The story I am about to tell is one that I have unfortunately been part of hundreds of times. I’m with our running group this morning and one of the runners says, “Hey doc, do you mind if I ask you a professional question”? “Sure”, I responded huffing. “So, I got this tight hamstring……”. When he was finished I asked ” Are you asking me for advice about self-therapy you can do for your chronically tight and painful hamstring OTHER than coming to my clinic for a proper exam and diagnosis”? I said this somewhat tongue-in-cheek knowing he wanted me to solve his chronic issue right there on the trail with a magical piece of information. “I suppose you have already been stretching, it, rolling it, strengthening it……all the traditional home therapy things”, I asked? We picked up the pace but I continued, “Instead of telling you another useless thing to do that will not fix your hamstring I am going to tell you a possible future”! The runner glanced at me sideways but I went on, “You see, I have been treating running injuries for 18 years, running long distance for 15 of those and promoting trail running events for 9 years. I tell you this because unlike most doctors I follow up with my patients whether I like it or not. I see them at trail races, I see them on Facebook, I see them at club runs and eventually I see them in my office”. Here is where I predict your future. I said knowingly, “Your hamstring has been hurting for some period when you run. Especially when you run faster or do hills”. I glanced his way and saw the look in his eye. He had not told me that information but now that I said it he agreed. “Yes, it hurts when I do hill repeats and does hurt more when I run faster”. We were now approaching a long gradual hill so I prepared by shortening my stride a little and continued, ” You are going to stretch that hamstring, roll it, massage it, strengthen it, even pray over it if you thought that would help. But it’s not helping and its is never going to help. Your hamstring is going to continue to worsen and you will continue to do things like take Advil, use ice and strengthen it all the while convincing yourself you are helping it. Your hamstring will be screaming in pain at you to stop running but you won’t listen to it. Massage terrorists out there will tell you that you suffer from trigger points and lumps and bumps in your hamstring and if they just beat the shit out of it you will feel better. Physical terrorists will say you have weak glutes and tight hamstring and tell you to perform exercises that make your hamstring feel worse but you will do them because your hamstring is “weak”. Your primary care doctor will take an x-ray and proclaim “nothing is wrong”……which will be an incorrect and idiotic statement as x-rays cannot and never did show muscle, an MRI would be necessary for that. You may eventually get a referral to a “Specialist” who begrudgingly orders the MRI only to tell you that nothing is wrong even though the radiology report states you have “Tendinosis” in your hamstring. When you google it, and question him/her about what you read they will dismiss you and tell you its “normal. We finally made it to the top of the hill so I could breathe normally again and finish my fortune telling. “This future I just told you has played itself out in my clinic hundreds of times with similar or exact conditions. It might take 3 months, it might take 3 years but you are working towards it. When you do finally come to my Running Injury Clinic your hamstring will be torn. The new MRI will show the tear AND the tendinosis and I must give you the option of surgery. Here is what they will do” I paused, “They will drill a few holes in your Ischial Tuberosity (SITS bone) then take fish hooks and hook your torn hamstring back to the bone and hope it takes. You may never even run again”, I said with gloom and doom. I smiled, “Now let me give you an alternative future. Your hamstring is in pain obviously trying to tell you something is wrong. We immediately get an MRI and see the tendinosis. We follow a scientifically researched protocol that starts with a PRP injection and is followed by isometric exercises for your hamstring then progressed to eccentric exercises to rebuild the tendon and get you back to running in 3 months”. I glanced over and saw the pain in his face. “Don’t worry I know you are not going to do what I just suggested as that would mean 3 months of no running. That is how I know how to tell your future. Runners run until they can’t run anymore. I’ll see you in my office in 3 years”.