Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly, Insync Physio in Vancouver. Vancouver's top physiotherapists, multiple times voted by their customers, best physiotherapists in Vancouver. And we're going to talk about hamstring strains. How are you doing today, Simon?
Simon: How you doing Mark, thanks a million for dialling in. I'm great to talk to you here today. I'm looking forward to chatting to you about hamstring tendinopathy, in particular actually. So, yeah, we'll get cracking right away, I suppose.
I had a client who came in a number of weeks ago, she's an avid runner. She's actually run numerous marathons and she was increasing her running up to maybe sometimes even more than that, 35, 40 kilometres. And she was getting really, really bad and pain in her glute, in her bum muscles. So that's generally how she started presented in the clinic. There was no huge swelling or anything like that. At first it was kind of global. It wasn't like she wasn't able to specifically point to a region in her glute muscles.
So again, it was gradual in onset. So you're kind of pretty sure it wasn't like an acute rupture or hamstring tear or strain or anything like that. She couldn't remember a specific event. Again, that crosses off a lot of that diagnosis like I spoke about before. And it just gradually began to get worse and worse where she wasn't able to run it all.
But in particular initially, it was at 35 kilometres and then she couldn't even run 5 to 10 kilometres. So that's kind of when she came into the clinic, so I saw her then.
Mark: So that's the diagnosis part of it? What was the treatment plan that you put her on and how did it go?
Simon: So I had a treatment plan Mark because initially it was more global. I actually treated her piriformis muscle, which is a tight muscle in the back of her glute. We've all heard about well most of us have heard about that muscle. The sciatica gets compressed down through there so initially, because it was global and she wasn't pointing at a specific spot. I thought it was piriformis syndrome.
So we settled that muscle first, we desensitize her whole system, but then after two or three sessions, we realized that she was coming in and then she was much more specific. What I mean by specific issue is pointing at her sit bone. So we sit on two bones called ischial tuberosity, is the fancy term we use. That's where all your hamstring muscles attached to. And placing that with her subjective of lots and lots of running, basically lots of hip extension and knee bending. That's what your hamstring does, over many, many kilo meters that the tendon was just breaking down and it wasn't able to keep up with the load that she was pressing on it.
So initial the treatment like you said, is basically what we call an isometric contractions. And isometric contraction is where you contract the muscle without actually moving through to range. You have to load the tendon. But you have to load it in a very specific and sort of measured way.
So new research has told us now that we actually should be loading it pretty heavy. She was in what we call a reactive stage of tendinopathy. So she'd be doing 70% of her own sort of body weight. An isometric max voluntary contraction we call it. What that does is it sort of breaks down the collagen crosslinks, it gets the tendon back to health.
And then we can do more of what we call isontonic. What do you see people doing in the gym. Lunges, squats lots of heavy weight through weight bearing. One key thing with hamstring tendinopathy is it's good to load it, but not in a compressed position. What I mean is compressed position is where you're leaning over, like bent over like a straight or stiff leg dead lift. That will be put in a lot of compression and tensile force on the issue of tuberosity. So you want to avoid that kind of stuff initially.
But eventually you want to be gone down into that position. So you'd be in a semi bent over position. Then lower and then lower until the tendon is able to withstand it.
And then you do a lot of energy storage and release. Which is like jumping, running eventually. So that was kind of the initial program. We got her isometrics first, then isotonics and then energy storage and then energy storage and release. And we just gradually increased her running back up from 5 to 10 kilometres, right back off to 25, 30 kilometres.
I've seen seeing her at present. So she still has a touch of tendinopathy, but it's much, much better. And we are loading the tendon into compression now so she's almost doing her straight leg deadlifts back to normal. Which is great.
Mark: So there you go. If you've got some problems with hamstring, tendinopathy, it's sore in your hams from running or any kind of exercise where your hamstrings are going to be bothering you. The guy to see is Simon Kelly at Insync Physio, he's in the Cambie Street office. You can reach them at (604) 566-9716, to book an appointment. Or check out the website insyncphysio.com. You can book online on there. And of course, Insync also has for the folks in Burnaby, they have a North Burnaby office at (604) 298-4878. Again, you can book online at insyncphysio.com. Thanks Simon.
Simon: Cheers Mark. Thanks very much.