Remember that dull, aching, pain in the butt I got back in April? That pain right where the hamstring attaches to the butt muscle? Well I finally have a diagnosis for it. It’s called High Hamstring Tendinopathy. It means inflammation of the tendons at the hamstrings. This type of injury is a tough condition to treat, as I’ve found out in the past couple of months!
About nine months ago, my marathon training was going brilliantly. I reached that stage where it all clicked nicely into place. Running was a pleasure and I had that feeling I could do anything. I began doing longer and longer runs and about three weeks before the marathon I did the Gade Valley 20-mile training run – it was pretty hilly but I still managed to run at 5min/km pace, which completely took me by surprise!
A couple of days later I did a 5k Parkrun and noticed a little niggle in the back of my leg as I went round. It was nothing unusual, I get niggles all the time in marathon training, but it ached a bit the next day.
The following week, I felt this deep ache in the lower part of my left glute with pain over the hamstring attachment. Pain was worse when I did intervals and sometimes the pain radiated down to the back of my hamstrings. Movements like touching my toes was painful.
I didn’t think much of it initially. I’ve never had an injury completely stop me running so I thought my pain would settle quickly if I rested more. I halved my mileage and spent more time doing stretching and swimming, with the idea that stretching my glutes was the solution to my hamstring pain. In July, Clinton and I went to Charmonix and did loads of easy runs/hikes. I began seeing a physio on a weekly basis and for a while the condition has improved.
In September, I started increasing the mileage again in preparation for the Abington Marathon. I focused on distance rather than pace and went up to about 40-50km a week, and in mid-Oct managed to shave 8 min off my PB with a time of 3.25! Unfortunately, while the symptoms have not deteriorated they haven’t exactly improved either.
In October this year, I got a referral to see a sports physician about this condition. I had an MRI which showed that there was inflammation around my tendons and confirmed that I have High Hamstring Tendinopathy. Thankfully there are no tears in the tendon and although the ischiofemoral space is a little reduced there is no evidence of posterior impingement.
Initially, the pain was focal over the ischial tuberosity region on the left, but now it is a little bit more diffuse with discomfort through the left glute and upper hamstring.
I get no pain during a long run or at rest or while sitting, but if I do interval training then the symptoms come on. If I do a long run, I will have a dull ache for an hour or two, and if I have done intervals, then it will be a tighter sharper pain.
I’m not sure what the actual cause of my injury was. My best guess is overtraining! I’ve never had hamstring problems in the past despite a lot of hill running and speed work. The difference this time was the amount of training I did – I increased the mileage from 30km to 50km a week and perhaps my tendons didn’t have time to adapt to the training load. Upon examination my physio also found that I had weak glutes. That was probably another contributing factor!
1. Strength training / physio
For me, doing glute and hamstring strengthening and theraband exercises has been an essential piece of recovery. At first, I was scared to do any movement, but I discovered that smart strength training helped me put the bounce back into my muscles and heal from pain.
2. Carry on running / incorporate cross training
Unlike most injuries, you cannot get your tendons to heal by resting. Tendons do not get better by resting – they need a moderate amount of probing! So I carried on running but reduced running (and other types of cross training) to a level that doesn’t increase symptoms.
3. Shockwave therapy
I have also started extracorporeal shockwave therapy (ESWT) which I hope can be helpful. Shock wave therapy is a non-invasive method that uses non-electrical high energy acoustic waves (via a hand-held probe) to treat various musculoskeletal conditions. The shock waves produce a rapid increase in blood circulation to the target area and the idea is that they will break down fibrous scar tissue and induce healing. Apparently, most patients report a reduction in pain after just 3-4 treatments.
Progress so far
I have had two EWST treatments so far and I am improving, but it is slower than I’d hoped. Previously, my pain was a fairly constant ache that was worse in the morning but improved as the day went on. Now it is only present during activities that load/compress the tendon.
London Marathon and Ironman Barcelona 70.3 are only four months away and hopefully I can start training properly again in a month or so!
Over the next month, I shall be increasing my rehab, focussing more on working glute max and hamstrings. I plan to continue with my cross training – which means more cycling and more swimming!