Hamstring Injury

Here are hyperlinks that are embedded in the text below.  I’m putting them here for quick reference

8-5-2016

I’ve got a hamstring injury – x 10 weeks now as of 8-5-16.  This post is intended for giving information for those I would consult on the issue, to document progress and to document useful links or details that might be useful to runners with or without such an injury.  It will change as new information or details are available.  I know it’s a bit excessive to document all this stuff but I’m basically disabled from running or even walking fast and trying to figure it out.

I’ve hyperlinked some of the details to avoid TMI and yet retain the information for myself or others who may be interested.  Thus, read along and click links if you want to read more.  At least now with a radiologic diagnosis I can spare you the lengthy explanation as to why I’m sure it isn’t pyriformis syndrome or a sciatic or hip joint issue.  MRI report is here.

Here are a few details I have gathered about hamstring anatomy and function in running. I hope to add to this page as there are good reasons to strengthen and condition your hamstrings for running but I haven’t yet added that stuff.

I’ve been lucky to be fairly injury free for my life and most aches have been something that I could either rest or just run or exercise through.  But this problem has been persistent, around 10 weeks as of the beginning of August 2016.  It began around June 18th 2016 and was noticed on a trail run at CRP / Big Cedar in Dallas and there are three potential causes or aggravators that I am considering, referenced here but I can’t say that there was a definitive incident that caused the injury.  I’m guessing that it was a trip and fall on the trail that started things. I had an MRI on 8/5/2016 and have confirmed that there is a proximal hamstring tear of around 50%.   I should include the fact that over the last ten week period, the symptomatology has remained completely unchanged without improvement or worsening.  Had I known that I had a significant tear, however, I would have been seeking earlier medical help and trying harder not to stress the hamstring.

MRI report is noted.  I have spoken with my excellent Baylor Hospital radiologist Dr. Greg Deprisko who kindly called me to talk about the details of my scan.  I will have more details an a link to images but the summary was that I have a proximal 75% tear of the biceps femoris head of the HS and partial tear of the semitendinosis head with tendinosis (edema and inflammation) of the proximal HS. Incidentally the right seems to show a bit of tear and perhaps tendinosis.  Subsequent discussion with another MRI radiologist suggested that it is probably less than 50% tear of the above tendons.

I have mostly abstained from running since the injury except for an occasional ‘trial’ run to evaluate the state of the injury.  And I have generally aborted those runs.  Here are details about the level of pain and specifically what exercises I can tolerate.  These provide some insight to the function of the hamstring that I had not ever really considered.  I am surprised at how hard I can do stairs, bike, etc with no pain but cannot run or walk without pain.

A very interesting realization is that this new left hamstring injury and pain is exactly like what I feel on the right side about 20 miles into a long road run but not so much with off-road.  I completed the 62 mi Miwok 100K on 5-7-2016 generally worn out but without a pathologic sort of ache anywhere.  When my R sided pain occurs, it is usually at a 9 min/mi pace 20 miles into a run on the road and is about the same level as this new left sided confirmed HS pain that occurs at the beginning of a run at only a 12 min/mi pace.  The R sided pain was frequently worsened post race by sitting in the car driving home.  Thus, due to the pain and MRI findings I have to conclude that I have an intermittent right sided hamstring tendonopathy as well.

Several folks have referenced the needs for ultrarunners to strengthen their hamstrings to prevent this sort of stuff.  There is an apparent diminution of strength that occurs in the posterior musculature with long distance runners.  I’ll post more as I learn more about this inclusive of ways to strengthen those muscles.

One more defining characteristic of my new L sided HS injury pain is that sitting in a car or on a ‘comfy’ chair or office desk chair is terrible and up to a 5/10 pain.  I get a dull almost throbbing pain at the inferolateral ischial area that becomes quite bad within 10 or 15 minutes.  Strangely (or perhaps not), when place an object on the chair resembling a bike seat then I can sit indefinitely without pain.  This object could be either rock hard like a block of wood, semi hard like a yoga block or soft like a 1000 cc IV bag or inflatable back rest.  As long as it does not put pressure inferolateral to the ischium then I’m OK.  This is exactly the location of the proximal hamstring tear.

Functio lasea – there is none in terms of weakness or instability.  That is, unless I consider that the pain causes loss of the function of running more than 4 mph.  Apparently, a worse HS injury may cause leg instability or notable weakness.  I do notice that with the HS-specific exercise of one leg prone leg curls, there is may be some weakness (20# L vs 30# R) but I limit the effort on the left due to pain and limit effort on both sides for fear of new or further damage.

Incidentally, regarding differential diagnosis,  I do not have nor have never had any symptoms I would refer to as ‘sciatic’ and my lumbar spine MRI done at the same time was normal.  Sciatic foot and leg flex tests are negative.  I have no lower extremity perceived muscular weakness or sensory deficit.  MRI shows no muscular atrophy in the affected hamstring.

So, I may be seeing a local orthopedic surgeon soon to help me evaluate my options.  I anticipate a trial of further conservative therapy.

As of 8-7-2016, I’m adding an activity log and commentary so I can remember what works, hurts, etc.

So, in summary

  • Significant left hamstring tear by MRI, some tear on the right and tendonosis L > R
  • 10 weeks of rather mild but unchanging left hamstring pain characterized by varying degrees of pain on running and walking and sitting improved a bit post MRI by strictly avoiding running activity x 1 week now and increasing swimming and stairs.
  • history of right sided thigh pain occurring only on a long run that I can now identify as being of hamstring etiology and identical to my left sided pain.
  • No perceived motor weakness or instability or sensory deficit.
  • No symptomatology referable to sciatic or other etiology and normal lumbar spine MRI
  • Other exercises with no or minimal hamstring use are totally painless (swimming, hard stair climbing, cycling)

Thanks for reading

DJ

8-7-2016 – reviewed MRI in person with the radiologist.  Probably not “75%” tear as dictated but <50%.  No gross displacement of muscle body like what one would see in an evulsion.  And I presume that “no muscle atrophy” is a comparison of R vs L and that might be a good sign for functionality in spite of the pain and objective evidence of injury.

Now, it’s going on 3 days since MRI.  Knowing the dx for sure I’ve been really careful not to aggravate it and seems to be about the best in the last 10 weeks.

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