Hi Michael, I am really sorry to hear that you are afflicted with this. It’s a terrible injury–for body and mind. That said, I want to tell you there is light at the end of a possible long and dark tunnel. It took me about 18 months from 1st injury to competing in my first triathlons again. Unfortunately, I got sidelined again by a different injury (sustained during PT) – but that’s another story and hopefully I’m over that one by now as well.
To be honest, you don’t need regular PT appointments if you are accurately diagnosed. The key exercises and progression is well-described on the web (YouTube and dedicated sites). And the exact details are person-specific, so you need to calibrate them as you go along.
Here are, what I now strongly believe are the three main principles to get you better:
- Follow a protocol that provides increasing load/strength exercises for the hamstring tendon (or any other tendons afflicted e.g. adductors). Progress from isometric to eccentric to dynamic exercises.
- Calibrate all exercises (PT and anything else such as hiking, lifting, walk/runs, swimming, biking, elliptical, …) so that you do feel discomfort during or after the exercises, but the pain has to return back to baseline within 24-36h.
- Keep a highly detailed pain AND exercise log where you note your pain level (ideally every morning and evening) and all activities you did that could potentially affect the pain.
The idea behind this is pretty simple: The PT program (point 1) has been shown in multiple studies to be effective in many cases where there is no injury to the tendon that would require surgery. This can not be said for any other intervention such as shockwave therapy, needling, PRP injection, steroid injection, …
The second point is based on the also proven fact that you do need to load the tendon to induce healing which causes discomfort. The thought is that if pain returns to baseline in a day or so, then you did enough to stress the tendon, but did not do any further damage that would set back the healing process.
The final point is something that is not often talked about, but it was crucial for me. If you do daily exercises (PT and other workouts) and push yourself, it is very hard to figure out what is too much and what is not. And if you push yourself in 5 different PT exercises all at once while you are also trying to get some cardio in, it gets even more complicated. This is where the detailed log comes in. Push yourself, but vary your exercises daily. If you then keep a written log (best in Excel so you can even plot various things out) you should be able to figure out over time what is well tolerated and what is not. That allows you to pile things up and progress in some areas, but still be slow and cautious in others.
Bit of a long story and I wrote this rather stream of consciousness style. Let me know if you would like more info (I got it in spades) or further explanations. Keep up the good fight!