Friday, July 22, 2016

A 12 to 18 month process .......

I've been patiently waiting for a follow up appointment with my physio since an ultrasound finally provided an explanation for 5 years of muscle fatigue/cranky muscles/tight upper hamstrings. Despite those ultrasound findings, 'pain' is not the term I would choose to describe my ongoing symptoms. I stick with 'tight and cranky' hammies. It is disappointing that an MRI in 2013 failed to detect the source of muscle fatigue, which I had localised to the hammies/glutes back in 2011. C'est la vie, 3 years later and 4 health professionals later, a diagnosis! It wasn't in my head after all! In the meantime I have totally trashed my proximal (high) hamstring tendons. The question is, what can be done at this point?
Location of proximal or high hamstring tendinopathy
The damage to the tendons cannot be reversed, it is a degenerative tendinopathy. However, the ongoing reactive tendinopathy (occurring in the remaining normal tendon tissue) can be restored back to normal. To manage the degenerative changes, the muscles that support the tendon need to be strengthened. It will be a balancing act of strengthening the hammies and then finding the right exercise program that does not stir up more episodes reactive tendinopathy. Despite the duration of this problem, the ultrasound suggests there is a reasonable amount of normal tendon tissue remaining and the sciatic nerves appear normal (no obvious adhesions or entrapment). So there is something to work with. The physio advises it will be a 12 to 18 month process! Once upon a time that would have sent me into a deep depression. However, this has been ongoing for 5! years, so 1 to 1.5 years doesn't seem that bad. It's all relative.
No more women's100 for a while

As for what that 12 to 18 months will involve, it's early days. The next 4 weeks are the starting point. Phase 1 will be LOTS of isometric exercises (e.g. the isometric bridge). These start the strengthening process and have been shown to reduce the discomfort associated with the condition when performed 3-4 times per day. There are also lots of things one should avoid doing. I really stirred up the reactive component of the tendinopathy recently with 'frustration intervals' (short, sharp speedy interval sessions), so running is something to be avoided. Gentle cycling is okay but no more Rapha Women's 100 for a while!  Other things to avoid include sitting for too long (avoid hard surfaces), too much walking (and walking up hills), hamstring stretches, deep squats, deadlifts, and hip flexion when standing (like when washing dishes and such). After the first 2 weeks of isometric exercises, if the hamstrings are more comfortable, then the next 2 weeks will include a mix of isotonic (e.g. swiss ball hamstring curls) and isometric exercises. Then it will only be 11 to 17 months to go!  

Friday, July 8, 2016

A 'bit of' bilateral proximal hamstring tendinopathy

Finally an explanation for the tight hammies that have been plaguing my running for the last few years! After messing around with various exercises and running form for the last few months, it was time to get some more imaging of the hamstrings. Sadly, back in 2013, an MRI failed to show up anything. Maybe because it is a bilateral problem and back then it was pretty similar on both sides, it wasn't obvious on the MRI (supposedly the gold standard imaging modality). Now days the right  side is always worse than the left and there continues to be a neural component mostly on the right side. An ultrasound today showed bilaterally inflamed proximal hamstring tendons, worse on the right. A shame for it to take this long to find an explanation. Thing is, I have never considered it to be 'painful' just tight and uncomfortable. Further, palpation of the affected region itself never hurt! I only feels tight with activity and gets irritated with prolonged sitting. Other people experience pain with exercise and palpation.
Unhappy inflamed hammies at their origin

Both side appear to be vascularised due to chronic inflammation
It is not a common condition, but there is plenty of information available on the internet. It is much discussed in various running and triathlon forums. Treatment usually involves rest (i.e. no running and limited cycling) and various physical therapy and exercise programs. I'm still to discuss what to do with my physio. But given the prolonged history, it won't be a quick fix if at all. Still nice to know what the problem is even if that means that's it for running. Time will tell.