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Battling chronic tendon injury.

I was injured doing yoga over 10 years ago, and I have never gotten over the injury. In yoga it is referred to as "sit bone" pain, but I believe it is essentially a high hamstring injury. I am 54 years old, weigh 112 lbs, and am 5 feet 6 inches. I have been a runner since 1972 and had never had hamstring issues until I combined yoga and running. I have practiced Ashtanga yoga for over 11 years.

I have rested, crosstrained, etc. I am able to run, but not at the intensity or duration I once did and during yoga I have to be very careful when doing anything involving the hamstrings, which in yoga is almost every asana. For running, it means no hills and no interval training. I have gone from 6:30 mile pace to 8:00 mile pace.

There have been times when even walking was difficult, and sitting at length (especially in a car) was very painful. Also, at the height of the pain, I could not even do 10 lbs on the curl machine.

My new yoga teacher has indicated it may involve the sacroiliac joint and the pelvis being "locked." I'm interested to know your thoughts on this and would really appreciate any suggestions to help me move beyond this injury.

Andrea Maracelli

Teaneck, NJ

While high hamstring tendinopathy is most commonly seen in runners, it can occur with other activities. Runners tend to develop this problem after years of running. Tendinopathy describes chronic injury to the tendon as opposed to an acute strain. As a result, stride length will decrease due to a loss of flexibility. Strength deficits will also be present. Single leg exercises to address the strength and flexibility deficits are essential to recover from this problem; stopping the offending activities may be a necessary component of the recovery process. Running through the problem will result in exactly what you are describing: a significant decrease in speed.

The "sit bones" (otherwise known as the ischial tuberosities) are on the bottom rim of each side of the pelvis. The majority of the hamstring tendons originate here. Sitting on a hard surface or in the bucket seat of a car will put pressure on this site, causing pain.

The pelvic bones attach to the sacrum, creating the sacroiliac (SI) joints. Any abnormality in the lower back and pelvis will impact other structures in the area. Chronically irritated proximal hamstring tendons may cause irritation of the SI joints. Irritation of the sciatic nerve and hip flexors may occur in conjunction with hamstring tendinopathy. It is also possible an alignment issue in your pelvis or back was the cause of the hamstring problem. Each step that you take is the result of a chain of events; a problem with one link affects the entire chain.

You should seek evaluation by a sports medicine specialist to assess alignment, mobility, strength and flexibility. You may discuss treatments in addition to exercises, such as platelet rich plasma (PRP) injections. Recovery will be a slow process, especially since the problem has been present for more than a decade. Hang in there with the therapy and you will likely note improvement in your symptoms.

Cathy Fieseler, MD

Tyler, TX

Without actually examining you I believe this pain could be caused from small tears in your hamstring or connected tendons. Since your hamstring attaches via tendon tissue, it is possible that the tears have occurred at the junction of the tendon and the hamstring muscle. Sometimes during yoga, participants will overstretch the hamstring causing these small tears. This can be the source of your pain.

If the pain is a result of performing yoga exercises on a firm mat, it is possible that the pain is caused by a bruising. In either case, pain while sitting for a prolonged period in a chair or in a car can be bothersome. This injury will also likely bother you when running, especially on an incline.

I would recommend that you perform higher repetition (15 to 20 reps) leg curls with low resistance. The first intent of these exercises is to stretch the hamstrings and glutes and increase blood flow to these working muscles. The second goal is to increase the strength in these muscles.

Gradually increase the resistance you are using until it is challenging to perform 10 to 15 repetitions in your leg curl exercise. If you experience any pain during either exercise, it is likely that it will be experienced when the muscles are in a stretched position, so pause in a stretched position for two seconds. Let any pain be an indicator that you have stretched sufficiently for that particular repetition. Use your pain to let you know when you have stretched far enough--never try to continue stretching through the pain.

You can place warm, moist heat on your hamstring/buttock area prior to working out to promote blood flow to the areas. Daily contrasting applications of heat before (20 minutes) and ice after (20 to 30 minutes) workouts will help to promote recovery.

When you feel that you are ready to return to running, you should begin on a flat surface and at a comfortable speed. And whenever you perform any exercise or work in a standing or seated position, try to maintain a slight bend at your knees, as this will reduce stress on your hamstrings and connected tendons.

John Comereski, MD

Ithaca, NY
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Title Annotation:THE CLINIC
Publication:Running & FitNews
Geographic Code:1USA
Date:Jan 1, 2015
Words:909
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