Chronic lower hamstring injury & rehab

Hi guys,

I have been experiencing pain behind my knee, towards the medial side of my left leg, for about 6 months. The pain is not in the knee itself, but rather feels like the distal region of one the hamstrings (semitendinosus or semimembranosus) or perhaps gracilis. 

I remember first feeling the pain while doing MN PE3 V-ups and pike leans. Since that time, I also found the injury would be triggered by doing any pancake, cossack squats or straddle movements. I have since avoided these movements as I know they will aggravate the injury. 

I have been seeing a phsyio, who has prescribed rehab exercises including shoulder bridges with feet on a gymball (2-3sets of15x5sec) and isometric holds of 4-5sets of 45sec with legs straight and feet on the gymball.

The injury seems to improve temporarily over a few weeks, before becoming re-aggravated, sometimes by something as innocuous as walking to work. Overall, the injury has not significantly improved over the 6 months period.

I was curious to know whether anyone else has experienced this injury and what they found was effective in rehabilitating it.

Thanks for your thoughts

HI james, I suspect that your rehab process it is not enough. You need general strengthening program which includes squat and straight leg/bent leg adduction exercise. When a problem returns it is because the rehab it is not completed. The exercises the physio given to you must have an increasing intensity, if not you have lowe chances to step back to the pain-free state.

6 hours ago, James McKenzie said:

Hi guys,

I have been experiencing pain behind my knee, towards the medial side of my left leg, for about 6 months. The pain is not in the knee itself, but rather feels like the distal region of one the hamstrings (semitendinosus or semimembranosus) or perhaps gracilis. 

I remember first feeling the pain while doing MN PE3 V-ups and pike leans. Since that time, I also found the injury would be triggered by doing any pancake, cossack squats or straddle movements. I have since avoided these movements as I know they will aggravate the injury. 

I have been seeing a phsyio, who has prescribed rehab exercises including shoulder bridges with feet on a gymball (2-3sets of15x5sec) and isometric holds of 4-5sets of 45sec with legs straight and feet on the gymball.

The injury seems to improve temporarily over a few weeks, before becoming re-aggravated, sometimes by something as innocuous as walking to work. Overall, the injury has not significantly improved over the 6 months period.

I was curious to know whether anyone else has experienced this injury and what they found was effective in rehabilitating it.

Thanks for your thoughts

Hi James,

From my experience, athletic therapists helped me more with my injuries than physio.  Not saying that physiotherapists are bad, but I just had better experiences with ATs.  It also depends on the person you work with! 

Hi James, 

I happened to be researching this myself the other day. Heres what I found.

Only do bent legged adductor stretches. Squashed frog, butterfly, horse stance etc. This is a more stable position for the knee.

And as Alessandro said, strengthen the muscles around the knee. Hamstrings, quads, adductors, abductors, calves. This is key!

Hope this helps. 

Thanks everyone for the replies so far.

I have been doing the GB Foundations (including the SLS series up to PE3 full squats) and bent leg adductor stretches (butterfly, squashed frog, flat frog etc), not specifically for rehab, but rather as part of my normal weekly routine. They do not aggravate the injured tendon. It's straight leg exercises that are problematic. For instance, I have previously aggravated the injury doing the exercises prescribed by the physio (see above) and also during HBP PE4 bench dips.

I re-aggravated the tendon 2 days ago. What approach do you recommend in the short-term? I will rest and avoid movements I know will trigger the injury. However, what about applying ice, heat, alternating ice + heat, foam roller, spikey ball or cross fiber friction massage?  

Once the acute phase of pain has dissipated, what have you found is the best approach to strengthening the injured tendon? I.e. specific exercises, sets/reps, scaling over time as strength improves. 

Thanks again.
 

Personally I used trigger point therapy and foam rolling on my inner hamstrings and gracilis, whilst avoiding the area near the knee. I also applied cold in the early stages and then heat thereafter to increase blood flow and repair. Friction massage or ice massage might be a good way to go as well.

In terms of exercises I have found exercises which require a fair amount of stability in the leg, so mainly contra lateral movements. That's not to say bi lateral movements won't help though.