High Hamstring Tendonosis (HHT)

/, Sports Injuries/High Hamstring Tendonosis (HHT)

I have seen many cases of High Hamstring Tendonosis (HHT) over the years.  Most patients have presented with  a similar set of symptoms.

Symptoms High Hamstring Tendonosis

Pain while sitting

Pain while running, biking or rowing

Increased pain while running faster

Increased pain while running uphill

Pain while stretching their hamstring

Since most runners I have seen share these set of symptoms it has become easier over time to accurately diagnose their injury.  Only with an accurate diagnosis can an effective treatment plan be prescribed.  Unfortunately for many they had seen a host of other types of practioners before seeing me.  These included Chiropractors, Physical Therapists, Massage Therapists, Personal Trainers, Yoga, Ice Clinics, Postural Therapists, Running Coaches and Orthopedic Surgeons.   Similar to sharing symptoms those with High hamstring Tendonosis seem to share negative experiences when seeing many of these types of therapists.

How do Chiropractors treat High Hamstring Tendonosis

The stories we hear about most Chiropractors and their approach to High Hamstring Tendonosis begins with an inaccurate diagnosis.  They tell the person their pelvis is rotated and that they need to have it adjusted 2-3 times a week for 4-6 weeks!  They often instruct the person to do aggressive stretching exercises that only make the injury worsen.  Some of them also seem to believe that if they “dig in there” hard enough this will somehow cure the injury.  It does not and only serves to aggravate it.

How to Physical Therapists treat High Hamstring Tendonosis

Most of the patients we have seen that have visited Physical Therapists have been told their hamstrings are too tight, their pelvis is rotated and they have weakened Gluteal muscles.  The person is instructed to come 2-3 times per week for 4-6 weeks. During this process they are instructed how to stretch their hamstrings and strengthen their Glutes.  Interestingly many of them also believe that if they can just “Dig in there” deep enough they can break up scar tissue and this will solve the problem.  It does not and only aggravates the heck out of it.

How do Massage Therapists treat High Hamstring Tendonosis

Maybe the Massage Therapists taught the Chiropractors and Physical Therapists or maybe it’s a “which came first the chicken or the egg” situation but Massage Therapists all seem to believe that if they can “dig in there deep enough” they can break up scar tissue, increase the persons range of motion and make them pain free.  This obviously does not work and only makes the person worse.  Unlike Chiropractors and Physical Therapists these Massage Therapists seem to only recommend 1 time a week for an indefinite period of time.

How do Yoga Therapist treat High Hamstring Tendonosis

Yoga seems to be all about stretching and isometric strengthening holds.  The Yoga Therapist obviously can not diagnose and so they really have no knowledge of what the person actually has going on.  They tell the person their alignment is off and they have tight hamstrings.  They believe that if you can stretch them beyond a normal range of motion that you will be better.  Not only does this not work but typically stretching actually intensifies the pain and makes the injury worse.

How do Personal Trainers Treat High Hamstring Tendonosis

You would think that the Personal Trainers would try to strengthen the persons hamstrings, and some do.  However, increasingly we hear patients tell us stories of how their personal trainer told them to sit on a lacrosse ball or some other ridiculously hard ball and apply rolling pressure for up to minutes at a time.  The person will describe the horrific pain they are in while doing it and incredibly will say something like “It really seems to be helping”.  They think this because when they finally stop rolling on the ball it starts to feel better!  This is like saying getting punched in the eye “Really helps” because it feels better when you stop getting punched!  Direct pressure on the High Hamstring Tendon is contraindicated and is known to make the injury worse.

How do Ice Therapists Treat High Hamstring Tendonosis

Ice therapy is nothing new.  Proponents of icing injuries have been around since the beginning of time.  Ice therapy clinics are new though.  Owners of these clinics claim their ice treatments will fix your hamstring injury, get rid of your cellulite while your at it and even cause you to lose weight!  Of course this is complete nonsense but runners with High Hamstring Tendonosis are desperate and will spend thousands of dollars on even the most controversial treatments.

How do Postural Therapists Treat High Hamstring Tendonosis

I am not even sure what a Postural Therapist is or what their credentials are but if you see one you will certainly be told your posture is causing all of your problems and that if you correct it your pain will disappear.  Of course this is ludicrous and after many postural correction sessions you sit straight up but your hamstring still hurts.

How do Running Coaches Treat High Hamstring Tendonosis

A good running coach will refer you to a great running injury doctor and some do.  Most tell the runner that their Hamstring Pain is caused by poor running form.  The most common thing we hear is that they have to switch from being a heel striker to a forefoot runner.  Whether or not forefoot running is superior to heel striking is irrelevant as their High Hamstring Tendonosis was not caused by their form nor will it be fixed by changing it.

How do Orthopedic Surgeons Treat High Hamstring Tendonosis

A visit to an Orthopedic Surgeon typically goes something like this.  A cursory exam, sometimes not even testing or touching the area.  An offer of a cortisone injection (contraindicated in cases of High Hamstring Tendonosis) and a referral to physical therapy (which does not work) only then to be told you need surgery.

So What the Heck Works to Fix High Hamstring Tendonosis

We have developed a treatment regimen for High Hamstring Tendonosis that works extremely well but must be followed to the “T”.  It all begins with resting from running.  I know, I know you don’t want to stop running but that is exactly why you are where you are currently.  Here is the good news.  You only have to stop running for a month.  After  a month you can begin running on an Alter Gravity Treadmill.  Here is how the program breaks down

Week 1:  Platelet Rich Plasma Injection

Week 2: Begin Isometric Strengthening

Week 3: Begin Light Stretching and Light Concentric Strengthening

Week 4: Begin Eccentric Strengthening and Alter Gravity Treadmill Running

Week 5: Continue Eccentric Strengthening and increase resistance on Alter Gravity Treadmill

Week 6: Continue Eccentric Strengthening and increase resistance on Alter Gravity Treadmill

Week 7: Continue Eccentric Strengthening and increase resistance on Alter Gravity Treadmill

Week 8: Continue Eccentric Strengthening and increase resistance on Alter Gravity Treadmill

This process continues as your hamstring builds new tissue to replace the fibrotic and tendonosis that was present.  Since everyone has a different level of injury it is difficult to know exactly how long it will take to gain 100% healing but it can be predicted based on your strength on the Alter Gravity Treadmill.  Most recover somewhere between 8-12 weeks.

There are a host of other things we get asked about to speed up healing such as nutrition, foam rolling, taping and electrical stimulators.  We find all of these to be somewhat helpful but not generally necessary.

To schedule an appointment with Dr. Allen email info@sdri.net or call 858-268-8525

By |2018-08-20T18:48:28+00:00August 20th, 2018|Running Injuries, Sports Injuries|0 Comments

About the Author:

Dr. Bruce B. Allen, DC, CKT is a graduate of Southern California University of Health Sciences, (LACC). Prior to becoming a Doctor of Chiropractic Medicine, he worked as a Physiotherapist and Personal Trainer throughout San Diego. Dr. Allen received his Bachelor of Science in Kinesiology (Human Movement & Sports Science) specializing in Kinesiotherapy from San Diego State University. In addition, Dr. Allen has had extensive experience working with patients for post-operative and sports injury rehabilitation in a local physical therapy clinic here in San Diego.

Leave A Comment