Proximal ( or High) Hamstring tendonopathy
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Proximal ( or High) Hamstring tendonopathy
Postby jpgibson » Mon Feb 26, 2018 9:54 pm
Anyone had any experience with this? Might be time to hang up the bike......
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Re: Proximal ( or High) Hamstring tendonopathy
Postby ValleyForge » Mon Feb 26, 2018 10:18 pm
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Re: Proximal ( or High) Hamstring tendonopathy
Postby jpgibson » Tue Feb 27, 2018 8:38 am
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Re: Proximal ( or High) Hamstring tendonopathy
Postby ValleyForge » Tue Feb 27, 2018 8:52 am
Good that you had the diagnosis backed up by an MRI. SMT is a "trendy" diagnosis and - if you have a new hammer, everything looks like a nail.jpgibson wrote:Clinically by a sports med physio, and then by MRI ( which was reported as a mild grade). Considering a prp injection as its been 3 months and I'm starting to get a bit frustrated by it!
It's part of the group of "enthesopathies" and they have a very slow repair course. Three months is still very early - perhaps stick with the treatments that have been shown to make a difference. Long-acting NSAIDs produce a moderate improvement; moderation of exercise to avoid sudden loading (weights, circuits et al) and stopping smoking if you do are the interventions that have evidence behind them too. PRP, hGH analogues, cortisone, focussed ultrasound, infrared and hyperbaric oxygen have all been trialled. And by that you can tell the results are pretty patchy.
Six to 12 months is the repair cycle you are looking at.
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Re: Proximal ( or High) Hamstring tendonopathy
Postby jpgibson » Tue Feb 27, 2018 9:23 am
I'm nearly 52, so that might have something to do with it too!
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Re: Proximal ( or High) Hamstring tendonopathy
Postby ValleyForge » Tue Feb 27, 2018 9:43 am
Generally repeated stressing of the affected tendon with exercise is recommended against. It is the repeated full loading and unloading of the tendon that seems to perpetuate the inflammation. Hamstring curls would not be helping in all likelihood.jpgibson wrote:Thanks so much! I'm just really impatient and want an instant fix. It nearly gets better then I do something that stirs it up ( bit).I'm much better than I was ( when to bend over would result in an 'ouch' ( or words to that effect!). I'm doing eccentric exercises ( my own interpretation with hamstring curls), which seem to help. Looks like I'll be careful and try to be patient. I suppose I shouldnt really complain as I can work, ride my motorbikes and go to the gym. It's really just cycling that might have to be retired.....
I'm nearly 52, so that might have something to do with it too!
It is absolutely classical to observe a cyclic pattern in these. Recovery is followed by return to activities and a flare-up. Then the cycle repeats. It might be best to look to non-intensive cycling, changing your bike fit to unload your hamstrings, aviod sprints & hills.
Another classical observation is the pain follows by several hours the exercise that triggers the inflammation. So evening & nocturnal symptoms are common.
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Re: Proximal ( or High) Hamstring tendonopathy
Postby jpgibson » Wed Feb 28, 2018 5:23 am
I think cycling might be out as it seems load AND compression on the tendon are the culprits, and a bike saddle seems to be optimally placed to compress the origin of the tendon.
Appreciate your help.Jonathan
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Re: Proximal ( or High) Hamstring tendonopathy
Postby jpgibson » Fri Mar 02, 2018 7:45 pm
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Re: Proximal ( or High) Hamstring tendonopathy
Postby vander » Mon Mar 05, 2018 11:04 pm
This is ust incorrect. All evidence for tendinopathy shows that loading (stressing) the tendon is important and necessary.ValleyForge wrote: Generally repeated stressing of the affected tendon with exercise is recommended against. It is the repeated full loading and unloading of the tendon that seems to perpetuate the inflammation. Hamstring curls would not be helping in all likelihood.
There is rarely inflamation in tendinopathies.
Hamstring curls will be great for it just need to load it right gradually and consistency.
As your physio seems JPgibson compression can be hard (cycling has plenty of that) but isnt inherently bad it is just a load that may be harder to tolerate.
Hamstring strengthening in hip extension is a good first step. Progress to more flexion (compression) if you can handle decent hamstring loads in flexion than cycling will be fine.
Tendinopathies can be annoying and need patience. Always remember that one of the first guys to treat a tendinopathy was trying to tear the tendon and ended up fixing it by loading it lots.
Dont be afraid of pain there will be ups and downs.
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Re: Proximal ( or High) Hamstring tendonopathy
Postby ValleyForge » Tue Mar 06, 2018 3:08 pm
Got me interested now. Can you share this with us?vander wrote:This is ust incorrect. All evidence for tendinopathy shows that loading (stressing) the tendon is important and necessary.ValleyForge wrote: Generally repeated stressing of the affected tendon with exercise is recommended against. It is the repeated full loading and unloading of the tendon that seems to perpetuate the inflammation. Hamstring curls would not be helping in all likelihood.
Which model are you referring to: inflammatory, mechanical, synovio-entheseal complex theory, auto-immune or genetic?vander wrote:There is rarely inflamation in tendinopathies.
Go.
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Re: Proximal ( or High) Hamstring tendonopathy
Postby jpgibson » Wed Mar 07, 2018 5:58 am
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396672/
My understanding is that there is a structural change in the tendon with repeated injury.The only evidence ( and I doubt it was an RCT) is for eccentric exercises ( I think it was in soccer players). Plenty of anecdotal 'evidence' for other treatments ( inc PRP).
In my case, I definitely get pain relief with eccentric exercises ( as I was told would occur) but I suspect I overdid the weight!
Thanks again for all the replies- I just have to be more patient!
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Re: Proximal ( or High) Hamstring tendonopathy
Postby ValleyForge » Wed Mar 07, 2018 7:16 pm
The model is where a tendon inserts into a bone, the nature of the "anchoring" is prone to poor blood supply. Also the fibroblasts which restore the collagen fibres are very slow. The pain seems to be from oedema and swelling in the tendon which worsens the blood supply. This cycle is seen in many parts of the mammalian body - in humans it is responsible for tennis elbow, golfer's thumb, the "nagging groin strain" of footballers; the list goes on.
Accept a period of limiting sudden loading of the hamstrings; then move into the recovery phase exercises. Long-acting NSAIDs from your GP will help you feel better, but not alter the end result.
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Re: Proximal ( or High) Hamstring tendonopathy
Postby jpgibson » Thu Mar 08, 2018 12:29 pm
I'm resigned to it taking a long time to get completely better and I'd love for it not to become semi chronic or chronic!
I dont think, based on my discomfort, I need NSAIDS at the moment.
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Re: Proximal ( or High) Hamstring tendonopathy
Postby vander » Mon Mar 12, 2018 9:53 am
No use me writing what others have done better.jpgibson wrote:Evidence is scarce for this problem.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396672/
My understanding is that there is a structural change in the tendon with repeated injury.The only evidence ( and I doubt it was an RCT) is for eccentric exercises ( I think it was in soccer players). Plenty of anecdotal 'evidence' for other treatments ( inc PRP).
In my case, I definitely get pain relief with eccentric exercises ( as I was told would occur) but I suspect I overdid the weight!
Thanks again for all the replies- I just have to be more patient!
https://www.tendinopathyrehab.com/blog/ ... erik-meira
https://trustmephysiotherapy.com/9-tend ... must-know/
https://www.tendinopathyrehab.com/blog/ ... athy-rehab
Plenty of RCTs and even systematic reviews about exercise and loading. It might not change structure but it changes pain. There is a donut hole theory which you could look up.
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Re: Proximal ( or High) Hamstring tendonopathy
Postby ValleyForge » Mon Mar 12, 2018 10:18 am
Great reading. The take home message (for me) is setting expectations and the progressive nature of the loading. Everyone wants to return to normal ASAP and that fuels the classic cyclic nature of symptoms.vander wrote:No use me writing what others have done better.jpgibson wrote:Evidence is scarce for this problem.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396672/
My understanding is that there is a structural change in the tendon with repeated injury.The only evidence ( and I doubt it was an RCT) is for eccentric exercises ( I think it was in soccer players). Plenty of anecdotal 'evidence' for other treatments ( inc PRP).
In my case, I definitely get pain relief with eccentric exercises ( as I was told would occur) but I suspect I overdid the weight!
Thanks again for all the replies- I just have to be more patient!
https://www.tendinopathyrehab.com/blog/ ... erik-meira
https://trustmephysiotherapy.com/9-tend ... must-know/
https://www.tendinopathyrehab.com/blog/ ... athy-rehab
Plenty of RCTs and even systematic reviews about exercise and loading. It might not change structure but it changes pain. There is a donut hole theory which you could look up.
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Re: Proximal ( or High) Hamstring tendonopathy
Postby vander » Thu Mar 15, 2018 9:35 pm
Second one is the big point. Also the effects of detraining in peoples rest overload approach. Complete rest is contraindicated.ValleyForge wrote: Great reading. The take home message (for me) is setting expectations and the progressive nature of the loading. Everyone wants to return to normal ASAP and that fuels the classic cyclic nature of symptoms.
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Re: Proximal ( or High) Hamstring tendonopathy
Postby jpgibson » Sun Mar 18, 2018 2:32 pm
Then I read the above paper: need to decide if I'm in the early or late phase!
Now my head hurts!
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Re: Proximal ( or High) Hamstring tendonopathy
Postby jpgibson » Tue May 08, 2018 7:55 pm
1.PHT just about gone
2.Stacked dirtbike a week ago-> # right scaphoid ( surgery)
3.Cant do anything but walk, so did 45km in 2 days ( at the age of 52), guess what? Yep can feel hamstring tendon again.
Hopefully I'll heal!
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