It has now been almost 24 weeks since I tore my right hamstring near the attachment point near the ischial tuberosity. I spent the first month or so with a traditional MD and physical therapy which only seemed to make the problem worse. I then switched to a chiropractic office and received Active Release Treatment (A.R.T.) and Gastron Techinque which at least relieved some of the literal pain in my ass. After resting for 8 weeks I was given the OK to start light running again since it was assumed that this was a minor tear which usually needs 6-8 weeks of rest. I ramped up to about 15 miles a week and even managed to do a 5-mile event but it hurt every time I ran more than 3-4 miles. That is when we decided to do the MRI and found the severity of the problem and I was back off running. So in the last nearly half year I have run only 6 weeks.
For the last few months I’ve been cycling, walking and tapering off my A.R.T. treatments. The pain in my butt and down my leg is no longer continuous, I can sleep at night without waking up due to pain, I can drive or sit a bit longer and I think much of the acute inflammation has now subsided. I see this very slow improvement but still haven’t gone a day where I don’t notice some pain in my rear or leg and I’m still not close to being ready to run again.
In the past 3 weeks I have abandoned my vegan diet and added back in a bit of animal protein (eggs, dairy yogurt and a bit of salmon) to see if that kicks my system into gear. I’ve also added in a BCAA supplement to try and utilized the protein more efficiently. I actually feel that I’ve improved over this time but again, is it the change in diet or just time? My PT routine has been pretty consistent – a lot of work on a slant board and wobble board (see Eric Orton’s workout protocol in The Cool Impossible), squats, eccentric hamstring contractions with a band and several stretches and exercises from Anatomy for Runners by Jay Dicharry.
The last real treatment option is something called PRP for Platelet Rich Plasma treatment. PRP is being used with runners and has shown some success. With PRP a doctor draws some of your blood, centrifuges it to concentrate the platelets and then injects this directly into the tendon tear guiding the needle with ultrasound. The idea of a 5 inch needle being stuck in my ass to get to the tendon tear deep in there does not really appeal to me. I don’t mind a shot but come on, this sounds a bit much. Evidently getting blood into the spot and the concentrated blood is sort of full of HGH seems to have a healing effect for some.
Given that we live in the information age I decided it was best to do some research on the topic. One study from 2011 on using PRP for hamstring injuries in NFL players showed that PRP was no more effective than rest and regular treatment protocols:
This preliminary study involving the use of PRP and rehabilitation program for the treatment of acute hamstring injuries in NFL players did not show any significant difference in time to return to play.
Another study from this year showed that PRP injections to the ischial tuberosity attachment seems to be somewhat effective for persons who failed a traditional treatment protocol. Yet the results were mainly pointing in that direction and really a larger study is needed as they state in the conclusion:
Based on the data, the authors cannot conclusively determine that PRP is a superior treatment; however, the data suggest that PRP is superior, and this hypothesis could be the basis for future research into the new field of orthobiologics.
Another study looking at dancers was interesting to me in that I found out the average time back after a hamstring tear in dancers is 30-76 weeks. Yes, you read that right, 7-19 months of downtime is common. That woke me up, I’m at week 24 and am thinking this is taking forever but it turns out I haven’t even hit the low end of the return to workout time for such an injury. This study was a case study on one dancer and showed that PRP did seem to work:
This case report demonstrates sustained subjective and functional improvements with near-complete repair on MRI with a single application of platelet-rich plasma in a severe tendon injury.
A few runners and triathletes have blogged about getting PRP with mixed results. One runner said that after the 3rd injection it seemed to work but was it the injection or just that time finally healed the problem.
So what’s an injured runner to do? Right now my next step is to get a consultation next month with Kim Harmon, MD at UW Medical who specializes in tendinopathy and does do PRP treatments. After reviewing my case and MRI results I may get an idea if PRP looks like a viable option in my case, my other MD thought that it would have been beneficial in the early stages of the injury but now that the main inflammation is down that it probably would not have much benefit. I’ll post an update when I find out more, until then I will keep biking and doing some light hiking in hopes that next year I’ll be back on the trails.