High Hamstring Tendonopathy

On the EN forum, the issue of high hamstring tendon injury was raised. I’ve had this on both sides over the past year, so I contributed:

I’m going to share my own experience with this over the past 14 months, not to tell anyone what to do, but to document what worked for me, and maybe provide some ideas.

Last year, starting back into training for Kona after Lake Placid, after my first set of TP run intervals, I developed pain on the right side, lower part of my butt, worst when I pressed in under the glute max muscle near the greater trochanter of the femur. Besides the pain, the other key symptom to me was pain when I would “paw” at the ground with the ball of my foot – that became important, as I used that sign (the disappearance of it) to help guide me back to running again. Since I wasn’t going to skip Kona unless I literally fell apart, I looked for ways to train through it. On the training side, I stopped doing speed/interval/high intensity work, and long runs, for a month. All of my running began to be at a faster cadence than previous, with shorter stride length. During August, I was running 5 days a week, 4-6 miles mostly, with a 9 mile and 10 mile run, all @ TRP. In September, I tried two attempt at “TP Intervals”, but ended up managing more like a half marathon pace for 2 x 1 mile. I dropped to 3 x/ week, with two runs of two hours. While my pain never went away – it hurt every step I ran – it also was not getting worse, so I trudged on.

The exercise program I developed during this time was focused on improving lower core strength and flexibility, with an eye towards long-term prevention as well as short term recovery. I played with several different exercise programs, but this is where I ended up, based on what I felt comfortable doings and what I felt was working. Stretching included the Yoga “good morning” pose, standard hamstring stretches, and holding my knee up to my chest while standing. Core work included crunches with my knees up, arms crossed on chest; front plank x 90 seconds; pelvic bridge static x 90 seconds; and pelvic thrusts (slow, emphasizing gluteal contraction) x 30. I did 30 side leg lifts, 30 clam shells, and 30 “reverse clams” (lying on the side, lower leg with knee bent, upper knee stationary close to lower knee, and rotating the upper leg so the foot went up and down). All of these were focused on feeling effort and strength in the hip flexors and small and large muscles of the gluteal area. In addition, I did side leg thrusts, front leg thrusts, and single leg knee bends, aimed at patellar stability. I tried to do these every day, usually managed 5 per week. One thing I should note is that for some stupid reason I had stopped doing most weight room and core work for about a year. Since I’d never really gotten any significant training injuries, I thought I must be immune, and stopped following my own advice to OFs to not give up on weight work, ever. So I decided maybe a part of the recovery should be a return to better strength, emphasis on helping the poor hamstring do its work.

While I was able to finish Kona, I only ran about 13 miles total, due to the pain. Since I had hernia surgery scheduled three weeks later, I shut down my running from that point forward, continuing with weight lifting (leg presses, seated quad lifts, no hamstring work) and the above stretching and core work. I had the surgery, & thus enforced rest from running. I started back up running after two months after Kona. In Dec, I ran 15 times/45 mi; Jan, 15 x/65 miles; Feb 11x/55 miles, working up to max 7 miles. Then, Feb 27, I broke my R great toe, and stopped running until May 10th, By the time I started back up, I was totally pain free, but very slow.

I did a standard IM build up from May 10-Oct 1 of 20 weeks, and while I got no faster (like 30 seconds per mile slower than before the injury), I remained pain free, which was my major goal. i did IM MD (at a very slow, but persistent 10-11 min/mile), 10 days later, I tried an interval treadmill set which went OK, and two days later tried an 80 minute treadmill progressive run. (It literally rained non-stop for seven days, which is why I was on the treadmill.) That was Sunday; on Monday, my left hamstring hurt worse than the right ever did the year before – the injury before Kona had been on the right. That scared me almost out of my mind, since I had my A race for the year coming up on Nov 13th. Like Kona, I was going to do that event unless I was in the hospital or a cast. So I took two days totally off from running, but kept up with my stretching and core work. then gingerly tried to go back to running. It hurt, but I persisted. Within a week, I was able to do some interval work, and managed three “long” (for HIM training) runs at reasonable pace. By race day, pain was not on the radar screen.

I had a respectable run in terms of HR, but my pace was a minute/mile slower than I anticipated. Probably a combination of the temps being 85F (this was Miami), and my training being inadequate. Two days after the race, I remain pain free.

So my personal conclusions:

  • Risk factors include: aging elite athlete; rapid return to intense training after an IM marathon; abandonment of weight training. If you’re over 50-55, stay in the weight room, and be very careful with building back into intense running soon after a marathon (either stand alone or IM)
  • In addition to the benefits of regular weight training & flexibility (stretching), specific exercises for the lower core (mid-thigh up to top of pelvic bone) are helpful for both prevention and return to pain-free function.
  • A period of rest can be helpful, but returning to running within a week is also feasible if the pain is improving while running. If it stays the same or gets worse, shut it down for several months in the off season.
  • Hamstring injuries are scary. I’m going to be doing my exercise program for the rest of my walking life.
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