Saturday, February 25, 2017

My hammies are trashed

Yep, trashed they are. Despite all the appropriate rehabilitation and taking it easy, they continue to niggle. Because of this and my continuing frustration, I consulted with another specialist sports medicine doctor to see what else, if anything can be done. She did a full assessment and found that strength-wise the hammies are good, the glutes are firing well (they often don't in runners), but the lower back is still far too stiff (admittedly back loosening exercises haven't been a high priority in recent times).

She is a strong advocate of progressive loading of the hamstrings, regardless of my age and other risk factors. I indicated I have had several attempts at doing this only to have the hammies get more niggly. So we then discussed the big 'C' word, yep corticosteroids. CSs are commonly used to control inflammation and the associated pain in joints, ligaments and tendons. The downside is they can mask damage and interfere with healing as inflammation is part of the healing process. Of course, it is also possible that the pathology in my tendons is due to an abnormal inflammatory response and switching it off for a while may be of benefit. So despite my distrust of CS injections I opted to go ahead and get it done. I have two focal areas in my right hammies that continue to niggle and these were the areas to target.

The procedure is done using ultrasound guidance by a specialist medical imaging doctor. The preliminary ultrasound confirmed the presence of ongoing inflammation (not much change from seven months ago 😞). When injecting the solution (in this case Celestone - active ingredient betamethasone) it helps better visualise the tendons and the doctor commented that there are some big holes in my tendons. So yep they are trashed. Prognosis is pretty poor. The imaging doctor commented that he had not treated a lot of people with hamstring tendinopathy as it is not a common problem. He did mention one person with a big defect in a tendon that responded well to CS injection. He said that given the size of the holes, PRP would likely have limited effect given the inability to adequately immobilise the area post-injection. The PRP I had last year certainly hasn't helped.
I hope I enjoy pool walking as much as this woman 😉
So next step is the exercise rehabilitation prescribed by the sports doctor after resting for one week post-CS injection. The CS injection can take anywhere from two days to two weeks or more to have an effect (if it does). At less than 24 hours post-injection, there is no notable improvement, with a bit of 'injection' soreness. Payback karma perhaps from all my days as a horse vet and all the injections I gave my patients in the rump 😉! The exercise rehabilitation will involve some pool walking as this will load the hamstrings more gently and have the added beneficial effect of working the lower back to improve its mobility. Cycling is okay, recommence the walk/jog programme and keep doing all the gym work I've been doing. Then return to the sports doctor in five weeks time for a follow up and progress report.

I'd like to say I'm optimistic, but based on the ultrasound findings I'm not. However, now that I know the opinion of the specialist sports medicine doctor, I'll just figure out a way to manage this so I can stay somewhat active.