My last try at figuring out this hamstring issue before I give up on powerlifting

Hello

I apologize in advance for the length of this post. It has been ongoing for 5 years so it requires some background information.

A little background:
I started training p90x in 2011. I played goalie in hockey as a kid for nearly 15 years but had little other physical activity. I started going to the gym and lifting in late 2012/early 2013 not really knowing what I was doing.

I have spent countless hours researching this issue and have had an x-ray, an ultrasound, 3 physiotherapists, 2 doctors and 4 chiropractors who can’t figure this out.

In 2013, shortly after I started lifting at the gym, I had a sharp pain (stabbing) in my left hamstring just under the glute when squatting. My form was likely terrible because it was a brand new movement but I cannot confirm what it was like back then. I stopped squatting and thought I was better after a few days because I hadn’t felt any pain other than during the actual squat. I went back to squatting and felt the same thing in the same spot and stopped again. I felt the same thing when deadlifting. Rinse and repeat this many times until I stopped squatting and deadlifting entirely for about a year while still lifting though (not knowing any better).

In 2014 I finally decided to try and get this fixed because I wanted to squat and deadlift again and ultimately powerlift.

I saw several chiropractors, physiotherapists, and a few doctors. I tried acupuncture, massage, graston, art ect and nothing helped.

One of the chiropractors had me do an ultrasound on my left hamstring which showed nothing. It should be noted however that I didn’t feel as though the person doing it put the wand where I’m actually feeling the pain.
One strange thing I noticed was that when I stood on my left leg only and lean forward, it feels very tight where the pain normally is (hamstring just under the glute) until there is a loud audible pop (similar to cracking knuckles) and then it feels much looser. This never happened before the pain/injury issue started and would only happen on the left side where the persistent injury was and not the right side.

I went to all these specialists they had varying theories but nothing seemed to work until 2 years ago a sports chiro first had me do an x-ray which again showed nothing abnormal. He then told me he had a theory that the strands of the muscle where all intertwined and that we needed to load it it fix it. We started doing single leg deadlifts with med ball, lunges, Nordic curls etc and I could barely do them. After a few months I steadily progressed and could do them fine so I stopped seeing him. I still couldn’t load very heavy on squats and deadlifts however and figured I would just need to keep progressively loading past these exercises with squats and deadlifts but it never went away.
At some point, around 1 year ago, the problem spread to my right hamstring as well and is now actually worse that the left side.

Fast forward to now, I have this sharp pain at the same spot in both hamstrings and more in the right side. I don’t feel it too much in the squat unless I go very heavy for me.
I can deadlift without pain only if I round my upper back (I think to shorten my range of motion).
Oddly enough, now both sides (since the right side is hurting too) will do the “pop” thing mentioned earlier about once every hour or so.

My hamstring strength seems fine on hamstring curls and I can fully extend them straight up while laying down so they don’t seem tight.

Things that hurt the most are deadlifts off the ground and at the top of the lockout, squats only at the very last portion of the lockout and being in the position for pendlay rows.

The pain is quite intense and very sharp and sudden and goes away nearly immediately once I get out of the specific position.

I have been reading a lot about pain science and recently asked Austin/Jordan for assistance on this same thing and they recommended to rack pull for a while. I have deloaded my deadlift from reps with mid 300’s to 135 as that is the only weight I can really do with minimal pain and keeping my back straight.
I don’t want to give up on deadlifts since I want to compete eventually.
The problem is I have been lifting extremely light on deadlifts and deloaded my squats a bit as well consistently for over 2 months thinking I can get my brain to calm down on focusing so hard but I haven’t made any improvements at all. Sometimes the pain is 6/10 with 185lb deadlifts and the next week its 9/10 and I even do them.

I would be more than happy to provide any additional information you are looking for or really do anything (if there is some sort of fee for additional support to finally solve this).

This seems to be an unsolvable problem and is really taking away from my love of lifting.

Thanks so much for your time,
Adam

Adam,
I am sorry to hear you have been dealing with this for so long. Before I go into too much detail I’m curious to hear what your research and experiences with healthcare providers have given you in terms of information and expectations for your symptoms. It sounds, from your report, like you have a proximal hamstring tendinopathy. This can certainly be a frustrating experience as tendons are very slow healing structures and ultimately have a capacity for load (in this instance typically volume is more detrimental than intensity). I can readily assure you that the likelihood of your muscles be intertwined is extremely low but the chiropractor did have the right idea on the way with which to treat a tendinopathy. The article below is related to patellar tendinopathy, but the heuristic for treatment is the same across all tendons.

Your hamstring strength may seem fine but this is predicated on “fine for what you are trying to do.” It is likely not the quantitative strength of the muscle so much as the ability of the tendon to accept load. To reiterate, tendons take a long time to turnover and respond best to heavy, slow training. Typically what happens is we start training the tendon in that manner (as it sounds like you did with Nordics, etc) and the capacity does rise but it is still not back to “normal.” Nordics also eventually have a ceiling effect unless you start holding a plate while you are doing them which makes catching yourself as you fall forward increasingly difficult. I tend to prescribe more stiff legged deadlifts or single leg deadlifts at tempo (5-1-3) to start. If you get this calmed down it is also likely worth having someone look at your deadlift set up. Sometimes having a tendency to jerk the bar off the ground can bring on some of these symptoms (I have obviously never seen you lift, but this is a common habit you see in this population).

Once you start building capacity in the tendons then getting back into training the full movement is warranted, but that does not mean the capacity work goes away immediately. If this has been going on for 5 years, anyone who tells you they are going to fix it tomorrow is lying to you. This will be a process, however, it is a process we have a very good understanding of ways with which to address at this point. I would be interested to see, if it has been two years since performing the loading exercises, how difficulty they are now.

I would also give this a listen. Stream Professor Jill Cook (La Trobe University) revisits BJSM podcasts after two years: First of Two by BMJ talk medicine | Listen online for free on SoundCloud

Hello Derek,

Thanks very much for your reply and information.

I would say in terms of expectations it has been quite varied. I have felt as though I have discovered the cause of the problem and how to fix it countless times but they never worked. I would say overall I’m fairly pessimistic that I can fix this however I do have quite a strong belief in the barbell medicine crew based on what I have been seeing in terms of training results from their programs and their information being put out.

I just finished listening to the podcast and reading the article.

Based on the information in this article should I continue my 7 week GPP program but focus on doing slow concentric’s on the squat and deadlift and a fast eccentric with as much weight as I can tolerate with a 3-4 on the pain scale?

It should be noted that I recently built a home gym so I don’t have access to machines but have 24/7 access to rack, barbell, dumbbells etc.

At this point I don’t care about anything other than rehabbing and fixing my hamstrings which is my primary goal. I’m currently on week 5 of the barbell medicine 7 week GPP program.

I performed the same exercises the chiro gave me a few months ago and noted I was able to do them all quite easily with minimal to no pain (IE I could hold a med ball and lean very far on nordic curls while before with the chiro I couldn’t even break a few inches before collapsing due to pain).

Thanks again,
Adam

Adam,
What would you say is the cause of the problem and how to fix it at this point?

I would recommend running the eccentrics at a tempo pace as well. Typically I will give athletes a 3-1-3 tempo. You do not necessarily need any machines as stiff legged deadlifts and single leg deadlifts can do a more than effective job of applying tension to the hamstrings.

This does get back to the conversation regarding capacity in tendons. It is rarely are you “strong enough” but rather are you “strong enough to do what you are trying to do.” Few lifters on the forum who likely qualify as “normal” with their goals and that is a good thing. Typically striving to stress the tissue enough to achieve pain free activities of daily living is not nearly enough to build in the capacity for a RPE 8+ lift. That being said, unfortunately with any tendinopathy it does come down to a game of patience.

Derek

Hey Derek,

As far as the cause of the problem I would say that any sort of load on the hamstrings beyond daily activity causes the problem (ie lifting). In terms of how to fix it, I have no clue.

I don’t know if I should be doing stiff leg/single leg everyday, once every few days, how many sets, how many reps, pain level before stopping/when to push through the pain, if whatever rehab methodology I’m doing is even helping (since so many for so many years haven’t) etc.

I’m really lost at this point after being given so many different theories and different advise from so many different “experts”.

My end goal is to be able to squat and deadlift with proper form pain free with the ability to continue my progress in weight lifted and eventually compete in powerlifting.

This seems like a far off goal at this point however as I can’t remember a time lifting without this pain as it started very near to when I started lifting.

At this point, if I was told I would be able to deadlift and squat pain free and with proper form a year from now, I would be ecstatic seeing as there seems to be no end in sight to this problem.

Yeah, I’m no expert, I just read a lot. Truth be told, we don’t really have the ability to speak with certainty on too many topics in healthcare. In the instance of a tendinopathy however, we do have some very good guidelines with which to address rehabilitation. The normal “prescription” (I use quotation marks as there is some titration to each individual here) is 3x/week for the heavy slow resistance. Typically I will start with 4x12 at an RPE 5-7 and progress over the next 4 weeks to 4x6 at an RPE 8+. It is okay to experience pain while performing the exercises, especially early on, but I will caveat this and say it obviously should be bearable.

I would say if you start working on this, there is a high probability that you could be deadlifting and squatting a year from now. That being said, I want to be clear that tendon loading is all about capacity and increasing that capacity over time. Almost always there is a ceiling to which symptoms will return but the goal is to raise that ceiling over time. Instead of a gradual decrease in symptoms tendons tend to be episodic in symptom manifestation to where when the symptoms are there, they are intense but there will be periods of no symptoms. This can add to the frustration and has a tendency to elicit the “here we go again” response. I would advocate looking at the progression of load tolerance as you begin to work on this i.e. symptoms came on at 225# versus 315#. Even though the symptoms would be the same level, there is much more capacity at the higher load. This is not however a challenge to constantly find the ceiling as that presents a different set of problems.

I hope this helps. Anything that has a long duration of symptoms is frustrating but the ultimate key is finding some variables that you can change and working on those. Right now, there are basic exercises that can help start the healing process in the tendons and get you working towards getting back to the bar.

I’m curious if there was any resolution to this issue? I have the same problem and it has been preventing my progress for almost two years now. It is very frustrating!