Steroids or surgery

Hi folks,

I was after some reassurance. I've suffered from hamstring tendinopathy for about 2years and my running has pretty much totally stopped. I've tried physio and shockwave therapy and the PT recommended seeing a consultant. The consultant has recommended before surgery trying steroid injections. But I can seem to find good things said about the procedure! I'm sceptical that after 2years the injections are going to make much difference and am tempted to just go straight for surgery. Any thoughts or suggestions?

Thanks,

Matt

https://www.facebook.com/YLMSportSci...type=3&theater

Try Chinese Acupuncture first. I'd be still sofabound if i hadn't given it a shot.

One other thing that springs to mind from my own experience is that if your body is in the stress response it won't heal shit. All resources will be diverted elsewhere. If you want to know if you are in the stress response or not the book 'Conscious Medicine' by Gill Edwards will solve it for you, and give you a background on the mind/body problem. Should be able to pick it up on ebay for under a tenner.

Chinese Acupuncture is part of the ancient Chinese medical system which has the mind as potentially being part of the problem, aswell as nutrition etc. The NHS gave me one clean bill of health after another, but in the Chinese model i was a car crash and about ready for the glue factory. Appointments cost 40-50 and you need 6-8 to know if it's going to work. Be ready for the cheese factor to go through the roof though; you're going to be hearing about Chi(Energy), Yin/Yang theory, Jing, Shen, softening, depletion, Arrogant Liver Fire...just roll with it, it's more powerful than most people will ever realise.

Other than that are you sure you've maxed out your friction massage? You can do it yourself in a variety of ways, i always favour Lacrosse balls. I never get stuck with that kind of stuff...voodoo flossing is also smashing for soft tissue release. I use a 4mins then wait 4 days schedule for friction work, the 4 days is required for clearing out the scar tissue so your 4min sessions only happen every 4 days.

Oh dear. This is almost exactly my world currently! Been having physio since August with no benefit to the Proximal Hamstring Tendon (though helpful in other ways). Also pilates and other conditioning. PHT getting worse.... Just been referred for a ultrasound guided steroid injection into the sheath around the PHT. Also recommended is Nordic Hamstring exercise. Try googling it. Unfortunately I cant put weight on my left knee, so need to find an alternative.
I was looking at some research re the injections: there seemed a good response for most, with some lasting benefits for some, and reassuringly, from the modest sample (60+) no-one reported a detrimental effect.
Anyone out there have a good news story about recovering from Proximal Hamstring Tendonopathy? I'd love to hear it!!

Well my injections are finally scheduled probably at the same hospital as you Old Whippet (North Tyneside? Are you NFR?).

It's then 6weeks to decide whether the effect is beneficial or I get to elect to be chopped up...

Quote:

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re the injections: there seemed a good response for most, with some lasting benefits for some, and reassuringly, from the modest sample (60+) no-one reported a detrimental effect

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This is good to read as I'm unconvinced by their benefit.

What a coincidence! Yep - North Tyneside. I've lost hope with physio for this. Had an assessment 2 weeks ago with a helpful bloke who referred e on for the procedure. Not heard anything yet - did you wait long?
I was NFR but left after persuading so many of my club (Derwent Valley Running Club) to come fell running, it felt wrong to rock up in a NFR vest.
I'll be very interested to hear of your experience of the treatment.

I had the first injection (right side) yesterday. The consultant brought up some interesting things he said that the MRI (2016) and the current ultrasound didn’t show any abnormality which is a bit confusing. When trying to pinpoint the site for the injection he seemed to imply that pain was only just in the right location for the diagnosis and the treatment. He also said he sends about 20% if people away without injection! I’m going to try and get more detail next week when the left side is due to be injected.

I’ve started doing deadlifts in the last month and this seems beneficial. Also been using a really good posture video which has a lot of hamstring mobility which seems to help some.

Will update about improvements as time progresses

Good luck with your recovery Matthew.
I had my ultrasound guided steroid injection approx 5 weeks ago. Scan showed tendon intact but with inflammation. Consultant reckons just a small amount of pathology gives a disproportionate amount of pain and impediment with tendon problems - whether it's Achilles, hamstring or tennis elbow.
I would say significant improvement in pain when driving - now reduced to 'discomfort'.
Tried a couple of miles running 2 weeks ago - disappointing. Will give it another go in a few days.
Also doing Nordic exercises to strengthen - as well as lots of spinning, which doesn't hurt at all, and Pilates. Still hopeful, but not holding my breath....

Keep going chaps. One thing I would say is make absolutely sure your pelvic posture is normal. Chronic hamstring strains can result from a pelvis that has adopted an excessive rearward tilt resulting in a functional shortening of the hamstrings. And here's the interesting bit...this often arises in active men from a subconscious movement to 'offload' a cam deformity of the hip. Google femoroacetabular impingement to learn about this. Moral of the story...get your hips checked first as many sports people have this without knowing it.

It’s good to know that you are seeing improvement. I’d caution to really take your time to ensure it’s really sorted. As for me it’s the same old same old. The steroids didn’t do much, still uncomfortable and achey. I’m seeing the consultant again and will ask about other options (surgery!?).

I’m trying to ignore all the races and running/cycling my friends are doing and really focus on climbing. But it’s just not the same!

Ah well. The benefits from the steroid injection are now history, and I'm as sore as ever. Got a couple of months driving more comfortably, but that's all history.
Any running results in me feeling as if I've been hoofed in the arse by a horse.
Been doing loads of strengthening work and barely run at all, with no let-up in symptoms.
So.... I've just written to the specialist to ask for a referral for surgery.
Did you get any joy with that?

I’ve been meaning to update this. The consultants were massively reticent about surgery. The guy I saw played up the complications massively (potential nerve damage, drop foot, the potential to really feck the leg up). So I’ve really gone off the idea. He also said that actually it would eventually get better but could take a couple of years (surgery rehab was 1yearish).

So, I’ve opted not to pursue it, definitely for the moment. I also began to see a different physio (a lad called Eythan at Gosforth wellness and physio) who reckoned as it hurt when I didn’t run anyway I might as well try a bit of running to get the endorphin release. Also been working on my pelvic tilt, lots of quad stretching, and been dry needling my hamstrings. Started the rehab cycle again with easy single leg deadlifts and bridges etc. And for the first time in over a year it feels like progress is being made. It’s damn slow and a little bit 2steps forward one back but I ran round simonside for 1.5hours on Thursday, it wasn’t perfect but it’s better than 2months ago.

Also I’ve started doing mindfulness meditation to try and stop fixating on whether it hurts or not and that’s been a big help with the stress/anxiety. I think realistically I’m still a fair way from training properly but feel like I can begin to see an end.

Had the results from the second MRI... improved from 2016 but still inflamed... sigh, it’s been sore this week which is disappointing considering I’ve had a month or so of improvements (with some running and everything!). I have another appointment in to see the consultant in 2 weeks so will discuss further then. Physio is confident that it’ll get better, stronger glutes, better hip flexor flexibility and better adductor strength are all on the cards.

I might enter the ROC MM and walk round just to keep in practice...

Just to update this invade anyone is following/reading.

Back up to 30+ miles a week with generally no pain. Started taking collagen supplement and doing 10min of rehab exercise. Seems to be working well.

Interesting Thread and very relevant to me. More than a year ago I developed many of the symptoms described above. (Very painful and raw feeling below my left bottom bone making sitting down and running difficult/impossible).I didn't get much joy from initial visits to a physio and a massage therapist. They and I thought my problem was an injury to a hamstring. No improvement on the back of their treatment. 6 months ago I spent some money, visited a specialist, had an MRI and the problem was diagnosed as ischial tuberosity tendinopothy i.e. damage to the tendon which attaches a hamstring to my bottom bone (on the left hand side). The specialist gave me 2 options - physio or steroid injection. I elected for the former as I wanted to avoid intrusive treatment of any sort. I've had 6 visits to the (new) physio who focused me on exercises gradually increasing the load and strengthening my glutes and hamstrings. I very gradually increased the length of time I ran (starting with walks then 10 mins very gentle running) avoiding speed and hill work as they exacerbate the injury. I also use an ischial tuberosity cushion (one with 2 big holes in it for your bottom bones to relieve pressure in that area) when I drive, am on the train and sit for long periods e.g. at work. I now run for up to 1.5 hrs on the roads with little discomfort. One thing that has helped I think is changing my running style and taking shorter strides especially on the left meaning I don't stress the tendon too much. My problem has definitely not gone - I get a lot of pain whilst sitting for long periods - I need the cushion. I have also stopped stretching my hamstring on the left for the same reason. Hoping to get onto the fells again once we're on top of Covid19. Hope what I've said helps others in some way. If there any updates or tips from others incl. those who have posted then it would be good to hear back. I'd like to get back to 'normal' e.g. being able to run quicker and push harder on hills but I think it will take time. I guess the best remedy would be to stop running altogether for however long but, well you know!

Just so you know there is a light at the end of the tunnel. MY symptoms have settled down massively (it's take 3-4years! and I'm still not on a bike), but I even had a month of 40-50miles per week last month. They do flare up every so often but no way near as bad.

SOme things that I've found that helped:
Easy reps of single leg deadlifts every day. I also take colagen supplements 30minutes before doing it. There is some evidence for this, I'll see if I can find the links and coaches who recommend it and you can make up your own mind.

I started deadlifting heavy weights twice a week (sorta 5 sets of 6 at rpe 7), this seemed to really help until I thought it was a good idea to go big and tweaked it abit setting a PR, anyway it's settled now.

Also trying to be less aware and stressy about it was a massive thing. Going out, running and focussing on other stuff was really benificial. It being chronic it's really easy for it to be the complete focus of a run, waiting for it to hurt so be mindful of other things as well. I developed a mantra "sensation is not pain" and when it began to tweak or feel I would repeat that.

Hope that helps and if I think of anything else I'll let you kno.w