following Treatments Have Had Mixed Results:

In Brief:

Prolotherapy

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

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

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

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

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/

Surgery

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.

Nutrition

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.

Nutrition, Vitamin D And Tendons

Nutrition – A Fundamental of Proximal Hamstring Tendinopathy Recovery

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.

How To Find Out What You Need

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.

Supplements – The Don’ts

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.

What to eat (as part of a varied diet) to maintain or help repair tendons.

www.healthyeating.sfgate.com/nutrients-needed-tendons-ligaments-4392.html

Vitamin D

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.

 

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.