Diagnosis and Treatment Proximal Hamstring Tendinopathy [Updated!]

[@mopoffool]

Watched twice, took notes, and will follow. Thanks!

[@vinceduquestories]

this was great thank you. As a 54 year old competitive tennis player, my body is starting to need a lot of prep and when I ignore it, I get injured. And this has been such a nagging injury not being able to sprint for balls and I thought that my hamstrings were just tight (which is the case initially) but I thought stretching was going to relieve the pain. So this was great thank you.

[@MichaelBraccio]

Glad the video was helpful! Hopefully it helps to keep you on the tennis courts 🙌

[@sneil8056]

one of the best videos on this topic that i have seen. thanks Michael

[@MichaelBraccio]

Glad to hear it. Hope it helps!

[@sneil8056]

@@MichaelBraccio yes it did. really good point re hamstring pull vs glute push in one's gait. i found this also applies to deadlifts: conventional was painful so i took a break and did some sumo (more glute, less ham) then went back to conventional and found more glute drive hence less hamstring pain. thank u!

[@KawiNinjagirl]

Thank you! This is so informative.

[@MichaelBraccio]

Glad to hear it!

[@meixeira]

I've been working at this for about one month and I'm almost completely pain free on my runs. It's certainly a tricky one to manage, but this video and your last one have helped improve the situation immensely. Going to check out your return to running video next. Thanks! again!

[@MichaelBraccio]

Glad they are helpful! I have a couple more PHT videos that I'm working on.

[@surreystar13]

Perfect video, the amount of help this can have on people is insane. Thank you so much!! Hopefully with the combination of rehabilitation exercises, I’ll be back to soccer soon.

[@MichaelBraccio]

Wishing you a speedy recovery to get back on the pitch!

[@karolostsiligkirian4514]

Thank you Michael! Super helpful

[@MichaelBraccio]

You're very welcome!

[@novacalucas]

Hi Michael! Thank you for the great video! Any of your patients has ever resolved the pain with motion (running, climbing stairs, etc) but still suffered from sitting pain? If so, How did they got free from It? Could It be nerve damage from the tendon disease? In this case a cortisone injection would be helpfull? Thank you in advance!

[@MichaelBraccio]

Thanks! Pain with sitting is typically a compression issue (especially when sitting on harder surfaces). I typically add more hip flexion exercises to help build up the tolerance to that position (like a wall sit). Could be a sciatic nerve issue or referral from the low back. Accurate diagnosis is always important! Generally don’t think cortisone injections are beneficial for tendon issues. Potential longer term issues with a cortisone injection.

[@cianliddy8639]

Hello Micheal, This is excellent information. Could I ask how long you think the progression from isometric to plyometric should take given medium amount of discomfort? Also, If I could offer some feedback, the information at the start of the video is very high level. It took me a while to absorb and I had to pause and rewind a lot. You might be losing some subsribers here that are looking for less technical info

[@MichaelBraccio]

Hi Cian, The time frame varies between individuals, so it's impossible to know how long it will take from isometric to plyometric. It's more about finding the load that is tolerated and gradually building from there, not necessarily rushing it depending on time. Also thank you for the feedback. I try to define all of the terms so that it's not as high level but still accurate. I'm happy to clarify anything that was missed in the video.

[@kirstendebiasi8739]

thank you. very informative!

[@MichaelBraccio]

Of course!

[@marcokraan]

When does one start after pht is diagnosed? Does one take rest for a few weeks? Or start immediately? In my case they didn't diagnosed me strate in the beginning. So my rehab was starting late! Very late! Hope you find time to answer. Thans! The videos are bright and simple to follow. My compliments

[@MichaelBraccio]

There's very few reasons why rehab would need to be delayed. Usually the focus is on how much load to start with for the rehab program.

[@jimkaneko1692]

Just subscribed to your channel. Is there a role for therapeutic ultrasound and/or topical NSAIDS for acute or chronic hamstring tendinopathy?

[@MichaelBraccio]

Hi Jim! Thanks for subscribing! There's probably not a role for therapeutic ultrasound, but it's not going to cause any damage either. There's some debate about NSAIDs for acute tendinopathy to reduce some of the initial fluid accumulation but there's not a lot of support on effectiveness either way at this point.

[@hamnashahid9859]

Hey Micheal, thanks for the video! My question is, the only tome I feel pain in my tendon is when I do some sort of lunge or step up. However hinging at the hips is not a problem is it okay for me to Include some sort of hip hinge along side with isometric movements? Or should I just wait a couple weeks before I start hinting on only focus on hip extension and isometrics ?

[@MichaelBraccio]

Hey Hamna. Usually not an issue to include movements that aren't provocative even if they include hip flexion.

[@TetsuoIronMan]

Hi Michael, I believe this is my issue, but I have difficultly finding an answer. Sitting for long periods of time so cause pain in my left glute, but any time I hip hinge, specifically with my knees bent that’s where it hurts the most. RDL is what led to the injury, going on 9 months now. Does this sound like hamstring tendinopathy? I can touch my toes and my glute pain is extremely mild, but if I were to Good Morning or RDL, even without load it is quite painful.

[@MichaelBraccio]

Possibly. There are a couple of conditions that can present similarly so it's tough to say without an examination.

[@jaspervandriessche2769]

I'm struggling with my lateral (high) hamstring when I'm sprinting. More specifically during late swing phase, it's not really pain but more a 'stretch' sensation. I did all these exercises (also nordics etc.) without pain but it's not really coming together when sprinting. The only exercise when I feel the recognizable sensation is when i'm lying in the doorpost with my leg extended and elevated or doing hip flexion & knee extension on a skateboard. With others, only in high stretch I'm feeling this. Could it be beneficial do to isometrics in these positions, I noticed that this kind of position is not frequently used... Or is this just too much stretch? I also have straight leg pull down in mind. Thank you!

[@MichaelBraccio]

When looking at sprinting mechanics, there is a quick hip flexion drive followed by extension. So it's important to build up the tolerance in these positions and loading.

[@smittybacall609]

Are you able to comment on what can work for treating this while treating a hypertonic pelvic floor? I was coming back from a flare up of hypertonic pelvic floor and played pickleball without stretching. The tops of my hamstrings really hurt right after, but I continued caring for it as a pelvic floor issue by keeping my legs up on pillows which made the pain at the attachment of the itial tuberosity a lot worse. Sitting on my sit bones is unbearable and hard surfaces are a nightmare. I'm 6'3" so basically always have to sit with my knees higher than my hips out in public and my legs are different lengths from ACL surgery.

[@MichaelBraccio]

Hi! I wouldn't think that any treatment for PHT would really interfere with a hypertonic pelvic floor. You'd probably just want to make sure that you aren't clenching everything when doing the PHT exercises. Some stress management strategies can be helpful for this combination as well, something like meditation to decrease the overall hypertonicity.

[@vikasgavhane8774]

Nice information it help me lot

[@MichaelBraccio]

Glad to hear it!

[@mopoffool]

How frequently do you recommend doing these exercises? For context, I'm a runner with chronic proximal hamstring tendinopathy and a recent partial tear at the tendon origin, which forced me to take several weeks off. Since then I've been rehabbing every other day for a few more weeks now. Should I be doing some of these exercises every day or stick to every other day?

[@MichaelBraccio]

Varies between individuals. Some can tolerate daily, some need a little bit more recovery for isometrics or concentric/eccentric loads. For plyometrics, usually having 2 day rest allows the tendon to recover.

[@ERTUo45]

I strength train and I do Ariel acrobats, it does not hurt when I lunge, squat, deadlift or anything like that. The only time I experience pain is when I stretch especially when I stretch my splits and oversplits. I want to keep stretching but it hurts. I’ve been doing single leg RDLs with an 8 lbs dumb bell for about a month and a half now. Is there anything else I should do? Or will it still take time for me to not feel the pain when I do my splits and eventually oversplits? Thank you! Your videos are very informative by the way.

[@MichaelBraccio]

Hi there. It sounds like you are only having pain with end range positions like the splits. So generally it is about building tolerance to those positions since exercises like the lunge and squat don’t challenge the end positions (deadlifts are close but depends on how they are performed).

[@terencetay9111]

I've been doing various exercises on the hammies and glutes including the weighted deadlifts. Some pain is still there (in certain positions) after longer strenuous runs, but its not as bad. Is this a slow and long journey to full recovery (no pain at all) or is pain-free totally out of the question?

[@MichaelBraccio]

I think that a full recovery is possible although it can take some time depending on what we are trying to return to (for example daily activities compared to Olympic lifting or marathons). One thing to consider is that running generally has a faster loading time than a lot of strengthening exercises like deadlifts, so might want to add in some exercises to match those quicker loading demands.

[@Janetitayt]

When is recommended to start these stretches exercises after a pulled muscle that caused pain in the gluteus. I injured trying to reach a ball and also feel pain in the inside and outside of knee. Thanks

[@MichaelBraccio]

Generally depends on the tolerance. Some rest might be necessary but typically trying to find an exercise/movement that is tolerated and gradually build up from there.

[@briannaferrell6719]

I’ve had a big problem with this. I think I’ve worked out my butt to much lol. But I was curious if I stopped working it out for 2 weeks would it go away and I could get back in it but not as severe? Or should I be doing those beginning exercises everyday?

[@MichaelBraccio]

It depends. Usually with a short term overload, reducing the load temporarily helps (think of it like running a marathon then taking a couple of days rest afterwards to let things calm down). But usually with long term overload, temporarily reducing the load doesn't tend to help much.

[@TC-kn9kk]

Thank you. I thought my sciatica was from the piriformis aggravating the sciatic nerve. I kept stretching but it was making it worse with compression.

[@MichaelBraccio]

You’re welcome. It’s not uncommon to hear sciatica and instantly think that it’s a tight piriformis.

[@e.mahleeyas9313]

Ive had this for about a year now and it does not go away. I do the bridge exercises and I lift heavy twice a week and everytime I do my heavy RDLs or single rdls I feel pain on one side but I just push through it. My problem is I cant take time off the gym for it to heal fully..Can this lead to anything worse if I just ignore it?

[@MichaelBraccio]

It’s debatable whether there are longer term consequences. But I’d try to find someone to help build up tolerance to the RDLs so that you can do them without pain.

[@robertoventricelli1840]

Ive been injured for a year and 3 months now and the pain doesn't seen to go away, I have just recently found this PHT and am working on strengthening my hamstring. Over the year though I had still been strengthening my whole leg area, so is it possible that my injury is PHT as I haven't been specially targeting my hamstring or do you think its something else??

[@MichaelBraccio]

It's challenging to say without a thorough history and evaluation. Different conditions can present similarly which may be why a certain approach (strengthening the hamstrings) isn't as effective.

[@keithsimmons1813]

Would this cause pain when driving? I get pain after an hour or so of driving that seems to radiate from this area. I can cross my leg under the other making a figure 4 and it eases off. Years ago when hiking on a cold day I had to take a big step up and felt a pop in this area.

[@MichaelBraccio]

Could be but could by other things. Best to get it assessed to figure out that’s going on

[@MrDaman95]

Wow, I don't usually have this pain but whenever I strech my hamstrings or go into a leg Splits I felt a sharp pain in my right leg in my lower inner glute going all the way through my hamstrings, gonna start this rehab today. My left leg is absolutely fine, should I just focus these movements on my right leg or still work both the legs?

[@MichaelBraccio]

Depends on the person. Some like to exercise both sides, some like to just focus on the one. Probably doesn't matter much in the overall recovery.

[@MrDaman95]

@@MichaelBraccio Thank You 🙂

[@dewaschhantyal3666]

I'm a soccer player and its been 3 month since i get injured. Im doing strengthening exercises But when i try to do sprint it feel pain and discomfort.how i can end this pain completely.plz rply?

[@MichaelBraccio]

You have to gradually increase the load to meet the demands of sprinting.

[@FoReNziiCz]

Where you located?

[@IRAGREENBERG]

Should this regimen be done daily or every other day?

[@MichaelBraccio]

Hi Ira. It really depends on how the hamstrings are responding to load. Generally the isometrics can be performed daily while the concentric-eccentric exercises every other day to allow the tendon to recover. But there's quite a bit of variation on how often these exercises are performed.

[@mikkelandre672]

Hey there i have been dealing with this for about a month and a half i am a powerlifter i will see a fysiotherapist soon. My plan is to attend the nationals in powerlifting in about 4 months is that possible can i expect to be ready for that i can still squat as it is now but i stopped because it wasent optimal

[@MichaelBraccio]

It depends. There seems to be a lot of variability on how people respond with PHT. I’ve had some people respond quickly but others take a little longer. But hopefully you are on the quicker end and able to compete 👍

[@mikkelandre672]

@@MichaelBraccio should i strengthen my hamstrings even tho they are strong as heck or should i just rest and use my massage gun on them

[@MichaelBraccio]

@@mikkelandre672 hard to say. With load management of the tendon, sometimes we have to reduce the load to allow it to calm down, other times we have to load it more. Strength isn't necessarily the factor here, but the tolerance to load and typically in flexed positions.

[@djnickhodgkins]

Followed all your advice over several months. Zero improvement. Don't know what to do now...

[@MichaelBraccio]

Hi Nick. Sorry to hear that you haven’t had much improvement. There’s a lot of factors to consider on why it might not be responding. For example, how much load was used during the exercises or how frequently the exercises were performed. But there’s other factors that might be contributing to pain syndromes like stress and nutritional factors. So it might be a good idea if you haven’t already to schedule an appointment with a healthcare provider that can take a full history to see what is going on.

[@novacalucas]

​@@MichaelBraccio​ Can stress slow down the hamstring tendon healing? That's a clue why my tendinopathy is taking so long to heal. 😢

[@MichaelBraccio]

@@novacalucas When it comes to pain, absolutely. There are many things that can contribute to pain besides strength (nutrition, sleep, stress, to name a few).

[@ako409]

Hello. I’m marathon runner and triathlete. My previous injury was it band syndrome. I cured 100% but after it, last 2 months I have this injury. Ultrasound detect 1.5 milimeter calcification at ischial bone and tendinopathy. Maybe sciatic nerve is also irritated, I have tight piriformis muscle. Last 1 month I stopped running. Can you please give me more advice?

[@MichaelBraccio]

Hello there! Without doing an examination to figure out what's going on, it's not possible to give accurate advice. So it might be a good idea to find a healthcare provider to provide you with some specific recommendations.

[@Dawn-we1qh]

Great instruction. I would appreciate if you could speak at a slower speed.

[@MichaelBraccio]

Thanks Dawn. Apologies on the talking speed. You can change the playback speed to .75 in the video settings, but I'll keep this in mind for future videos.

[@mason6883]

Does road bike cycling cause compression on the hamstring tendons?

[@MichaelBraccio]

Technically yes. Sometimes adjusting the seat height can help if worries about compressive loads

[@mervynrogers7354]

Very helpful but would you mind just talking a little more slowly so us older folk in the UK and others around the world can follow you more easily - It's not a race!

[@MichaelBraccio]

Thank you! Sorry, the coffee must have gotten the best of me before filming. I'll try to speak slower in the future.