Hey there! I made an updated version of this video for PHT which goes into some of the more common questions from this video and goes a couple of different exercise progressions as well. ua-cam.com/video/ryWCFkI63Cs/v-deo.html
@@videoman191 I had started to do the exercises and it was definitely helping me. I believe that the imbalances and weakness that I had in my glutes, hips and hamstrings may have also played a part in a ski accident that resulted in a torn ACL, MCL, meniscus tear. Yes, falls happen and it was an accident, but knowing some of the things I know now, I will focus on overall strengthening for my body and working on correcting any imbalances I have in the future rather than make running my easy "go to" for exercise. I do feel that I am healed now. I've been doing a structured strength program to recover from my knee injury that includes the exercises explained here for the past 6+ months.
Thank you so much for making this! My injury is getting better, it’s been 9 weeks, but I’m going to follow this video until I’ve made it out of phase 3
@@MichaelBraccio so I’m fused L 5-S1 T 7/8 and C 3-7 lower and upper with hardware . I’ve developed this and it’s killing me pain wise . I also have a torn right SI joint . What would swimming or water pt be the best for me I have it bilateral . Ty
@@julietaferrario4934 That's tough to say. I'm usually an advocate for finding some sort of physical activity that you are able to do and like to do (walking, swimming, dancing, weight lifting, etc). Everyone is able to tolerate different levels of activity so find what you can do and start working from there.
Great info! Particularly regarding how running gait imbalances can contribute to the condition. I think I'm guilty of neglecting my glutes and overworking my poor hammy's while hitting the trails. Will give the exercises a try. Thanks Michael! Keep up the good work!!
Great explanation! I've been struggling with this for months (and watching lots of videos...) this is the first time I've understood why the hip flexion can cause issues for the tendon. Thanks! What sort of timeline do you find is typical for these different stages?
Thanks! Honestly, the timeline is all over the map. Sometimes people progress right on through, others take a little longer at each stage. I'd focus on how your tissues are responding to load and progress based on that.
im quad dominant and hip flexors are always tight. I do up hill sprints and karate. Lots of front kicks and side kicks. Your video was very helpful in fixing by ass pain. regards.
I've been struggling at this on and off for 5 years. I'd have pain for few weeks, then not much for months. Still able to run sub 19min 5k and 1,26 half marathon. But now I've really hit a wall. This pain near my sit bone wont go away after 3 month of no running at all. Pain would stab me in the glutes in different areas. Sometimes randomly while standing, sitting, walking. I've had enough tbh. Your video hopefully will help me.
Sorry to hear this! Hopefully the video will help you. I made another video recently on home exercises for PHT which may be helpful. ua-cam.com/video/UAvDabmsyDc/v-deo.html
Hi Karl, I am a runner also and around your times also :) well slightly slower (5k pr is 19:14 and half mar pr 1:28:16). I injured my self first during a random soccer game in July 2019 (I was sprinting too much on the wing without much warmup, and it was cold weather). Then I kind of recovered with physiotherapy and I even managed to run the Sydney marathon in Sept 2019. However I injured myself a second time in Feb 2020, again with soccer, and since then I haven't really recovered yet.... I stopped running for around 2 months in July August Sept 2020, and did lots of physio exercises (lots of these bridges, arabesque, and several glutes and hamstring strengthening), now the physiotherapist said that I can run 4 to 5 times per week, but actually my butt still hurts, particularly after sitting long.... not sure what i should do.... probably just continue with the exercises he told me and running easy...?
@@paolongong hi mate. Good to know your running. I'm still not running. Quite happy to wait tbh. I'm doing same exercises and bridges. No stretching at all. I also got a peanut shaped ball to sit on. I can feel the difference after just 3 days. I believe it's going to work. Keep at it, let's smash 2021 when we are recovered..
@@karlosfandango6637 and Paolo, mates! I am currently experiencing exactly what you both described. how are you 2 feeling? I have a marathon coming up in about 10 days so after that I am going to hit recovery and rehab of this hamstring pretty hard.
My orthopedic doctor could not identify my pain correctly. This is what I have! Now I can finally try to recover! I can not even sit in a chair to work the pain is so great!
Hi Taryn! Hope this video helps you out then! I have a couple videos on PHT so you have some variety to choose from. Hopefully you can get back to sitting comfortably again.
Thanks for the video. I've been suffering from this injury a couple of months now, not really knowing what it was, and assumed it would just get better, but it hasn't. After finding your site and this video, looking forward to trying it. Thanks!
@@benchmarks1016 A hamstring stretch would just give information on whether the tendon can tolerate compression on the ischial tuberosity, so it's not necessary (although common) for diagnosis. Generally for diagnosis it is location of the pain near the insertion of the hamstrings plus pain with loading the proximal hamstrings.
Hey! I tore one of my hamstring muscle 2 years ago. Then after a few weeks I started running and always felt a sharp pain in the gluteus area during Sprints and longer uphill runs. Unfortunately, I tore my cruciate ligament on the same leg while skiing while I was recovering. It was just over a year since the operation and I am knee is fine again. However, I couldn't do sprints during training because I still have this sharp pain in my gluteus. I did a MRI and I have tendinopathy at the base of the medial hamstring muscle (Tuber ischiadicum). I am currently receiving treatment ( shock wave therapy). I've been to several physiotherapists but they haven't been able to help me yet. I also went to an orthopedic surgeon and he diagnosed pelvic obliquity and I received insoles. My question: When I bend my stretched leg at an angle of 65 degrees I have a snap or jump of the tendons in the area between the hamstrings and the gluteus. It doesn't really hurt, but I think it may irritate the area even more. Is the tendon sore and thicker? or where does the snap come from? I have a 2x1cm large water retention in the tendon according to the MRI. Will that go away again when I start Witz stage 1? i think i need a lot of patience in the recovery. Would you recommend the exercises in the video to me oder do you think I have another injury? I know that my injured leg is weaker compared to the other and now i am doing isometric exercises to strengthen it. Thank you for your videos and I hope you can help me. I just want to return to sports and play football again. Greetings from Austria!
Hey Calvin. It’s tough to say since you have a couple of things that could be contributing. Honestly I’d look for a physio that specializes in running to help you with your return. As for the popping in the hip, there’s many different things that can cause the popping (for example, ligaments, tendons, labrum). Usually popping isn’t that big of a deal but it depends.
i’ve been struggling with this for 6 months now. everytime i feel like i’m making progress and i’m feeling good, i start doing the plyometrics and the deadlifts and then the pain returns. should i wait until i feel virtually no pain before transitioning to those exercises? I have no pain with the glute and hamstring bridges
Apologies on the delay (for some reason I wasn't getting notifications). Plyometrics can be challenging on the tendon which is why they are usually at the end of a rehab program. The key to PHT is gradual loading. So if deadlifts are something that you'd like to return to, I'd slowly start adding load with the hip in a flexed position. For example, you might deadlift from blocks to raise the bar so you don't have to flex the hip as much.
Thanks for explaining this. Could this cause anterior knee pain when walking, with hip flexion and hip extension, because the hamstring is tight? What are your experiences with physical therapy to improve it?
Thomas Hemming Larsen there could be a compensation pattern leading to the anterior knee pain (loading the quads and knee more). It probably doesn’t have a lot to do with the hamstring tightness. PT can be helpful for PHT. Just need to find someone to help load progressively.
Thank you for this! I'm a dancer and twinged my handspring kicking my left leg - I now feel a pain that after much google has lead me to proximal hamstring tendinopathy. Can I continue to dance as long as it isn't irritated? Thank you for the exercises, I will be doing them consistently and hopefully recover!!
Ps. I will see a local physiotherapist as I know you can't strictly give me a yes or no but I am just wondering if you think any exercise will hider the recovery process of this injury as I just want to recover as soon as possible. Thank you!!
Thnx Michael for this amazing good video and explanation. I have a high hamstring tendon injury for 2 weeks now. Sadly I denied the pain and I went on doing my sumo deadlifts. Then I started to stretch which was a huge mistake to treat the tendon pain I found out later. I started isometric exercises for 3 days ago. I have a little question. How long does a stage last? Is it just as long as you don't feel pain anymore and then go on to the next stage? BTW I'm 57 yo man. Do full body fitness and power training 2 times as week. I have a long history of tendon problems but only on the elbows. I had tennis and golf elbows and distal Biceps tendon problems on both arms. The first time I had distal bicep tendinitis I was 28 yo.
Hey there. There's no specific timeframe for each stage, as it depends on the person's tolerance to loading. If the tendon can tolerate more load, then gradually progressing to more is fine. But if the tendon needs a little more time to adapt, then spending time at that stage is probably best. Plus other factors like age, diet, previous injuries, etc will all factor in the adaptation.
It depends on the person, as there isn't a set timeframe for everyone. I try to progress the exercises as soon as they are tolerated, especially from isometrics to concentric-eccentric.
Hi Galen, I don't think it's that simple with stretching and PHT. There's a lot of fear around stretching because it adds some compressive load and can be irritating. But it's generally not harmful to the tendon (it can be painful though) and compressive loading is needed for the tendon at some point (otherwise you would never lift your leg again). On the flip side, I don't think stretching is the most useful approach for PHT. Hope that provides some context. I made a general video on this topic if you want to learn more ua-cam.com/video/6H5wvAYoX3w/v-deo.html
@@MichaelBraccio hey Michael, thanks for your reply and that video. Seems like it's a matter of balance. My PT had my stretching (on back, piriformis stretch and raised leg, now touching close to toes) every day and I think following your videos, that might be excessive. The best approach seems like limited stretching. I'm about 1 month out from injury so still kinda fresh too
As a result of both sitting too much and starting to ride my bicycle again I have been having hip area pain. It felt like hamstring tendonitis but I thought it might ber piriformis syndrome because I have had that in the past. After watching a lot of UA-cam videos and stretching and exercising with little relief, I went to an orthopedic doctor. He saw my crushed back disc and decided it was a back problem. Returning to my original thought I was looking into how to treat tendonitis in the hamstrings and found your videos. Because I'm old it may take a while but at least I am now hopeful about relieving my pain. After some more poking on the internet, I am wondering if I have ischial bursitis. The symptoms sound like proximal hamstring tendinopathy. How does one tell the difference? Also, I found a seat cushion that has cutouts for the ischia that has made sitting mostly painless.
Eh. They can be help to decease pain temporarily. It can be used as an adjunct treatment but needs to have a loading program for rehab. I don't incorporate foam rolling/lacrosse balls in my treatment plans nearly as much as I used to.
Following an ACL surgery 3 years ago, I haven’t had full knee extension while walking and standing. I recently had surgery to remove lesion preventing this. I’ve had problems with PHT over the past year, especially after hitting the effected leg with a heavy load of exercises two summers ago. Could gait cycle have caused this? I was a skeptic when my Dr. said it but it sounds like you have seconded thIs. Will getting back proper gait eventually repair? Along with exercises? Thanks for input
Thank you for this well informed video. I have a question so I had a grade 2 strain in my upper hamstring the one under the glutes. And I did 2 months of rehab and was doing Romanian deadlifts just with the bar and progressing as well as sumo deadlifts. I aggravated the hamstring no restrain or worse apparently and I’ve been doing the rehab for the aggravation for about 16 days. There is still moderate pain right now. I’m just wondering that when this heals will I go straight back into the deadlifts and plyometrics? And how common are aggravations. Also if I should be able to go back into sprinting and change of direction after a couple days from now after it heals. The strain wasn’t fully healed yet to my knowledge. Thanks
Hello! It's challenging to say. Sometimes a flare up is just a little bump in the road and things can progress. Other times the flare up needs to have the exercises/load regressed to build back up again. All depends on how the tissue responds to loading. Overall, flare ups can be fairly common. Especially when it is a more chronic issue. Best to track progress over longer periods (to see it making progress) compared to day to day (might have quite a bit of fluctuations).
@@MichaelBraccio yes I am regressing back to some earlier exercises, the pain didn’t go away yet. I am finding some hip flextion exercises more painful then others. I am a bit confused tho because the hamstring is still strong. How long should this pain take to go away normally? Also would it get worse with sprinting?
@@mayankchopra3739 the relationship of strength and pain is a little complicated. The strength that you built up doesn't just disappear when there is pain. There is no 'normal' timeframe for flare ups. Sometimes a flare up can be a day or so other times longer. There might be an average length for a flare up but can vary. Sprinting would place more loads on the hamstring which may aggravate hamstring issues.
wow. I think I get this from doing splits and squats. Now I don't know if I must exercise with bodyweight only? Like some power walking, yoga and//or pilates? Or should I jjust rest and do the rehab exercises?? Thank you! It's the only video I have found understand my symptoms
That's tough to say. Usually start with exercises that don't exacerbate the symptoms and build from there. Sometimes rest is necessary but not complete rest.
Hi Michael! I’m 15 years old and am big into weightlifting and football... I just recently (a few weeks ago) felt a gradual pain while deadlifting in my upper hamstring/deep within my glute and am wondering if this is what I have. I get a burning pain deep within my glute while sitting for a prolonged period of time and a sharp pain in my hip flexor/Pelvic bone. It really starts to hurt when doing any leg exercises except the hamstring curl, I’m still doing conditioning for football but stopped all leg exercises... I really need help because I don’t know what this is...(It also gets worse after sprints)
Hi Justin! Sorry to hear about the hamstring/glute pain. There can be several different things that would cause pain in that area (including proximal hamstring tendinopathy), but you'd need to have someone do an examination on you to determine what the cause of it is.
It really depends. Sometimes the loads need to be reduced if they are causing too much irritation. But some pain with exercises is tolerated with tendinopathy rehab.
Hi Michael, thanks a lot for the video... I replied to Karl Budworth comment below and if you read it you can see my story with PHT... It's such a pain.... I am "allowed" to run again according to my physio... but need to keep doing at least twice a week sets of arabesque with a weight (it's for my right hamstring) and different slides/pull up with the leg (not sure how it is called). But just last sunday I had a long trip driving the car (738 km!) and since then it really hurts again... I guess that sitting long is really bad.... is there anything that I can do to relieve pain from sitting? I haven't taken any anti inflammatory or painkiller so far... would it be worth it sometimes?
Hey there! Sitting is one of the positions that tends to irritate PHT (probably has to due with the compression of the tendon against the bone). There's a mixed debate on the usefulness of anti-inflammatories. They might be helpful to reduce the pain in the short term but they have also been shown to slow tissue healing.
I’ve commented on one of your posts relatively recently in which you replied. I’ve got more questions relating to my symptoms. I can sprint up the stairs with no pain, I can do sprint specific isometric holds (much harder than the suggestion on here), and I can do any other gym exercise, such as Nordics etc, with no-minimal pain, but when I run it flares up and radiates down my groin area or the side left side of my hamstring (it’s only on my right hamstring at the moment). What does this sound like to you? It sometimes hurts to hip hinge, however when it does it’s barely at all, in fact I’d say a 1-10 on a pain scale, just feels like tingling. It’s so weird and I don’t know what to make of it, why can I do very good strict nordics and not run (even if they’re just posture runs and not at max velocity)? RDLs hurt a bit more, more like a 3-4/10, but nothing too bad, and I can do them with 80+ kg for 6 reps???? I really need any ideas, I’ve been on and off rehabbing since September 2018 for it. Also might be good to know that the tendons behind my knees (both knees), can also ache, and they click lots too. When I do nordics, I feel pain and tightness at these tendons as I go down, and it restricts me from going down even further (I have the strength to go further, but the back of both knees stop me doing so). What does this info sound like to you? How can I do Nordics, bend over and touch my toes without pain, but do a 70+% of max velocity run and i start to feel it and it radiates down the left side of my right hamstring. Thanks again :) just very anxious about it as I want to get back racing
Strength is only one aspect of recovery. Running places different loads on the body which the body needs to be able to adapt to. In general, nordics are a great exercise but mostly focused on the distal hamstring (although there is certainly some carryover). I’d discuss with someone near you who can do an exam and see what might be contributing.
Who can diagnose this issue? Can a PT or should I consult an Orthopedic Doctor? I've read stuff about Tendonopthy's being able to be diagnosed by just load tests but then I've read that for Hamstring Tendonopothy's oftentimes an MRI is needed. Thanks!
A lot of healthcare providers can diagnose the issue but it depends on their experience. So it's better to find someone that treats PHT than purely credentials alone. MRI isn't needed for the diagnosis, usually a history and examination is sufficient. MRI is usually more helpful if other pathologies are suspected.
@@MichaelBraccio Hey Michael. Thanks so much for responding! I appreciate it. Real quick. So would the gold standard be an orthopedic doctor who specializes in Hamstring issues, specifically PHT? Or could you find a competent PT who could diagnose it as well? I made an appointment with an Orthopedic Doctor whose speciality is in Hamstring Issues so I'm hoping this works out.
@@kiwicoproductions2828 I wouldn't say that there is a gold standard necessarily in terms of professions. Usually someone who works with sports injuries would be somewhat familiar with PHT (could be a MD, PT, ATC, or DC).
Now in doing these isometric and plyometric movements, is it expected to still feel some pain in our hamstrings? Or should we not feel any pain whatsoever when doing these exercises?
I have been having what I believe to be Proximal Hamstring tendinopathy or maybe a tendinitis. The issue started 2 weeks ago. I think i exasperated it trying to stretch and foam roll as I thought it was simply a tight hamstring muscle. Last night I was in enough pain to wake me out of my slumber.. So I began research. Where do I start, it's a fairly new injury? How is it diagnosed what type of doctor should I see to get referral to physiotherapy or do you think its minor enough to start at home rehab? Thanks in advance for any advice or direction.
Usually a sports chiropractor or physical therapist can diagnose the issue. A sports medicine doctor can also be helpful in the diagnosis and referral process.
I wouldn't say that either would rule in or out PHT. Might have something to do with the knee flexion of the squats vs the lunges that might be the difference in this case.
great and informative video.. apperciate ur efforts ..I am a physiotherapist.. can i ask about sth .i have a pinch like pain whenever i bend my back in the ischial tuberosity area and also when i strech the hamstrings wihout any sign of tendiopathy ..i am usullay an active person working out almost 4-5 days per week at home ..my workout plan contain : body weight exercises , kickboxing , and juming rope and it goes with about 40 min ,and i sterch afterward by like 6 hours ..warming up as well before strating .. it is been week and pain nerve goes away but it decrease a little bit ..what i have done lately going for walk, putting an ice pack ..and doing some gentle streching exercises .. wondering if there is any test can i do at home during this lockdown to know excalty what is the diagnosis ....or .should i return back to my workout schedule gradually nowmatter what ...or it is gonna do a further harm ? ..any adevice would help a lot .. thanks in advance .
Hello! It’s difficult to say because there are a couple of things that can present similar to that and not any good tests you can do at home to help figure it out. Would be best to see if someone does telehealth visit to sort through what’s going on.
Great video! I have been suffering from a partial tear + tendinosis in my right hamstring due to using too much weight during a hip thrusts 3 months ago, and it keeps getting reinjured snd I have continuously lost a lot of strength in the glutes, however whenever I try to do glute excersizes for pt my hamstrings take over and get reinjured. It’s a vicious cycle and I miss being active, and I’m scared that there is scar tissue build up and that it will never be the same/heal. Any suggestions for safe excersizes and how to return to doing pt without putting strain on the hamstrings? Thanks so much!
Hi Abby. I wouldn't be too worried about scar tissue build up. It's part of the normal healing process and is rarely an issue overall despite the common narrative. As for exercises, most exercises are generally safe to do. It's about finding an exercise that you will comfortable with engaging the glutes (and hamstrings) and building up from there. Generally when doing a glute bridge/hip thrust the closer your heels are to your glutes the more glute and less hamstring activation there is which might be helpful. But whenever the glutes contract, there will be some hamstring to some degree (they work together for hip extension).
Hi Michael. Thanks very much for this video. I've been struggling with this for almost 2 years now. The only time it's gone away is when I basically stopped doing any exercise and avoided sitting as much as possible. Now that I start back doing exercises, the pain returns like it never went away. Any advice on how to actually recover from this? Many thanks
Depends on what you’ve done over the previous 2 years. Maybe following a progressive exercise program consistently can help to remove. Sometimes a more generalized exercise program might be useful. Difficult to say which route would be best for you.
It's not really time dependent but more so how the tendon responds to loading. For really sensitive tendons, I might stay with isometrics for a little longer to load them but usually I try to load with movement if tolerated. Other things to consider when progressing is how the tendon is tolerating load throughout the day (sitting, walking, etc).
Hi Bryan! There's not a specific amount because it varies between individuals. More sensitive tendons may need to start with less load whereas some can tolerate more loading. So it's finding the balance that feels challenging but doesn't irritate the area for the entire day.
I suffered an avulsion of left hamstring 1 1/2 years ago. Did not have surgery. Continue to have pain from proximal tendinopathy. Can do most eccentric exercises without any pain, however, if I try to do a more concentric exercise such as dead lifts. or if I stretch, I produce a sharp pain in the tendon area. When I run, I can keep pain to a moderate soreness as long as I keep distance low and speed slow. How much pain is o.k. to have when trying different exercises? Seems like when I do stuff like stretching or deadlifts, it aggravates the injury, but I also seem to have reached a point of no improvement. Want to get back to running. Any suggestions?
Hi Cathy. I'd suggest having a follow up to see how/if the avulsion healed. A hamstring avulsion might need to have a different treatment approach than a tendinopathy. But it sounds like the hamstring isn't tolerating compression well (whenever the hip is flexed). Gradual strengthening exercises into hip flexion might be helpful. Pain is quite subjective, so it's difficult to say how much pain is okay. For many tendinopathy rehab programs, pain is okay with the exercise. And other research has shown it's not detrimental (bjsm.bmj.com/content/51/23/1679). But better to have a medical provider supervise to make sure that the rehab program is appropriate.
Hi I injured my hamstring in Feb 2020 and after 8 months of pain, got a diagnosis of hamstring tendonopathy after an MRI in October. Since then, I have been doing the exercises I was advised to do by my physio and no running, jumping etc, no weight training or squats lunges etc. I have been very aware of not stretching and being careful when bending down etc. however today when leaning over I mindlessly pulled my hamstring again and now I have the full ache and twingey pain I had back in October. I am so worried that today’s one accidental stretch has potentially got me back to square one :( just want this to get better. I would appreciate any advise or suggestions you have. Thank you in advance 🙏🏼
The recovery process usually fluctuates (some good days, some bad days, some improvement, and some regression). That's why it is important to look at the overall trend instead of day to day. So if you need to temporarily reduce the rehab loads because of some increased irritation, that doesn't mean that it is a large set back. Stay positive.
@@MichaelBraccio thank you so much for your reply! Digressed yesterday after adding a too heavy dumbbell to my glute bridges. In quite a bit of pain now so I’m hoping a few days rest will help and I’ve not digressed too much 😥
What do you do if there is no pain during the long leaver bridge but the next day you are very sore? Do you do the exercise every other day? Or just push through and keep doing it?
It’s usually better to be a little more cautious and reduce the load so it isn’t very sore the next day. It’s not the best idea to overload the tendon too much and have to take prolonged periods of time off because you pushed too hard too soon.
Should I just keep stretching it and will it get better if I do. And how long will it take to heal because I want to get back into squatting and Bulgarian squats.
The long lever holds or with movement? I normally recommend 3-5 reps of 45 second holds but that can vary between individuals. For movement, I usually do 3 sets of 10 initial but eventually add more sets and less reps as the load increases. It depends on the tendons tolerance to load. If the tendon pain fluctuates a lot day to day or if there is a consistent flare up with low load activities (sitting, walking, etc), then I might have someone do the isometric bridges. If the tendon can tolerate higher loads, I progress them to keep the exercises challenging. Hope that helps
My GP has diagnosed me with tendinitis of the upper hamstring and I have trouble walking it feels incredibly tight when I walk I find it hard to bend my leg when I walk. But is very sore to bend down or deadlift as you said here... what can I do
What are the things to do to avoid hamstring injury, I had an injury about a year ago hamstring injury and I decided to keep playing after 2 weeks then it didn’t go for a long time but after a while of not playing soccer i didn’t feel it anymore but then I hit the gym about 3 weeks ago and I felt it I thought it was because I was putting to much load into it . Just yesterday my soccer tournament started and I felt like a muscle pull in my back thigh it felt like I couldn’t run so I stopped but the next day today I’m feeling a little pain in the left leg of my bum what are the thing I need to do what is your advice ?
Generally to avoid hamstring injuries it is a combination of gradual strength training and appropriate load management. A common error we see is that once the pain subsides people go right back to their previous activity level. But sometimes the activity needs to be reduced and gradually increased over time.
I had my hamstring evaluated and I was told that constantly re-injuring my hamstring over years that I’ve developed scar tissue in my hamstring making the nerves extremely sensitive to any type of movement. From this information I’ve been having a hard time distinguishing if it’s pain from exercising or if my nerves are overly sensitive to certain movements which gives me a hard time understand if I’m healing or not. If you could respond to this and give me your thoughts on scar tissue and if the pain I’m feeling is from the sensitive scar tissue and I should proceed with what I’m doing.
It's possible that scar tissue can irritate the sciatic nerve. Usually numbness and tingling is the indicator if the sciatic nerve is involved. But overall I think that scar tissue probably plays a small role compared to other things involved with injuries such as PHT.
Hey bro! I tried to see how high I could kick! And I didn’t stretch enough before doing it and I felt a rip in my hamstring when I kicked it! It’s been several months now and it still hurts really bad when I sit for too long or it just hurts when there is pressure in that part! What should I do?
There's not a strict criteria. I usually try to see how the tissues tolerate adding speed to the exercises in phase 2 to gain some insight into how they would tolerate plyometrics.
As long as you need to. It's more about how difficult the exercises feel and how the tendon is tolerating the load. Feels easy and no/little pain? Try progressing.
I picked up this injury 3 weeks ago and I caught it very early on so it wasn’t sore to touch or anything like that it’s only when I do a sprint or sit for a long time I feel a tingling sensation down from my glute to behind the knee.I’m a soccer player so sprints and changes of direction are very common in my training ,since my pain is very light when do you think I can start playing again
Hey Michael Im rehabing After 6 months of Osgood schlatter's disease in which i have walked in crutches for these 6 months. After 2 months of very low intensity training i felt i could walk again. After 4 days of walking without crutches i started feeling this sharp pain in my pht. I've gone back to the crutches for these last 4 days and my pain has calmed i also haven't done any exercise these 4 days. I think i will try the bridge exercise tomorow. Hopefully it doesn't hurt. And After how many days of rehabing my pht will i be able to start reintroducing walking without crutches like 4-5 days? It's pretty important that i walk as im starting highschool in 3 weeks😅 Btw love your content Love from France
Hello Julien. Thanks a tough one. It's hard to know exactly when to introduce something as it really depends on how the tissues respond to loading. Sometimes they tolerate more load quickly, other times they take time. The goal is to gradually increase the load until you are able to do what you want to do.
I’ve had a mild pain deep in my hamstring but it doesn’t feel like it’s the muscle which is injured. I feel this twinge if I move in bed or put weight on my leg sometimes. It’s never painful but it’s annoying and I want to fix it. The problem is I’m not sure what the issue is and I’m worried about making it worse
Hi Matt. It can often be difficult to isolate a specific tissue as a source of pain or discomfort. Usually have an examination to determine if something serious is going on and then a tailored treatment plan to help decrease that twinge can be helpful (and also reduce the fear of making things worse).
It’s a great question. It definitely can resolve on its own. Although there seems to be a slow recovery process for PHT compared to other tendinopathy. Not exactly sure why that is though.
I picked up this injury 3 weeks ago and I caught it very early on so it wasn’t sore to touch or anything like that it’s only when I do a sprint or sit for a long time I feel a tingling sensation down from my glute to behind the knee.I’m a soccer player so sprints and changes of direction are very common in my training ,since my pain is very light when do you think I can start playing again
Hi Peter. That's difficult to answer, since everyone's body responds differently. Sometimes the tissues tolerate sprints/COD quickly, others take a little bit to tolerate it.
So your advise is, after healing, to gradually start bodybuilding like a fresh start with no weights and build progressively. I imagine after healing we have fresh fibers that never trained before, mixed with old strong ones. If we return as never hapened we will break those fresh fibers and injury again.
Sort of. I would say that gradually increasing the loads placed on the tendon and hamstrings would be helpful, but I wouldn't consider that bodybuilding.
![Diagnosis and Treatment Proximal Hamstring Tendinopathy [Updated!]](http://i.ytimg.com/vi/ryWCFkI63Cs/mqdefault.jpg)
![Diagnosis and Treatment Proximal Hamstring Tendinopathy [Updated!]](/img/tr.png)
Hey there! I made an updated version of this video for PHT which goes into some of the more common questions from this video and goes a couple of different exercise progressions as well. ua-cam.com/video/ryWCFkI63Cs/v-deo.html
There is definitely an odd, but a pattern nonetheless:
fewer subscribers equals a smarter specialist in the video...
I am most impressed.
Glad it was helpful!
I've been struggling with this for over a year and this is the best explanation and demonstration of exercises I've come across. Thank you
glad to hear it! I'm actually working on updating this video but hopefully this helps you!
Are you cured? Ive been also with this for over a year its so annoying
@@videoman191 I had started to do the exercises and it was definitely helping me. I believe that the imbalances and weakness that I had in my glutes, hips and hamstrings may have also played a part in a ski accident that resulted in a torn ACL, MCL, meniscus tear. Yes, falls happen and it was an accident, but knowing some of the things I know now, I will focus on overall strengthening for my body and working on correcting any imbalances I have in the future rather than make running my easy "go to" for exercise. I do feel that I am healed now. I've been doing a structured strength program to recover from my knee injury that includes the exercises explained here for the past 6+ months.
Loaded with very good info. Best video on this subject. Cheers Michael!
Glad it was helpful!
Thank you so much for making this! My injury is getting better, it’s been 9 weeks, but I’m going to follow this video until I’ve made it out of phase 3
You are welcome. Hope it is helpful!
Does it hurt to bend over with one leg forward? Had this on and off for months
@@DudeWheresMyCardz oh yeah kind of it’s not so bad anymore I never knew quite what I had
Thank you ! I’ve had pain with this for years. Great explanation and achievable therapy.
Glad to hear the video was helpful! I'm actually in the process of updating this video! Hopefully we be out soon.
thanks Michael- this was really helpful- I watched 3 other you tube videos and yours was the only really good one!
Glad to hear this was helpful! If you have any questions please feel free to reach out.
@@MichaelBraccio so I’m fused L 5-S1 T 7/8 and C 3-7 lower and upper with hardware . I’ve developed this and it’s killing me pain wise . I also have a torn right SI joint . What would swimming or water pt be the best for me I have it bilateral . Ty
@@julietaferrario4934 That's tough to say. I'm usually an advocate for finding some sort of physical activity that you are able to do and like to do (walking, swimming, dancing, weight lifting, etc). Everyone is able to tolerate different levels of activity so find what you can do and start working from there.
Thanks!
You’re welcome!
Thanks Michael ❤❤.....i used to do 170kg deadlift and 130kg squats but now i couldn't lift 80 kg.. Hope these exercise will help me...
Hope they get you back to lifting!
Great video. Thanks
You’re welcome. Hope it helps.
Great info! Particularly regarding how running gait imbalances can contribute to the condition. I think I'm guilty of neglecting my glutes and overworking my poor hammy's while hitting the trails. Will give the exercises a try.
Thanks Michael! Keep up the good work!!
Glad you found it helpful! If you have any questions, feel free to reach out.
Great explanation! I've been struggling with this for months (and watching lots of videos...) this is the first time I've understood why the hip flexion can cause issues for the tendon. Thanks! What sort of timeline do you find is typical for these different stages?
Thanks! Honestly, the timeline is all over the map. Sometimes people progress right on through, others take a little longer at each stage. I'd focus on how your tissues are responding to load and progress based on that.
would be great if you were in my area, I'd definitely go see you for my pt recovery
Hopefully this video helps!
im quad dominant and hip flexors are always tight. I do up hill sprints and karate. Lots of front kicks and side kicks. Your video was very helpful in fixing by ass pain. regards.
Glad to hear it! With all the kicking, makes sense that you would be quad and hip flexor dominate.
I do have tight hip flexors as well: Foam rolling my quads has help me a lot!
I've been struggling at this on and off for 5 years. I'd have pain for few weeks, then not much for months. Still able to run sub 19min 5k and 1,26 half marathon. But now I've really hit a wall. This pain near my sit bone wont go away after 3 month of no running at all. Pain would stab me in the glutes in different areas. Sometimes randomly while standing, sitting, walking.
I've had enough tbh. Your video hopefully will help me.
Sorry to hear this! Hopefully the video will help you. I made another video recently on home exercises for PHT which may be helpful. ua-cam.com/video/UAvDabmsyDc/v-deo.html
Hi Karl, I am a runner also and around your times also :) well slightly slower (5k pr is 19:14 and half mar pr 1:28:16). I injured my self first during a random soccer game in July 2019 (I was sprinting too much on the wing without much warmup, and it was cold weather). Then I kind of recovered with physiotherapy and I even managed to run the Sydney marathon in Sept 2019. However I injured myself a second time in Feb 2020, again with soccer, and since then I haven't really recovered yet.... I stopped running for around 2 months in July August Sept 2020, and did lots of physio exercises (lots of these bridges, arabesque, and several glutes and hamstring strengthening), now the physiotherapist said that I can run 4 to 5 times per week, but actually my butt still hurts, particularly after sitting long.... not sure what i should do.... probably just continue with the exercises he told me and running easy...?
@@paolongong hi mate. Good to know your running. I'm still not running. Quite happy to wait tbh. I'm doing same exercises and bridges. No stretching at all.
I also got a peanut shaped ball to sit on. I can feel the difference after just 3 days. I believe it's going to work.
Keep at it, let's smash 2021 when we are recovered..
@@paolongong sent a video.
ua-cam.com/video/TBVeZAZCAo8/v-deo.html
@@karlosfandango6637 and Paolo, mates! I am currently experiencing exactly what you both described. how are you 2 feeling? I have a marathon coming up in about 10 days so after that I am going to hit recovery and rehab of this hamstring pretty hard.
My orthopedic doctor could not identify my pain correctly. This is what I have! Now I can finally try to recover! I can not even sit in a chair to work the pain is so great!
Hi Taryn! Hope this video helps you out then! I have a couple videos on PHT so you have some variety to choose from. Hopefully you can get back to sitting comfortably again.
Hi Taryn, I have the same problem and sympathize with you. Did the exercises help?
Thanks for the video. I've been suffering from this injury a couple of months now, not really knowing what it was, and assumed it would just get better, but it hasn't. After finding your site and this video, looking forward to trying it. Thanks!
You are welcome! Hope that it helps in your recovery!
THANK YOU!
You’re welcome! I also created an updated version of this which might be useful: ua-cam.com/video/ryWCFkI63Cs/v-deo.html
Great video! Thank you for all the different exercises and breakdown of the progression levels to strengthen.
You are welcome!
Great video, what if one does not have pain while doing the hamstring stretch, but only has pain while sitting.
For a PHT diagnosis or for rehab?
@@MichaelBraccio diagnosis
@@benchmarks1016 A hamstring stretch would just give information on whether the tendon can tolerate compression on the ischial tuberosity, so it's not necessary (although common) for diagnosis.
Generally for diagnosis it is location of the pain near the insertion of the hamstrings plus pain with loading the proximal hamstrings.
@@MichaelBraccio thankyou!
Hey!
I tore one of my hamstring muscle 2 years ago. Then after a few weeks I started running and always felt a sharp pain in the gluteus area during Sprints and longer uphill runs. Unfortunately, I tore my cruciate ligament on the same leg while skiing while I was recovering. It was just over a year since the operation and I am knee is fine again. However, I couldn't do sprints during training because I still have this sharp pain in my gluteus. I did a MRI and I have tendinopathy at the base of the medial hamstring muscle (Tuber ischiadicum). I am currently receiving treatment ( shock wave therapy). I've been to several physiotherapists but they haven't been able to help me yet. I also went to an orthopedic surgeon and he diagnosed pelvic obliquity and I received insoles.
My question: When I bend my stretched leg at an angle of 65 degrees I have a snap or jump of the tendons in the area between the hamstrings and the gluteus. It doesn't really hurt, but I think it may irritate the area even more. Is the tendon sore and thicker? or where does the snap come from? I have a 2x1cm large water retention in the tendon according to the MRI. Will that go away again when I start Witz stage 1? i think i need a lot of patience in the recovery. Would you recommend the exercises in the video to me oder do you think I have another injury? I know that my injured leg is weaker compared to the other and now i am doing isometric exercises to strengthen it.
Thank you for your videos and I hope you can help me. I just want to return to sports and play football again.
Greetings from Austria!
Hey Calvin. It’s tough to say since you have a couple of things that could be contributing. Honestly I’d look for a physio that specializes in running to help you with your return.
As for the popping in the hip, there’s many different things that can cause the popping (for example, ligaments, tendons, labrum). Usually popping isn’t that big of a deal but it depends.
i’ve been struggling with this for 6 months now. everytime i feel like i’m making progress and i’m feeling good, i start doing the plyometrics and the deadlifts and then the pain returns. should i wait until i feel virtually no pain before transitioning to those exercises? I have no pain with the glute and hamstring bridges
let me know your thoughts! i really feel stuck right now
stejeliteK from my experience it does eventually go away, slowly ease yourself into it all and it will go away keep your head up
Billy Coghlin thank you, that is reassuring
stejeliteK no problem, what’s your situation now ?
Apologies on the delay (for some reason I wasn't getting notifications).
Plyometrics can be challenging on the tendon which is why they are usually at the end of a rehab program.
The key to PHT is gradual loading. So if deadlifts are something that you'd like to return to, I'd slowly start adding load with the hip in a flexed position. For example, you might deadlift from blocks to raise the bar so you don't have to flex the hip as much.
Thanks for explaining this. Could this cause anterior knee pain when walking, with hip flexion and hip extension, because the hamstring is tight? What are your experiences with physical therapy to improve it?
Thomas Hemming Larsen there could be a compensation pattern leading to the anterior knee pain (loading the quads and knee more). It probably doesn’t have a lot to do with the hamstring tightness.
PT can be helpful for PHT. Just need to find someone to help load progressively.
I'm pretty sure I have this, it's hard to find experts that know about this injury
Well these videos are helpful! Happy to answer any questions.
Thank you for this! I'm a dancer and twinged my handspring kicking my left leg - I now feel a pain that after much google has lead me to proximal hamstring tendinopathy. Can I continue to dance as long as it isn't irritated? Thank you for the exercises, I will be doing them consistently and hopefully recover!!
Ps. I will see a local physiotherapist as I know you can't strictly give me a yes or no but I am just wondering if you think any exercise will hider the recovery process of this injury as I just want to recover as soon as possible. Thank you!!
Usually complete rest isn't necessary. Most of the time maybe there are some modifications that are helpful but it depends on the individual.
Thnx Michael for this amazing good video and explanation. I have a high hamstring tendon injury for 2 weeks now. Sadly I denied the pain and I went on doing my sumo deadlifts. Then I started to stretch which was a huge mistake to treat the tendon pain I found out later. I started isometric exercises for 3 days ago. I have a little question. How long does a stage last? Is it just as long as you don't feel pain anymore and then go on to the next stage?
BTW I'm 57 yo man. Do full body fitness and power training 2 times as week. I have a long history of tendon problems but only on the elbows. I had tennis and golf elbows and distal Biceps tendon problems on both arms. The first time I had distal bicep tendinitis I was 28 yo.
Hey there. There's no specific timeframe for each stage, as it depends on the person's tolerance to loading. If the tendon can tolerate more load, then gradually progressing to more is fine. But if the tendon needs a little more time to adapt, then spending time at that stage is probably best. Plus other factors like age, diet, previous injuries, etc will all factor in the adaptation.
@@MichaelBraccio thank u so much
When would you you recommend starting concentric and eccentric exercises? and also plyometric exercises?
It depends on the person, as there isn't a set timeframe for everyone. I try to progress the exercises as soon as they are tolerated, especially from isometrics to concentric-eccentric.
Thanks Micael. Great video. Should I avoid Yoga while recovering from PHT? Thank you.
Not necessarily. Most of the time the movements can be modified if there is something irritating.
Hi Michael, is stretching helpful or harmful? I've heard conflicting for this injury. Thanks, Galen
Hi Galen, I don't think it's that simple with stretching and PHT. There's a lot of fear around stretching because it adds some compressive load and can be irritating. But it's generally not harmful to the tendon (it can be painful though) and compressive loading is needed for the tendon at some point (otherwise you would never lift your leg again). On the flip side, I don't think stretching is the most useful approach for PHT. Hope that provides some context. I made a general video on this topic if you want to learn more ua-cam.com/video/6H5wvAYoX3w/v-deo.html
@@MichaelBraccio hey Michael, thanks for your reply and that video. Seems like it's a matter of balance. My PT had my stretching (on back, piriformis stretch and raised leg, now touching close to toes) every day and I think following your videos, that might be excessive. The best approach seems like limited stretching. I'm about 1 month out from injury so still kinda fresh too
As a result of both sitting too much and starting to ride my bicycle again I have been having hip area pain. It felt like hamstring tendonitis but I thought it might ber piriformis syndrome because I have had that in the past. After watching a lot of UA-cam videos and stretching and exercising with little relief, I went to an orthopedic doctor. He saw my crushed back disc and decided it was a back problem. Returning to my original thought I was looking into how to treat tendonitis in the hamstrings and found your videos. Because I'm old it may take a while but at least I am now hopeful about relieving my pain. After some more poking on the internet, I am wondering if I have ischial bursitis. The symptoms sound like proximal hamstring tendinopathy. How does one tell the difference? Also, I found a seat cushion that has cutouts for the ischia that has made sitting mostly painless.
Hello! Hopefully they provided some good advice for you to recover. Sometimes imaging can be scary but it doesn't always tell the full picture.
What's you opinion and knowledge about the usefulness of foam rolling and balls for working the upper hamstring?
Eh. They can be help to decease pain temporarily. It can be used as an adjunct treatment but needs to have a loading program for rehab. I don't incorporate foam rolling/lacrosse balls in my treatment plans nearly as much as I used to.
Following an ACL surgery 3 years ago, I haven’t had full knee extension while walking and standing. I recently had surgery to remove lesion preventing this. I’ve had problems with PHT over the past year, especially after hitting the effected leg with a heavy load of exercises two summers ago. Could gait cycle have caused this? I was a skeptic when my Dr. said it but it sounds like you have seconded thIs. Will getting back proper gait eventually repair? Along with exercises? Thanks for input
Potentially. ACL-R can alter motor control/gait and lead to increased loads on the hamstring.
Thanks for the input and the videos
Thank you for this well informed video. I have a question so I had a grade 2 strain in my upper hamstring the one under the glutes. And I did 2 months of rehab and was doing Romanian deadlifts just with the bar and progressing as well as sumo deadlifts. I aggravated the hamstring no restrain or worse apparently and I’ve been doing the rehab for the aggravation for about 16 days. There is still moderate pain right now. I’m just wondering that when this heals will I go straight back into the deadlifts and plyometrics? And how common are aggravations. Also if I should be able to go back into sprinting and change of direction after a couple days from now after it heals. The strain wasn’t fully healed yet to my knowledge. Thanks
Soccer is also my main sport. The two exercises I listed were just two of many btw.
Hello! It's challenging to say. Sometimes a flare up is just a little bump in the road and things can progress. Other times the flare up needs to have the exercises/load regressed to build back up again. All depends on how the tissue responds to loading.
Overall, flare ups can be fairly common. Especially when it is a more chronic issue. Best to track progress over longer periods (to see it making progress) compared to day to day (might have quite a bit of fluctuations).
@@MichaelBraccio yes I am regressing back to some earlier exercises, the pain didn’t go away yet. I am finding some hip flextion exercises more painful then others. I am a bit confused tho because the hamstring is still strong. How long should this pain take to go away normally? Also would it get worse with sprinting?
@@mayankchopra3739 the relationship of strength and pain is a little complicated. The strength that you built up doesn't just disappear when there is pain.
There is no 'normal' timeframe for flare ups. Sometimes a flare up can be a day or so other times longer. There might be an average length for a flare up but can vary.
Sprinting would place more loads on the hamstring which may aggravate hamstring issues.
wow. I think I get this from doing splits and squats. Now I don't know if I must exercise with bodyweight only? Like some power walking, yoga and//or pilates? Or should I jjust rest and do the rehab exercises?? Thank you! It's the only video I have found understand my symptoms
That's tough to say. Usually start with exercises that don't exacerbate the symptoms and build from there. Sometimes rest is necessary but not complete rest.
Hi Michael! I’m 15 years old and am big into weightlifting and football... I just recently (a few weeks ago) felt a gradual pain while deadlifting in my upper hamstring/deep within my glute and am wondering if this is what I have. I get a burning pain deep within my glute while sitting for a prolonged period of time and a sharp pain in my hip flexor/Pelvic bone. It really starts to hurt when doing any leg exercises except the hamstring curl, I’m still doing conditioning for football but stopped all leg exercises... I really need help because I don’t know what this is...(It also gets worse after sprints)
Hi Justin! Sorry to hear about the hamstring/glute pain. There can be several different things that would cause pain in that area (including proximal hamstring tendinopathy), but you'd need to have someone do an examination on you to determine what the cause of it is.
should these hurt at all? like deadlifts hurt me, should i fight through the pain or do bridges until the pain is non existent in the deadlift?
It really depends. Sometimes the loads need to be reduced if they are causing too much irritation. But some pain with exercises is tolerated with tendinopathy rehab.
Hi Michael, thanks a lot for the video... I replied to Karl Budworth comment below and if you read it you can see my story with PHT... It's such a pain.... I am "allowed" to run again according to my physio... but need to keep doing at least twice a week sets of arabesque with a weight (it's for my right hamstring) and different slides/pull up with the leg (not sure how it is called). But just last sunday I had a long trip driving the car (738 km!) and since then it really hurts again... I guess that sitting long is really bad.... is there anything that I can do to relieve pain from sitting? I haven't taken any anti inflammatory or painkiller so far... would it be worth it sometimes?
Hey there! Sitting is one of the positions that tends to irritate PHT (probably has to due with the compression of the tendon against the bone).
There's a mixed debate on the usefulness of anti-inflammatories. They might be helpful to reduce the pain in the short term but they have also been shown to slow tissue healing.
I’ve commented on one of your posts relatively recently in which you replied. I’ve got more questions relating to my symptoms. I can sprint up the stairs with no pain, I can do sprint specific isometric holds (much harder than the suggestion on here), and I can do any other gym exercise, such as Nordics etc, with no-minimal pain, but when I run it flares up and radiates down my groin area or the side left side of my hamstring (it’s only on my right hamstring at the moment). What does this sound like to you? It sometimes hurts to hip hinge, however when it does it’s barely at all, in fact I’d say a 1-10 on a pain scale, just feels like tingling. It’s so weird and I don’t know what to make of it, why can I do very good strict nordics and not run (even if they’re just posture runs and not at max velocity)? RDLs hurt a bit more, more like a 3-4/10, but nothing too bad, and I can do them with 80+ kg for 6 reps???? I really need any ideas, I’ve been on and off rehabbing since September 2018 for it. Also might be good to know that the tendons behind my knees (both knees), can also ache, and they click lots too. When I do nordics, I feel pain and tightness at these tendons as I go down, and it restricts me from going down even further (I have the strength to go further, but the back of both knees stop me doing so). What does this info sound like to you? How can I do Nordics, bend over and touch my toes without pain, but do a 70+% of max velocity run and i start to feel it and it radiates down the left side of my right hamstring. Thanks again :) just very anxious about it as I want to get back racing
Strength is only one aspect of recovery. Running places different loads on the body which the body needs to be able to adapt to.
In general, nordics are a great exercise but mostly focused on the distal hamstring (although there is certainly some carryover).
I’d discuss with someone near you who can do an exam and see what might be contributing.
Who can diagnose this issue? Can a PT or should I consult an Orthopedic Doctor? I've read stuff about Tendonopthy's being able to be diagnosed by just load tests but then I've read that for Hamstring Tendonopothy's oftentimes an MRI is needed. Thanks!
A lot of healthcare providers can diagnose the issue but it depends on their experience. So it's better to find someone that treats PHT than purely credentials alone.
MRI isn't needed for the diagnosis, usually a history and examination is sufficient. MRI is usually more helpful if other pathologies are suspected.
@@MichaelBraccio Hey Michael. Thanks so much for responding! I appreciate it. Real quick. So would the gold standard be an orthopedic doctor who specializes in Hamstring issues, specifically PHT? Or could you find a competent PT who could diagnose it as well? I made an appointment with an Orthopedic Doctor whose speciality is in Hamstring Issues so I'm hoping this works out.
@@kiwicoproductions2828 I wouldn't say that there is a gold standard necessarily in terms of professions. Usually someone who works with sports injuries would be somewhat familiar with PHT (could be a MD, PT, ATC, or DC).
Now in doing these isometric and plyometric movements, is it expected to still feel some pain in our hamstrings? Or should we not feel any pain whatsoever when doing these exercises?
Some pain while doing the exercises is tolerated in the protocols for tendons. Obviously the pain has to be reasonable though.
I have been having what I believe to be Proximal Hamstring tendinopathy or maybe a tendinitis. The issue started 2 weeks ago. I think i exasperated it trying to stretch and foam roll as I thought it was simply a tight hamstring muscle. Last night I was in enough pain to wake me out of my slumber.. So I began research. Where do I start, it's a fairly new injury? How is it diagnosed what type of doctor should I see to get referral to physiotherapy or do you think its minor enough to start at home rehab?
Thanks in advance for any advice or direction.
Usually a sports chiropractor or physical therapist can diagnose the issue. A sports medicine doctor can also be helpful in the diagnosis and referral process.
Does it make sense that squats don't hurt? But lunges on the left side does? Trying to rule out or see if I have this tendinopathy
I wouldn't say that either would rule in or out PHT. Might have something to do with the knee flexion of the squats vs the lunges that might be the difference in this case.
great and informative video.. apperciate ur efforts ..I am a physiotherapist.. can i ask about sth .i have a pinch like pain whenever i bend my back in the ischial tuberosity area and also when i strech the hamstrings wihout any sign of tendiopathy ..i am usullay an active person working out almost 4-5 days per week at home ..my workout plan contain : body weight exercises , kickboxing , and juming rope and it goes with about 40 min ,and i sterch afterward by like 6 hours ..warming up as well before strating .. it is been week and pain nerve goes away but it decrease a little bit ..what i have done lately going for walk, putting an ice pack ..and doing some gentle streching exercises .. wondering if there is any test can i do at home during this lockdown to know excalty what is the diagnosis ....or .should i return back to my workout schedule gradually nowmatter what ...or it is gonna do a further harm ? ..any adevice would help a lot .. thanks in advance .
Hello! It’s difficult to say because there are a couple of things that can present similar to that and not any good tests you can do at home to help figure it out. Would be best to see if someone does telehealth visit to sort through what’s going on.
@@MichaelBraccio ok .. I'm gonna take ur advice in account .. and will contact with a professional colleuge as soon as possible... thank u so much 🌹
Great video! I have been suffering from a partial tear + tendinosis in my right hamstring due to using too much weight during a hip thrusts 3 months ago, and it keeps getting reinjured snd I have continuously lost a lot of strength in the glutes, however whenever I try to do glute excersizes for pt my hamstrings take over and get reinjured. It’s a vicious cycle and I miss being active, and I’m scared that there is scar tissue build up and that it will never be the same/heal. Any suggestions for safe excersizes and how to return to doing pt without putting strain on the hamstrings? Thanks so much!
Hi Abby. I wouldn't be too worried about scar tissue build up. It's part of the normal healing process and is rarely an issue overall despite the common narrative. As for exercises, most exercises are generally safe to do. It's about finding an exercise that you will comfortable with engaging the glutes (and hamstrings) and building up from there. Generally when doing a glute bridge/hip thrust the closer your heels are to your glutes the more glute and less hamstring activation there is which might be helpful. But whenever the glutes contract, there will be some hamstring to some degree (they work together for hip extension).
Hi Michael. Thanks very much for this video. I've been struggling with this for almost 2 years now. The only time it's gone away is when I basically stopped doing any exercise and avoided sitting as much as possible. Now that I start back doing exercises, the pain returns like it never went away. Any advice on how to actually recover from this? Many thanks
Depends on what you’ve done over the previous 2 years. Maybe following a progressive exercise program consistently can help to remove. Sometimes a more generalized exercise program might be useful. Difficult to say which route would be best for you.
2 years and counting! I can't get rid of this bilateral proximal tendonopathy.
Sorry to hear that! There are a lot of factors to consider besides just loading for tendinopathy that might be worthwhile to look into
How long on the isométric phase and só on ?
It's not really time dependent but more so how the tendon responds to loading. For really sensitive tendons, I might stay with isometrics for a little longer to load them but usually I try to load with movement if tolerated. Other things to consider when progressing is how the tendon is tolerating load throughout the day (sitting, walking, etc).
How many sets, reps, and frequency per week should you start out with? I am struggling with this injury!
Hi Bryan! There's not a specific amount because it varies between individuals. More sensitive tendons may need to start with less load whereas some can tolerate more loading. So it's finding the balance that feels challenging but doesn't irritate the area for the entire day.
I suffered an avulsion of left hamstring 1 1/2 years ago. Did not have surgery. Continue to have pain from proximal tendinopathy. Can do most eccentric exercises without any pain, however, if I try to do a more concentric exercise such as dead lifts. or if I stretch, I produce a sharp pain in the tendon area. When I run, I can keep pain to a moderate soreness as long as I keep distance low and speed slow. How much pain is o.k. to have when trying different exercises? Seems like when I do stuff like stretching or deadlifts, it aggravates the injury, but I also seem to have reached a point of no improvement. Want to get back to running. Any suggestions?
Hi Cathy. I'd suggest having a follow up to see how/if the avulsion healed. A hamstring avulsion might need to have a different treatment approach than a tendinopathy.
But it sounds like the hamstring isn't tolerating compression well (whenever the hip is flexed). Gradual strengthening exercises into hip flexion might be helpful.
Pain is quite subjective, so it's difficult to say how much pain is okay. For many tendinopathy rehab programs, pain is okay with the exercise. And other research has shown it's not detrimental (bjsm.bmj.com/content/51/23/1679). But better to have a medical provider supervise to make sure that the rehab program is appropriate.
Do you recommend stretching your hamstring at all
It depends. For sensitive tendons in the beginning, probably not. But compression of the tendon needs to be introduced in the rehab progression.
Hi
I injured my hamstring in Feb 2020 and after 8 months of pain, got a diagnosis of hamstring tendonopathy after an MRI in October. Since then, I have been doing the exercises I was advised to do by my physio and no running, jumping etc, no weight training or squats lunges etc. I have been very aware of not stretching and being careful when bending down etc. however today when leaning over I mindlessly pulled my hamstring again and now I have the full ache and twingey pain I had back in October. I am so worried that today’s one accidental stretch has potentially got me back to square one :( just want this to get better. I would appreciate any advise or suggestions you have. Thank you in advance 🙏🏼
The recovery process usually fluctuates (some good days, some bad days, some improvement, and some regression). That's why it is important to look at the overall trend instead of day to day.
So if you need to temporarily reduce the rehab loads because of some increased irritation, that doesn't mean that it is a large set back.
Stay positive.
@@MichaelBraccio thank you so much for your reply!
Digressed yesterday after adding a too heavy dumbbell to my glute bridges. In quite a bit of pain now so I’m hoping a few days rest will help and I’ve not digressed too much 😥
What do you do if there is no pain during the long leaver bridge but the next day you are very sore? Do you do the exercise every other day? Or just push through and keep doing it?
It’s usually better to be a little more cautious and reduce the load so it isn’t very sore the next day. It’s not the best idea to overload the tendon too much and have to take prolonged periods of time off because you pushed too hard too soon.
Should I just keep stretching it and will it get better if I do. And how long will it take to heal because I want to get back into squatting and Bulgarian squats.
Recovery varies between individuals. Some people respond more quickly, some take some time.
How many sets of long leaver glute bridges do you do? And how long do you do them until you move to the next phase
The long lever holds or with movement?
I normally recommend 3-5 reps of 45 second holds but that can vary between individuals. For movement, I usually do 3 sets of 10 initial but eventually add more sets and less reps as the load increases.
It depends on the tendons tolerance to load. If the tendon pain fluctuates a lot day to day or if there is a consistent flare up with low load activities (sitting, walking, etc), then I might have someone do the isometric bridges. If the tendon can tolerate higher loads, I progress them to keep the exercises challenging.
Hope that helps
Ichial bursitis permanent solution please i hav been suffering from 3 year 1 have take injection still no relief
I got severe pain near lower butt. Please help me what to do. Please
My GP has diagnosed me with tendinitis of the upper hamstring and I have trouble walking it feels incredibly tight when I walk I find it hard to bend my leg when I walk. But is very sore to bend down or deadlift as you said here... what can I do
Hello! You might want to look at this video here ua-cam.com/video/UAvDabmsyDc/v-deo.html.
@@MichaelBraccio thank you !
What are the things to do to avoid hamstring injury,
I had an injury about a year ago hamstring injury and I decided to keep playing after 2 weeks then it didn’t go for a long time but after a while of not playing soccer i didn’t feel it anymore but then I hit the gym about 3 weeks ago and I felt it I thought it was because I was putting to much load into it . Just yesterday my soccer tournament started and I felt like a muscle pull in my back thigh it felt like I couldn’t run so I stopped but the next day today I’m feeling a little pain in the left leg of my bum what are the thing I need to do what is your advice ?
Generally to avoid hamstring injuries it is a combination of gradual strength training and appropriate load management. A common error we see is that once the pain subsides people go right back to their previous activity level. But sometimes the activity needs to be reduced and gradually increased over time.
Tore my hamstring a little over 4 weeks ago and now that I can run and stuff again I get sore in that area a lot
I had my hamstring evaluated and I was told that constantly re-injuring my hamstring over years that I’ve developed scar tissue in my hamstring making the nerves extremely sensitive to any type of movement. From this information I’ve been having a hard time distinguishing if it’s pain from exercising or if my nerves are overly sensitive to certain movements which gives me a hard time understand if I’m healing or not. If you could respond to this and give me your thoughts on scar tissue and if the pain I’m feeling is from the sensitive scar tissue and I should proceed with what I’m doing.
Have you tried sport massage to eliminate scar tissue build up
It's possible that scar tissue can irritate the sciatic nerve. Usually numbness and tingling is the indicator if the sciatic nerve is involved. But overall I think that scar tissue probably plays a small role compared to other things involved with injuries such as PHT.
Sports massage is unlikely to have an effect on scar tissue.
Hey bro! I tried to see how high I could kick! And I didn’t stretch enough before doing it and I felt a rip in my hamstring when I kicked it! It’s been several months now and it still hurts really bad when I sit for too long or it just hurts when there is pressure in that part! What should I do?
Yikes! Hopefully it was a really high kick! I would have it assessed by someone to see what you did so you can get back to high kicking.
How do do you know you're ready for phase 2 and then phase 3?
There's not a strict criteria. I usually try to see how the tissues tolerate adding speed to the exercises in phase 2 to gain some insight into how they would tolerate plyometrics.
How long should I spend on each stage before progressing to the next
As long as you need to. It's more about how difficult the exercises feel and how the tendon is tolerating the load. Feels easy and no/little pain? Try progressing.
I picked up this injury 3 weeks ago and I caught it very early on so it wasn’t sore to touch or anything like that it’s only when I do a sprint or sit for a long time I feel a tingling sensation down from my glute to behind the knee.I’m a soccer player so sprints and changes of direction are very common in my training ,since my pain is very light when do you think I can start playing again
Hey Michael
Im rehabing After 6 months of Osgood schlatter's disease in which i have walked in crutches for these 6 months. After 2 months of very low intensity training i felt i could walk again. After 4 days of walking without crutches i started feeling this sharp pain in my pht. I've gone back to the crutches for these last 4 days and my pain has calmed i also haven't done any exercise these 4 days. I think i will try the bridge exercise tomorow. Hopefully it doesn't hurt. And After how many days of rehabing my pht will i be able to start reintroducing walking without crutches like 4-5 days? It's pretty important that i walk as im starting highschool in 3 weeks😅
Btw love your content
Love from France
Hello Julien.
Thanks a tough one. It's hard to know exactly when to introduce something as it really depends on how the tissues respond to loading. Sometimes they tolerate more load quickly, other times they take time. The goal is to gradually increase the load until you are able to do what you want to do.
I’ve had a mild pain deep in my hamstring but it doesn’t feel like it’s the muscle which is injured. I feel this twinge if I move in bed or put weight on my leg sometimes. It’s never painful but it’s annoying and I want to fix it. The problem is I’m not sure what the issue is and I’m worried about making it worse
Hi Matt. It can often be difficult to isolate a specific tissue as a source of pain or discomfort. Usually have an examination to determine if something serious is going on and then a tailored treatment plan to help decrease that twinge can be helpful (and also reduce the fear of making things worse).
This isn't gonna go away by itself right?
It’s a great question. It definitely can resolve on its own. Although there seems to be a slow recovery process for PHT compared to other tendinopathy. Not exactly sure why that is though.
I picked up this injury 3 weeks ago and I caught it very early on so it wasn’t sore to touch or anything like that it’s only when I do a sprint or sit for a long time I feel a tingling sensation down from my glute to behind the knee.I’m a soccer player so sprints and changes of direction are very common in my training ,since my pain is very light when do you think I can start playing again
Hi Peter. That's difficult to answer, since everyone's body responds differently. Sometimes the tissues tolerate sprints/COD quickly, others take a little bit to tolerate it.
are you alright now or does it still hurt i also play soccer
I got this after biking. Please help me
Hi Richard, Did you have a specific question? I have multiple videos on PHT that might be helpful and answer any questions that you have.
How long is it going to take me for it completely heal?????
Depends. I would say average is 3-6 months but varies between individuals.
Michael Braccio well it’s been gone now lol
@@king-qi2ks what did u do to heal it completely. I’ve had it for 1 month and 2 weeks and it hasn’t gone away.
@@angadkohli7533 yes I did. It took about 5 months
So your advise is, after healing, to gradually start bodybuilding like a fresh start with no weights and build progressively. I imagine after healing we have fresh fibers that never trained before, mixed with old strong ones. If we return as never hapened we will break those fresh fibers and injury again.
Sort of. I would say that gradually increasing the loads placed on the tendon and hamstrings would be helpful, but I wouldn't consider that bodybuilding.
No one is talking about distal diagnos. Fuck intertnet and popilism.
Distal hamstring would have similar exercises as muscle strains. ua-cam.com/video/bsVZO4E97Sw/v-deo.html
Wow , U should learn to relax your eye lid muscles or u can have eye dryness.
I never blink.
Terrible.
Is there something in the video that you found was inaccurate?