Proximal Hamstring Tendinopathy Knowledge Dump - My Experience, Recovery, and Tips

Howdy all - I've been looking forward to the day I get to post this as I've noticed there is scant resources / posts here regarding a relatively common injury for sprinters, the Proximal Hamstring Tendinopathy. This is something I was recently diagnosed with, and have made huge strides in recovery since. I'd love to share some of the resources I used pre and post diagnosis and what the recovery process has been like. This will be a pretty long post, and I apologize as I am not sure there's a good way of writing a TLDR for this, though this (https://www.physio-pedia.com/Proximal_Hamstring_Tendinopathy) article is fantastic in explanation of both symptoms and management.

Proximal Hamstring Tendinopathy - What it is, what it feels like, and how you might be able to test for it.

Let me preface this section with this: I acknowledge that I will include some resources here that aid in home testing for this injury, but if you seriously suspect you are suffering from PHT, you will need to see a medical professional. I write about this later in the recovery section but without a physical therapist I don't think my recovery would have been nearly as successful as it is.

So this was really where my journey began, with a pain in my ass (lol). I noticed that I would develop a highly localized pain in my left buttock near my "sit" bone, or the area of my buttock that makes the most contact with a surface when sitting, and that this pain was most intense shortly after higher intensity workouts (endurance / volume days did not provoke nearly the same response). I also noticed the pain would be present after prolonged periods of sitting on harder surfaces such as a wooden chair. I realized something was seriously up when this pattern continued despite increase in rest days. I began googling the symptoms as I have described them above and almost immediately PHT caught my eye as it fit the description perfectly. To be doubly sure as to what I was dealing with, I used the following videos to test for the possibility of the injury, both are incredibly easy to perform and deliver relatively unambiguous results

So you might be asking, if I made the point of stating that this is something you need to see a medical professional about, why bother with all this research on my own? The answer is this - tendinopathies can easily be exacerbated by continuing training, heavy weightlifting, and even stretching (more on this later) and so I wanted to be sure as I could of the nature of this injury, in order to avoid making it worse.

Diagnosis and beginning recovery

After I was relatively sure this issue was PHT, I made an appointment with an Orthopedic and sports clinic. I was initially seen by a Dr. who performed palpation of the area, as well as several different flexibility and motion tests. Because the pain was so localized and the manual tests all returned the same result, we both decided that imagining was unnecessary. I also live in the USA, so as you all know healthcare here is fucked, and imaging would be insanely expensive and basically just tell us what we both knew already. However, if your Dr does recommend imaging, please do as they say, it just so happened that in my case it was not recommended (much to my wallet's relief). At this point we scheduled several PT appointments.

PT initially consisted of 2 visits a week for the first 3 weeks. A typical appointment consisted of about 10-15 minutes of Graston scraping of the affected area, followed by several strengthening exercises. After the first week I noticed an almost immediate reduction in pain, and after 2 weeks it was very significant.

During the first month, I had to change my training pretty significantly. I unfortunately cut down nearly all of my speed/sprint days and moved into almost exclusive endurance training (but thats fine since indoor season was wrapping up anyways and I wanted to build more endurance for outdoor in May). The rule of thumb described to me by my PT was "No more than 85% exertion, or 3-4 on a pain scale whichever comes first." Meaning, I could take a workout to 85% intensity, or work until I hit a 3-4 / 10 pain level. Also during the first month I performed isometric hamstring exercises 3 times a day, a great resource for these, as well as more info on what PHT is like can be found here (https://www.youtube.com/watch?v=uzbg4ZOWwoQ). Lastly, stretching was a no-no, at least at first. Because the injury affects a tendon that elongates under load, stretching in the early stages of this injury can actually do more harm than good.

Continued recovery and return to practice

Thankfully after about 6 weeks of PT, strict compliance to workout modifications, and daily strengthening exercises, my recovery progressed very well. At this point, you can expect your strengthening exercises to include more dynamic movements such as half-rep nordic hamstring curls, resisted hamstring curls, and roman chair extensions to name a few. Additionally, you can expect to see some return to sprinting in your workouts. At this point I was cleared to include 1 day in my week of straight sprinting / speed work (think workouts like 100m repeats or resisted 60m parachute runs) so long as I made sure to pack it up if the hamstring ever hit that 3/4 pain mark, the other 4 days were still varying types of endurance workouts. Lastly, light stretching was now allowed once again. Don't overdo it here, this is a very touchy but incredibly important recovery phase that if handled right will allow you to transition back into normal. Please keep in mind everyone's timeline is different, you might recover earlier than this, or it might take you longer.

Current status, looking ahead, and tips

I am now 2 months in and am feeling pretty good. I meet with the PT once every 2 weeks, and in a month I likely will no longer have to do that more than on an as needed basis. My speed days are still holding at 1 day a week, but will likely increase to 2 in a few weeks. The strengthening exercises have now progressed from bodyweight and resistance bands to actual (albeit light) weights, and I honestly just add them in to my normal lifting routine (I lift 3 times a week in addition to the track workouts). The exercises are ones such as hex bar deadlift, slow form hamstring curls, and slow eccentric nordics.

I feel like I am probably missing something here, if you have any questions please comment and I will do my best to answer. Last but definitely not least here are all the random tips I couldn't somehow fit into the above wall of text

  • Compliance is key. If your Dr or PT tells you to do something, do it as if your life depended on it
  • Hydrate Hydrate Hydrate
  • There is evidence that taking a collagen supplement can aid recovery, I did (and continue) to do this myself
  • Massage guns and foam rolling are also great. They dont provide the intensity of Graston, but done once or twice a week they can help aid
  • You WILL have to change how you train, so just prepare for that. You can pay your debt now, or rack more up and pay big time later in the form of a chronic injury or even tendon rupture
  • Lastly, bulletproof them hammies. I am certain that it was my lack of attention to my posterior chain of muscles that caused this issue in the first place. Focus on building a very good strong foundation on the off season. There is a reason people always tout injury prevention as a benefit of weight training