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Thread: Hamstring Tendinopathy - experience here?

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    Default Hamstring Tendinopathy - experience here?

    Been Ďtrainingí (increasing ride length and frequency) steadily over the last 3-4 months for a ride Iíve entered (Australian version of líEtape - 136km & 2700m climbing) which is in two weeks.

    This week a pain in my leg which I thought was a tight hamstring has been diagnosed as hamstring tendinopathy - basically tendinitis at the top of the hamstring.

    Has anyone here suffered from this? Any commentary around recovery etc.?

    Iím seeing a physiotherapist so Iím working on professional advice already - just want to get a feel for how likely it is that Iíll be doing this ride...

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    Default Re: Hamstring Tendinopathy - experience here?

    There is a lot of discussion over on the triathlon forum, Slowtwitch. Its usually a problem associated with running. Here's one thread

    https://forum.slowtwitch.com/forum/S...pathy#p2979770

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    Default Re: Hamstring Tendinopathy - experience here?

    Quote Originally Posted by d.bancroft View Post
    There is a lot of discussion over on the triathlon forum, Slowtwitch. Its usually a problem associated with running. Here's one thread

    https://forum.slowtwitch.com/forum/S...pathy#p2979770
    Shit. So this could be a long road... but thanks for the heads-up.

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    Default Re: Hamstring Tendinopathy - experience here?

    Position-wise, the only thing that’s changed for me lately is the wider Q-factor of the White Industries cranks on my Hampsten. Could that be the culprit?

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    Default Re: Hamstring Tendinopathy - experience here?

    Tendonitis is over-use inflammation. So you just over-did it at some point and then kept going and now you have tendinitis. Good that you've gone to a physiotherapist.
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    Default Re: Hamstring Tendinopathy - experience here?

    I've been dealing with this for 4-5 years. Eccentrics and strength training help a lot. As soon as I stop, or over train, it comes back.

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    Default Re: Hamstring Tendinopathy - experience here?

    Same as the other replies. Only rest really makes it go away, NSAIDS make it tolerable, PT and strength training and good fit are future prevention. I get it when I ride my Cx bike long distances in the winter and spring if I'm not careful (not this year as the s**t weather has limited my riding). Mine comes from a leg length discrepancy that I have compensated in my road shoes (Look cleats with a Specialized shim) but not in my MTB/Cx shoes (SPD). The short leg 'reaches' and stresses the hamstring insertion. OP's Q factor shift may have contributed.
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    Default Re: Hamstring Tendinopathy - experience here?

    Quote Originally Posted by j44ke View Post
    Tendonitis is over-use inflammation. So you just over-did it at some point and then kept going and now you have tendinitis.
    Quote Originally Posted by ldamelio View Post
    {snip} ...Mine comes from a leg length discrepancy that I have compensated in my road shoes (Look cleats with a Specialized shim) but not in my MTB/Cx shoes (SPD). The short leg 'reaches' and stresses the hamstring insertion. OP's Q factor shift may have contributed.
    It’s starting to make sense now.

    I’d ramped up the distances carefully to avoid any kind of over-training risk, but, because most of my longer rides have been wet, almost all of those kms have been on the bike with the wider q-factor - so I have inadvertently jumped into an overtraining scenario there.

    The change in q-factor is not insignificant being at least an 8mm change over any crank I’ve run in recent times, and 11mm change Vs my Shimano cranks. It is all the only thing that has changed, bio-mechanically.

    I have an LLD too, but I’ve been riding with that for the last 10yrs with compensation.

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    Default Re: Hamstring Tendinopathy - experience here?

    Had it several years ago. In hindsight mine was overuse coupled with undiagnosed hip labral tear that likely changed my gait and positioning as well. Anyway, it is VERY slow to recover from, especially when you love running/riding and use that as a stress release "cope with life" etc as I did. I tried all the normal stuff including PT, but what helped ME, and I share in case it is helpful in your case: (and again I was focused on NOT completely stopping activity) I found a Japanese chiropractor who would do graston technique (essentially an instrument-assisted deep friction massage) on the area--given where that area is, your butt is exposed etc, and I was not able to find a western chiro who'd do it. That and eccentric loading (doing essentially a reverse single-leg Romanian deadlift where I started standing upright with kettlebell and focused on the affected leg as I bent at the waist lowering the kettlebell toward the floor--you may not need much weight at all depending on how bad it is. I also iced after I doing proper warm up and my eccentrics. if I could have figured out a good way to do cross-friction ice massage at the area where the hamstring inserted, I'd have added that. Anyway, doing the chiro/graston and eccentrics, and icing coupled with only doing easy rides and jogs (and backing off if I felt it), it still took many weeks into several months to resolve. after that i worked hard doing 20 min of stretching after workouts to get more flexibility in hamstring, calf, quads, piriformis, and ITB

    good luck!

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    Default Re: Hamstring Tendinopathy - experience here?

    I had this combined with a small tear in my hamstring. It took a very long time (18-24 months) to heal.

    I went to two different PTs and made sure that they understood that I wanted to return to riding as fast as possible. In hindsight this was a mistake on my part. Both of them understood and did the best they could but I think the treatment actually led to a longer recovery time (deep tissue massage, lots of stretching, lots of exercises, etc). I'm also pretty sure that my excitement to do the work didn't help. In other words, "The PT told me to do this 2x a day. So I'm going to stretch 6x a day."

    Eventually I quit the 2nd PT out of frustration (he literally said, "I've done everything I know how to do and you're just not improving.") and hung up the bike for a while (close to 6 months IIRC) and relied on ice packs (2 at work, 3 at home).
    When I finally got back on the bike I was pain free (and slow AF). A consult with Happy Freedman @ HSS in NYC led me to shorter cranks (he thought that the crank arm at 12:00 was putting additional stress on my hamstrings) I noticed (and liked) the change immediately.

    The moral of my story: recovering harder is not a thing. I probably could've saved myself a year + a whole lot of $$$
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    Default Re: Hamstring Tendinopathy - experience here?

    Those foam rollers worked miracles for me. I'm not sure exactly what they're called, but you move yourself over them using bodyweight as the pressure.

    Some have textures and some don't. They are relatively inexpensive if you want to try a few different ones.

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    Default Re: Hamstring Tendinopathy - experience here?

    Yeah, I have a foam roller and a Theragun - I’m allowed to do both, but only on the muscle.

    I’m not allowed to stretch yet.

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    Default Re: Hamstring Tendinopathy - experience here?

    If you are riding through it remember that if you decrease the hip flexion angle (higher bars, seat forward) you will decrease the end pedal stroke strain on the hamstrings. Narrow Q, solid platform pedal with play in the cleat may help too.

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    Default Re: Hamstring Tendinopathy - experience here?

    Quote Originally Posted by rabo View Post
    If you are riding through it remember that if you decrease the hip flexion angle (higher bars, seat forward) you will decrease the end pedal stroke strain on the hamstrings. Narrow Q, solid platform pedal with play in the cleat may help too.
    Thanks. I've booked a bike fit for a couple of weeks time - hopefully to give me a bit of recovery time, then assess where I'm at and see what might need tweaking to better manage this.

    An update with the physiotherapist yesterday morning has shown no progress in the last week despite being (mostly) good with my exercises, which is making him think it might be worse than he first thought - albeit still not what he would term a serious bout.

    I'm in the process of ordering bits to move the wider q-factor bike back to a narrower setup - which pains me, because those cranks suit the bike so well; but, as much as anything, removing such a big difference in q-factors between bikes seems logical anyway (and it's significantly cheaper than what I would have done to make both bikes wider!). I already run Shimano road pedals so that sorts the solid platform with float.

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    Default Re: Hamstring Tendinopathy - experience here?

    Also ; google the articles from Asker Jeukendrup about tendon injury and nutrition (gelatin) .
    really interesting information there.

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    Default Re: Hamstring Tendinopathy - experience here?

    High hamstring tendinopathy has been an ongoing issue for me over the past year or so. Last summer I saw an ortho doc who sent me to PT who prescribed strength building mostly Romanian Deadlift type stuff to build up my hamstrings. I don't really think it is strength issue, but nonetheless I did the work with mixed results.

    Last summer we moved to Northern Wisconsin from Northern California where I was used to riding year round. Outdoor riding fin Northern Wisconsin for me ended this past October and I have been on the trainer since. The pain/discomfort has waxed and waned throughout the winter: it increases when I use higher watts but if I just spin at a higher (for me) cadence then I have fewer problems, but it is still there. I have moved my seat forward and that has helped some, but the problem is still there. If I can find a knowledgeable fitter in this area or within reasonable driving distance, I plan to try that too.

    At this point it is tiresome since on those days when the tendon feels inflamed I am uncomfortable while on and off the bike. The doc says she can try a cortisone shot, but I am not ready to go there yet. From what literature I have read and looking on various cycling forums for folks with similar issues, this is an injury that can take a very long time to heal. Good luck with your treatment progress and recovery.

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    Default Re: Hamstring Tendinopathy - experience here?

    Quote Originally Posted by rabo View Post
    Also ; google the articles from Asker Jeukendrup about tendon injury and nutrition (gelatin) .
    really interesting information there.
    Sorry if this becomes a thread drift but is anyone using gelatin or have knowledge or opinions about it for healing and exercising? I have not but have read mixed things from it works to it doesn't really do anything.

    I don't have anything useful to add about the tendinopathy except that the older I get the more the problems add up. It feels like no pain ever goes away forever, only subsides for a while. I have had cortisone shots in the past and generally found them effective for different issues. A few weeks ago I was at the ortho and they prescribed cortisone pills. I was happy to take them for the generalized anti-inflammatory effects. I felt great while on the pills for the 6 day course but the day after the last pill my whole body became sore. Like the worst workout ever sore. That lasted a few days during which I managed to build a nice new painful knot in my back. I'm not blaming the pills for that but it hasn't been a great 10 or so days.

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    Default Re: Hamstring Tendinopathy - experience here?

    Quote Originally Posted by metalheart View Post
    High hamstring tendinopathy has been an ongoing issue for me over the past year or so. Last summer I saw an ortho doc who sent me to PT who prescribed strength building mostly Romanian Deadlift type stuff to build up my hamstrings. I don't really think it is strength issue, but nonetheless I did the work with mixed results.

    Last summer we moved to Northern Wisconsin from Northern California where I was used to riding year round. Outdoor riding fin Northern Wisconsin for me ended this past October and I have been on the trainer since. The pain/discomfort has waxed and waned throughout the winter: it increases when I use higher watts but if I just spin at a higher (for me) cadence then I have fewer problems, but it is still there. I have moved my seat forward and that has helped some, but the problem is still there. If I can find a knowledgeable fitter in this area or within reasonable driving distance, I plan to try that too.

    At this point it is tiresome since on those days when the tendon feels inflamed I am uncomfortable while on and off the bike. The doc says she can try a cortisone shot, but I am not ready to go there yet. From what literature I have read and looking on various cycling forums for folks with similar issues, this is an injury that can take a very long time to heal. Good luck with your treatment progress and recovery.
    Already sounds familiar.

    My exercises are dead lifts (starting from a high point as I can't get near the ground right now!), bridges/eccentrics, side planks with 'clamshell' movement - all to strengthen gluten and hamstrings. Some days they make it feel worse, though (like today); and then I have a dull ache all day, which is tiresome.

    The bike fit I have booked in is with a physio who used to work above the bike shop I managed in London before we move to Sydney. I mention that because it means that, firstly I know I can trust her as a physio as I have used her before, and secondly I know who trained her in fitting and know that I can trust that knowledge. She also races, so she's totally aware of the need to ride and the impact of not riding.

    In fact she's already mentioned that the location of the tendinopathy in relation to the saddle and any resulting compression against the saddle can make it worse, so that could be worth investigating (for all of us who suffer).

    I changed my seatpost and stem yesterday in preparation for the fit (the stuff I had on the bike is not the kind of kit that is good for doing repeated fit adjustments). In doing so I noticed that the saddle on that bike was circa 15mm further back that it should have been. I haven't used that bike as much recently, but I can't help thinking that is another likely contributor.

    Frustratingly, I was above target to add around 50% to last year's ride total, and that was my biggest year in a long time (although the previous year would have equalled it if it hadn't been for the bushfire smoke). I had built up steadily towards the end of last year and was able to maintain some of the momentum of the quieter Christmas period (which is the biggest change over previous years), so my volumes haven't spiked so much as me just maintaining consistency. Now if I ride I'm done after a slow hour because I'm riding at such low intensity that it's probably damaging me mentally ("I'm better than this, damn it!") and I'm bored of the dull ache that usually accompanies it.

    Part of the issue for me is that no particular movement or action on the bike makes it worse or hurt more, so I feel like I could just push harder and deal with the pain; but that's not going to do me any favours long term. I hate indoor trainers with a passion, but I do plan to pick one up so that I can perhaps work towards some harder sessions without feeling so pathetic on the road (and to avoid hills, which is tricky here).

    Cortisone ain't happening for me. I can't get comfortable with the idea. I might try PRP, but I've read that's pointless unless you do some of the remedial work in the first place. Given that it's not cheap, that seems to make sense.

    Quote Originally Posted by rec head View Post
    I don't have anything useful to add about the tendinopathy except that the older I get the more the problems add up. It feels like no pain ever goes away forever, only subsides for a while. I have had cortisone shots in the past and generally found them effective for different issues. A few weeks ago I was at the ortho and they prescribed cortisone pills. I was happy to take them for the generalized anti-inflammatory effects. I felt great while on the pills for the 6 day course but the day after the last pill my whole body became sore. Like the worst workout ever sore. That lasted a few days during which I managed to build a nice new painful knot in my back. I'm not blaming the pills for that but it hasn't been a great 10 or so days.
    Sorry to hear that. Referral injuries (i.e. injuries that come about through using your body differently to accommodate the pain of the original injury) are one of biggest pet peeves, so I'm trying to do all I can to avoid those too.

    But yeah, this definitely reaffirms my general dislike of the cortisone idea.

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    Default Re: Hamstring Tendinopathy - experience here?

    So Rich, just a question - you are totally sure this is hamstring tendonitis and not ischial bursitis? I once had a super painful ischial cyst and the pain went down the back of my leg at its worst. I couldn't sit on a saddle and had to cant my hips while seated at the dinner table. The bursa that gets inflamed is right at the attachment point for the tendon connected to the hamstring. It is palpable. Like a small grape. Treatment was anti-inflammatories, ice, and then eventually changing my saddle. I was using a Fizik Arione with a cutout, and the seam that created the edge of the cutout proved to be an irritation. I switched to a Prologo that seemed to be similar but different in the concerning areas, and it worked. I did a fair amount of pilates targeted on that area and some time off the bike, but it wasn't that long. Maybe 3-4 weeks.
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    Default Re: Hamstring Tendinopathy - experience here?

    A hamstring resisted contraction or/ and a hamstring end range stretch should differentiate a contractile source of pain vs a bursa imo.

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