Maintaining aerobic base during rehab for high hamstring tendinopathy

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  • #39604
    NWBC
    Participant

    Hi there,

    I am in the midst of early rehab exercise progressions to treat high hamstring tendinopathy (HHT) and have taken a break from running as of 2 weeks ago to avoid making the problem worse. I’ve been trail running for 20+ years but in 2018 I started with coached training for 50K distance races and it was in that year that the HHT developed. Last spring, I worked with a physio to successfully return to running and I ran two 50K trail races and ~1500 km of training distance (which is low for some, but for me was my biggest year to date) essentially without pain. I continued to run through the winter but reduced the volume and shifted my focus to base building by doing slow runs of various lengths (up to 20 km or 2-ish hours) consistently through the week, and at/just below AeT. I also included cross-country (both skate and classic) skiing and maintained a fairly consistent core stability and general strength routine. This was all done without the classic pain in the butt HHT symptom.
    This year I opted to ‘coach myself’ and started with the UA Big Vert plan in January to prepare for a May 29th 50K trail race. All was going well until I started with the hill sprint workouts at which point the tendon pain returned. Now I’m stuck with HHT, once again, but this time 10 weeks out from this race!

    I am wondering how I can maintain (or even build) my aerobic base while I rehabilitate the injury. If good trail conditions persist, I can cross-country ski for a while longer but I find (at least while skate skiing) I can’t keep my heart rate below my AeT and still maintain forward momentum on my skis! I haven’t tried my classics since the HHT returned, but I may be able to maintain a slower pace and lower HR in that mode. Wondering if any of the UA coaches have any advice or feedback. Is it reasonable to apply my running specific AeT to workouts on my skate or classic skis? As well, once its too warm to ski, what’s the best alternative to running while recovering from HHT? I want to wait a couple more weeks before trying short walk-runs to test the hamstring tendon but no matter how you cut it, I’ll have lost at least 4 weeks of actual run training. Although I will have to see how quickly my body responds to the rehab progression, do you have any other advice for preparing for the May race, given the injury?

    Thanks!

Posted In: Injury & Rehab

  • Keymaster
    Scott Semple on #39610

    Sorry to hear that. That sounds frustrating.

    I recently asked our head coach (Scott J.) about the same question: AeT HR applied to XC. When new or inefficient at the sport, it won’t apply. There’s too much additional muscle mass being recruited for a running AeT to apply. Using a drift test on a flat course is how you can figure it out.

    If running aggravates the injury, then I would try steep hikes. Most ultra races have a lot of hiking anyway, so it won’t be non-specific.

    Moderator
    Pete Dickinson MS,PT on #39666

    I usually take a fairly aggressive approach to tendon rehab with a return to walk/run ASAP depending on level of pain and functional loss. Starting at 1min walk/2min run is usually available unless any jogging is painful. Performing your rehab activities prior to this will help. Tendons do not do well with rest after an initial acute phase, it just further degrades their function. Pool running can help supplement volume. If you are over 40, other regions can generate upper hamstring pain. If this is the case you can be missing the boat on your rehab focus.
    Pete

    Participant
    NWBC on #39691

    Pete – thanks for the feedback. I tried what you suggested and will continue with that, see how it goes. I am, by the way, over 40 years old (44, female) and am interested in learning what else you think could be going on.

    Scott – thanks for the suggestions. Would be great to do a drift test on skate skis but we lack flat course! And for now hiking steeply is a movement that my hamstring tendon doesn’t like. Soon can though, I hope.

    Moderator
    Pete Dickinson MS,PT on #39713

    Repeat episodes of hamstring pain in an older athlete can be many things. As we age, our nerve openings exiting the spine become more narrow giving the opportunity for nerve compression sending pain to our hamstrings, ischial tuberoties, etc. When this happen you often have little back pain, and are hard to convince it’s anything else but the area that hurts!! It this is the case, then spine mobility and core strength become more important as a rehab direction. Of course other things can cause leg pain such as facet cysts, disc herniations, muscle fascial restrictions, and training errors.
    Cheers,
    Pete

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