Oh you thought you would win you silly hamstring injury, you thought you would go ahead stop me in the midst of my best training, racing, and most enjoyable block of running ever. And you did for a good amount of time, but now I’ve figured you out and am ready to rid my life from you.
My hamstring issues had lurked in my mind and in my body for months until the Ice Age Trail 50 miler. After Ice Age I recognized I had a problem, after Bay2Breakers that problem soon was serious. So lets set the scene. I’m having the best year of running. A new half marathon PR, unbelievable 100 mile trail debut, and a 4 min marathon PR at Boston made it easy to ignore the hamstring. I mean all that was required was a few easy miles to warm up and to stay away from running under 5 min pace. Those problems seem trivial when training for marathons and beyond. After Ice Age 50 mile there was no ignoring the pain though. The pain was getting worse, not better, and even worse, I had Western States less than 2 months away.
Gym, active release therapy, massage, rest, heat, cold, walking, riding. I tried them all in desperation to get ready for Western States. Throw the kitchen sink at the injury and hope something sticks. Maybe they were helping, maybe not, but the week of Western a painful flat 4 mile run guaranteed I’d be watching rather than participating in my first Western States experience. After the obligatory month off to rest, sulk, drink beer, and forget about running I got serious about understanding hamstring tendinopathy and more importantly countering it.
First, what is it? Well upper hamstring tedinopathy is literally a pain in the ass. More specifically for me it was right where the hamstring inserts on the ischial tuberosity. Driving, sitting at work, walking fast (uphill) all triggered pain. So what exactly is going on in the hamstring? Well you might think pain = inflammation at the tendon. However, tendon pains associated with inflammation is tendinitis (the -itis refers to inflammation). Instead tendinopathy is this ultra vague term that refers to degradation of the tendon without inflammation. It could be improper remodeling of the tendon after injury, could be degradation of the tendon? hmmm, those sound bad and they are. But whats worse is that none of the doctors, physical therapists, massage therapists, acupuncturist, could tell me exactly what is going on. Or in the words of a physical therapist at University of California San Francisco “well we don’t really know how to treat it because we don’t know exactly what is going on at the tendon”. Great.
Still just because they don’t know for sure how to treat it doesn’t mean they don’t try. So I dove into the literature for my own and found that 30% of the time stretching and strengthening worked, 30% of the time platelet enriched plasma (PRP) injections works, 30% of the time cortisone injections worked, surgery worked 50% of the time, and 0% of the time did they know why or how. Where to start??? Well I started conservative, but fully expected the end result to be surgery. Maybe I was pessimistic after two months. I began with exercises derived from this article (and this article), which are the most comprehensive and on point articles I came across. First I did simple on legged bridge exercises for several weeks to strengthen the gluts and hamstrings. Next I introduced more eccentric work, hip raises with one leg up on a chair and limited two legged swiss ball curls. I like the swiss ball curls because they allow you to compare how my good hamstring felt relative to my injured hamstring. I kept up the massages with Stefan who would spend nearly the entire hour just focused on my hamstring, but dropped all the other extra treatments I couldn’t afford. To regain some cardio fitness I was on the elliptical and stairclimber at 24 hour fitness where I would often leave a pool of sweat at the base of whatever unfortunate machine I choose to punish myself on (Kenny Kane has an excellent skit on this).
Eventually I started running. Half a mile, one mile, 3 miles, 10 min pace, 9 min pace. I added in eccentric work on the hamstring curl machine at the gym. Bring 65 lbs up with both legs and then slowly lower it with one leg, it’s the quintessential eccentric exercise and it works. But I needed one more thing. Flexibility. Like many runners I hate stretching and it shows. Both my PT and Stefan were embarrassed at my lack of flexibility. So about 4 weeks ago I made the stretching daily central to my recovery plan. Whether I do dynamic rope stretching, put stretch up against the wall, or use it as an excuse to get in the hot tub, I stretch daily, while doing the strengthening every other day. Since then I’ve moved on to 5 miles, with hills, a little sub 7 min pace, and a few back to back days of running. Sure I’m not out the woods yet, I haven’t pushed myself on any runs, and I’m really out of shape, but I’ll take it over where I was at the beginning of June.
Recovery is a slow process, but if there is nothing else one can learn from ultras it’s that the relentless progress forward is what matters most. The whole process really puts into perspective how important running is to me, but leaves me with a much greater appreciate for the little things that running offers us. Right now each little victory is huge. And let’s be honest, we all know that being injured is a pain in the ass.