stubborn hamstring - I'm desperate!

[roadhog]

Over the last year, I've developed a chronic hamstring issue that I just *can't* lick. I'm many months beyond frustration and open to any solutions. Here is some background...

I like to run about 40-50 miles a week, about 80% of it is on rugged and hilly forest trails. I also road cycle quite a bit.

15 months ago, I "tweaked" my r hamstring (very mild class 1 strain) playing ultimate frisbee. Throughout last winter I kept up my running. I could always feel it, but it never really bothered me (of course I know this was a mistake in hindsight). Last Spring I was gradually increasing mileage to prepare for some summer events. At some point I noticed that my hammy was getting worse and soon I was limping after runs and it was affecting my gait.

In May I took 3 weeks off - no activity at all. It made no difference. On June 1st I quit running entirely and only cycled thru the summer. During this time I saw a dr. and was refered to physical therapy. The PT was focused solely on my running mechanics and stretching. I followed all his stretching routines for a month while also never running. No luck.

Any time I attempt to run, after 3 minutes I could feel it and I quit after 7 minutes or so becuase I felt like I was causing more damage.

In August I quit even cycling in case that was slowing my healing somehow. It is now almost mid-December. I haven't run or cycled in 16 weeks and haven't run in 6.5 months! But the problem still persists with no improvement.

In Oct I saw a new sports med dr. She felt that I have a scar tissue problem (though without feeling my leg or anything once) and also refered me to PT. So for the last 6 weeks I've been going to PT twice a week for ultrasound treatments. I've also gone on my own to a massage therapist for 3 sessions of deep tissue massage since the PT clinic seems uninterested in massage. I have been stretching twice a day for weeks and weeks as well.

There has STILL been no improvement. I can feel it when walking, but it hurts any time I try to run.

Any thoughts? I'm truly desperate and going out of my mind. I HAVE TO GET BACK ON THE TRAILS!

btw I'm a 34 y.o. male. I've been running my whole life. Never had a hamstring prob before.

[Heidi]

Hi

Do you get any pain or other feelings when doing any other activities. Such as sitting down for long periods, driving, moving from sitting to standing or anything you can think of?

Have you ever had any back pain?

Have you ever had any other injuries to either leg, foot, hip, back etc?

How would you describe the pain and where in the hamstring is it? Does it radiate at all?

Sorry for the questions, but they may help establish what could be the cause of your pain.

[roadhog]

Thank you Heidi for your prompt response. Of course I'm happy to provide any info that might be helpful.

The pain is high-mid hamstring. In the area anywhere from 2-4 inches below the crease where my thigh meets my buttocks. I would not say it radiates. Fairly localized discomfort. No acivities like driving or anything cause me trouble. I am able to produce the pain with certain movements while not running. Generally, a reverse leg raise (lying on stomach and rasing one straightened leg off the ground) aggravates it much more than a hamstring curl does - though I can feel it usually in a curl as well. Moving from sitting to standing doesn't bother it. Any movement which would mimick the muscle requirements of the reverse leg raise as I described it would especially bother it.

I've never had any real back pain troubles. No injuries to my lower extremities. I am somewhat prone to ITB troubles only when my regular runs exceed 15 miles or so.

[Heidi]

Thanks for the info.

The reason I was asking about referred pain and pain when sitting etc was in case it was a neural problem, possibly radiating into the hamstrings from the sciatic nerve. This doesn't seem to be the case from what you've said.

Does your massage therapist feel anything when he/she massages the hamstring? And do you feel its tender to the touch when getting a massage?

Have you ever had any core training? I think this would be my next step. If the core isn't string and the pelvis not stabilised this can slow healing of a hamstring injury as they attach to the pelvis.

My other thought would be, are there any trigger points in the gluteal muscles, esp glut medius. These can sometimes refer pain to this area.

[extremeskins]

Hey Roadhog,

Ok, we've established that you are able to recreate the pain with any "contraction" of the muscle (ie. hip extension, knee flexion).

When you experience any pain/discomfort (or recreation of your symptoms) from the contractions.... does the pain from the activity "increase" or "stay the same"? Is the pain sharp or dull/achy?

How about applying a "stretch" on the muscles? For instance, a straight leg raise (on your back... lifting up your leg.... with AND without your knee flexed)?

With your knee straight (fully extended).... can you bring your hip up to 70-90 degrees?

FYI, a lot of muscle strains are generally due to muscle imbalances. And why most athletes injure their hamstrings is because of a lack of gluteal strength as an synergist. I would recommend you start strengthening your glutes (max/med).... to help take some of the load off the hammys.

As far as treatment.... has the physical therapist assessed the length of your hamstrings/quads/ and other muscles acting on the hip (TFL, ITB, Iliopsoas, Adductors long/short)? Have they performed muscle tests (strength testing) of the medial/lateral hamstrings (semimembranosus/semitendinosus and biceps femoris) to see which one is actually strained? Because the stretch/strengthening exercises for those muscles are different.

Just to give you an idea... if you've found a good therapist or not :-)

And get some Active Release Techniques (ART) done on your hammys. I guarantee it would help :-)

Cheers.