A preface to the Barbell Medicine crew - thank you for all of the wonderful content that you put out.
I’d been going back and forth on whether to post this, where to post it, etc; but after the most recent podcast I decided to make an account and post here. Note that this is my own personal experience and that I have no degree or technical training in anything medical, so I’m not really qualified to help anyone. I’m hoping, though, that maybe someday someone going through what I was going through can find this thread on Google and save a bit of time on their rehabilitation because of it. There is basically ZERO on the internet about recovering from PHT in strength sports. So without further adieu:
I’m 5’11", 190 lbs, and switched from distance running to powerlifting in 2016 although I had been doing some sort of weight training for the past two decades. In July of 2018 (15 months ago) I started to notice a deep pain in my left glute at the top of my deadlifts. Initially most of the time I only ever really felt the pain with weight on my hands or on my back so it didn’t really bother me in every day life. I was working with a coach and reduced my deadlift volume in an effort to mitigate. We also dropped Good Mornings and Barbell Rows, which became more and more excruciating as the pain progressed over the weeks.
I had a powerlifting meet in October and was not interested in pulling out of it. Even with the reduced volume and elimination of accessories, though, it seemed like every time I pulled more than 50% of my max the pain would return with a vengeance, radiating upwards into my SI joint. Like most of us do, I turned to the internet and diagnosed myself with high hamstrings tendinopathy (after teetering on this, ischial bursitis, and piriformis syndrome). I managed to pull 518 in the meet, which was far less than I wanted, and I couldn’t even squat 400 despite hitting 445 in training. I thought that maybe it was time to put powerlifting on the back-burner, and after the meet I parted ways with my coach putting my faith in a DPT for some rehab.
The DPT did a bunch of ART and gave me a handful of exercises to do including slow eccentric single-leg deadlifts, single-leg bridges, fire hydrants, and monster walks. One thing that I did notice was that the monster walks in particular seemed to help a bit. I thought - bingo, I need to do more glute activation. Over the course of several months I slowly started working my way back up to big boy weights while adding the rehab exercises into my training a few times per week. Eventually I got my working sets back up around 400, nearly pain free. Then, out of nowhere, ouch. Extreme pain again. I rested up and tried warming up a week later - nope. I told my DPT, and he started doing Graston 3x per week. The hope was that since this guy was scraping sharp instruments on my butt that I would heal right up… Well I didn’t. I made zero progress from Graston. I decided to go see a Sports Otrho.
The Sports Ortho did a pretty extensive ultrasound of my tendon and found significant degradation of the biceps femoris origin at the ischial tuberoscity. He prescribed more PT and Graston. Great. 3 more months of PT and doing exercises religiously, and I still couldn’t deadlift 135 without pain. The Ortho suggested a Tenex procedure, which is basically irrigating, blasting, and sucking out the bad tissue using a special machine and ultrasound in hopes that the body would rebuild from there. It looked promising so I went for it. After a few weeks he sent me back to physical therapy. Again, the monster walks seemed to help a bit but the rest of it did absolutely nothing for me. My PT did mention something though - that I seemed to have some problems with my SI joint. Indeed, my SI joint constantly felt like it needed to be cracked. I could stand up and push my legs away from one another, usually eliciting such relief. Incidentally I also deadlifted and squatted with a significant amount of anterior pelvic tilt. I was artificially elongating my hamstrings every time I hip hinged.
As time went on, my whole left side started to hurt. It was like whatever was wrong with me was spreading like a virus. After months and months I still felt like I was going nowhere with my PT and Ortho, I made an appointment with a chiropractor from the ACBSP. He was an hour drive from me and I’d have to take time off to go, but I didn’t care - I thought “this guy is going to fix me”. After two months of adjustments, starting at several times per week (and still at once per month), I finally felt like I could start “trying” again. Note that during this time there were no rehab exercises aside from light squats (for my own sanity). I love going to the chiro - in and out in 10 minutes and no extreme pain / sweating like there was at the PT.
In September I was hitting deadlifts 2-3x per week, working up from light weights. After a few weeks I had to travel for work, so instead of lifting at home I went to a gym in the area. As an ego lift I did 405 for 3 triples and then a last set of 4 with only a little pain. What was different? I was on a deadlift platform and it had almost been a week since my last deadlift session.
I got home and a few days later tried to deadlift again. The pain was back and I couldn’t even get 225 off the floor without wincing, in fact - the OTHER hamstring started to hurt. I moved to the hard floor and it was a little better, but not much. I called it a day and decided that it would probably be best to wait a week between sessions from then on. A few days later I loaded up the bar with 315 for triples. I focused on a neutral spine, bracing so hard that I nearly passed out. The bar flew up and my butt didn’t hurt too bad, although it seems like the other side is now something to worry about. Maybe I was onto something?
On a whim, I built a reverse hyper and started using it after my workout for a few light sets. I noticed that I could do a decent amount of work with it and that it didn’t bother my hamstrings at all. I thought- what else can I do for them? Weighted glute bridges? Sure - just can’t go too heavy. Nordic holds? Roger, those don’t hurt at all and I can actually feel them “pulling” at the attachment points. I’d go slow and controlled, pausing at full extension for all of my accessories.
4 weeks ago I started an actual training cycle. I used 445 as my deadlift max, not because I thought I could pull 445 pain free but because I was pretty sure that with correct bracing I could make it through the workouts with the prescribed weights. Every single time I had extra time at the end of my workout and tried to work ahead, my hamstrings reminded me that I definitely needed a week between deadlift workouts. I could fortunately do accessories on other days, though, and they actually seemed to help when it was game time.
Last Thursday I pulled 475 at RPE 8. The weight was light but the bracing was hard. I must finally be doing it right.
Tl;dr:
-
If you have high hamstrings pain at the top of your squats and deadlifts, take a look at your pelvis and try to get it neutral. If you’re like me, you probably thing that forcing your legs to do more work than your back at the start of a deadlift will lead to less weight being lifted - and you might be right. Learn to properly brace and do it anyhow. I’m getting used to seeing stars.
-
Deadlift on a hard, flat floor.
-
Activate your glutes.
-
See what accessory work you can do that you can feel in the affected area, but doesn’t cause you pain. There’s a chance that what your doctor has you doing isn’t hard enough to make a difference.
-
If you go through cycles of something feeling great then feeling awful, and they’re offset by every other workout - consider cutting it from on the workout when it traditionally feels awful. Not everyone can deadlift multiple times per week. I’m not sure that this thing will ever truly go away, but it can definitely be managed by being conservative with intensity and frequency.
-
Don’t give up. For me, some combination of a good Chiropractor and the things above has finally yielded results. The PT, Tenex, and Graston didn’t do anything for me but maybe they could help you. The guys that run this site could give you much better advice.
-
Don’t be afraid of the pain. It will happen, but it doesn’t necessarily mean that things are worse. Maybe you just went too hard and it will be fine the next session. If you fear it and let it frustrate you, you’re yielding. Don’t.