Percutaneous Tenotomy - experiences, results? (Read 116 times)

I've been struggling with a partial tear of my proximal hamstring tendon and likely tendinosis for about 5 months.  The short version of the story is growing discomfort while sitting, feeling like my gait was "off" when running, inhibited, but not really painful, PT focused on neural component and flexibility, finally an MRI in December with two very different interpretations: the doc who ordered it said it's a mild strain/very slight tear and did not insist on time off, just modified workouts and PT, then a second opinion resulted in the recommendation of a cortisone injection and percutaneous needle tenotomy - the kind where they use ultrasound to locate the damaged tendon areas and poke it repeatedly with a needle to encourage more blood flow and proper healing.  I've definitely decided against the cortisone at this point.

So...my predicament is that after seeing a chiro a couple times, who assessed that my hips were out of whack and subsequently popped them, I've been feeling about 95% better the past week.  I'm kicking myself for not going to the chiro sooner, but all the PTs I saw insisted my hips looked aligned...guess not.  I have the ultrasound scheduled for this coming Thursday, at which point I can elect to have the tenotomy done in the same visit.  I'm not sure it's necessary, however, I don't want to NOT get the procedure done and find that I am still only running at 95% through the spring season.  Time off sucks, but if it's the only thing to get me 100% healed, then that's what I need to do.

Has anyone had percutaneous tenotomy done, for their hammy or another tendon?  What was your recovery like?  Time frame and activity level?  Anyone had or heard of negative results?  The one doc (at the Rothman institute in Philly) said 2 weeks down time and 4 weeks until I'm back at my usual activity level. Obviously I will be asking the doc tons of questions, but looking for anecdotes as well.  Thanks!

One wonders what kind of objective measure was used to determine that your hips are (were?) out of whack.  It wasn't mentioned whether or not this was revealed after the MRI or perhaps your chiro is really, really good.  (Who needs imaging anyway?)

And if it is simply a matter of "popping" them back "into whack(?)", then isn't it also conceivable that they should pop right back out?  (We are obviously not talking dislocation here.)

Anyways, now that you have real information, I hope you have a speedy recovery.

Injuries suck obviously.

 after seeing a chiro a couple times, who assessed that my hips were out of whack and subsequently popped them, 

That's what they do. That's all they do. That, and wire you up to electrostim while they leave you alone for 10-15 minutes, billing you their regular rate. 9 times out of 10, chiropractors are useless. They have a very small set of tools, and every problem becomes one appropriate for those tools.

 I'm kicking myself for not going to the chiro sooner, but all the PTs I saw insisted my hips looked aligned...guess not.

If you're feeling better, great, but you really lucked out. I would always trust a PT over a chiropractor. Incidentally you can learn to check your hip alignment on your own, and correct it. I really need to get around to acquiring that skill myself.

Thanks for the input and opinions.  I wasn't going to go into detail about the chiropractor because it worked - I went from nagging pulling, tightness and a general feeling that my stride was off to immediate relief and a sense of just running normally again the very next day and have remained so for the past week save for a tiny bit of tightness at the top of the tendon/ischial tuberosity about an hour after I run, which tells me that I do have lingering soft tissue damage.  I actually do have a history of dislocations - in 2006 I ran for 2 months with a severely dislocated SI joint, to the tune of one leg being an inch longer.  My high school sport trainer picked up on that and was able to pop it back in a weird clamshell like motion while I was on my back, pubic symphysis was also involved.  This I can now usually catch and fix on my own, and yes, to answer your question, if I can easily "pop" things back into place, they also easily "pop" out.  But it comes down to habit - the body learns to compensate when things our out of alignment, and then relearns correct form when things are in alignment, so my chiro visits usually look like 2 in 2 weeks, my body resets and is fine for about a year or so.  I've also dislocated ribs and my fibula, all fixed in one visit by my chiro.  This time around, I felt like, in addition to the general crappiness of my hammies, I wasn't getting good "power output" from my hips and glutes, despite them being relatively strong from glute isolating PT exercises.  Last time this happened (fall 2013), my SI was out.  There are a number of ways to check if hips/lower back are out of alignment, all a bit sketchy and kinda subjective.  I complained to the 2 PTs I was seeing that I thought this was the case, but they insisted I was fine and I just had a slight leg length discrepancy and a higher left arch (right leg seemed shorter to me).  They checked length when I was lying on my back.  I described the general sense of fatigue from my hips to the chiro and he immediately checked hip alignment by slowly rotating a table with me leaning against it from vertical to horizontal so that I was supine.  He then identified various points on my sacrum that should line up, I realized they were not, a horizontal crack commenced and then a twisty one and I went home and ran pain free and effortlessly, likely because realigning the hips relieved some constant tension on the hammies.  SOOooo, that's what worked for me, I see him when I need to, always with good results.  I have definitely had experiences with chiros who said they could cure my asthma, said I needed to see them 1 x week for the rest of my life and that my spine would degenerate and I would die...but this guy seems to know his stuff. He does not hook me up to stim and let me sit there for 15mins.  One of the xrays I had taken before the MRI looked a little skewed to me, but the ortho said it was fine.  I will take another look at the MRI to see if anything looks wrong with my hips, but the docs were focused on the tendon, so there's a chance they didn't consider my hips.

But either way, I was curious about percutaneous tenotomy experiences.  I've heard one tale of misery from a girl who had an Achilles percutaneous tenotomy done and she spent the subsequent year in way more pain than pre-tenotomy.  Obviously my tendon has been damaged; chiro adjustments will not heal the tissue, I know that.  The pain is minimal; so I'm not quite where you are, Tchuck.  An ultrasound should reveal tendonitis versus tendonosis, but I'm not keen on the cortisone idea anyway.  As Spaniel said, surgeons will cut...and I felt that the guy at Rothman was overly enthusiastic about the cortisone and tenotomy.  I am at a place where I can run regular mileage, some at my old training pace (6:45-7:00), but I am hesitant to do speed work (things like 200s sub-mile pace, or :36-:37 for me)...speed is my weakness, so I kinda have to run some fast miles to race well.  But the VitD3 is an interesting correlation; can't hurt to try!

Good stuff, thanks! I think the stretching was retarding my healing. One pt was fixated on increasing my ROM, and even though he also worked on gaining more ROM in my lower back and neural glides, I'm just super tight and I think the focus was misplaced.

I'm doing hamstring curls with a stability ball and standing hamstring catch while at work, and added curtsy squats recently to help with extension of the opposite hip. What are your go-to exercises? And anything of note with your nutrition? I eat a lot of pretty much everything, so while I'm probably not deficient in anything, I could improve things by cutting out some baked goods

 

 

• eccentric hamstring exercises (there's 3 or 4 exercises I try to do on a regular basis)
• not over-stretching.
• trying to improve nutrition/digestion
• home ultrasound therapy

Also, I stumbled upon http://www.tendinosis.org/

 

a bit of practice to get the form right so you are flexing solely at the hip.

That.  Weight lifting of any sort was never my forte - I'm awkwardly proportioned and my lower back doesn't bend - however learning to do this properly will be advantageous, regardless of the benefit to my hammies.  I am aware of AIS, and I think the mobility-type work I've found to be helpful is along those lines, but I'll look into it more.

For stretching, what seems to work w/out straining the hamstring is this technique

 Lay on back with both legs flat on the ground.

 Lift one leg and clasp with both hands behind the knee. The quad should be pointing straight towards the ceiling if possible.

 Using your quad muscle, slowly try to straighten the bent leg (keep the other leg on the floor). Hold for a couple seconds before lowering.

 Repeat 15 to 20 times each leg. 

Yes, that's exactly the AIS technique for hamstring. Except that I use a strap around the foot, and pull gently on that to enhance the stretch, rather than pulling on the knee.

MTA oh, not quite -- the AIS stretch I have in mind keeps the stretching leg straight the whole time. You repeatedly raise it from flat as far as you can, using your quads and hip flexors, assisting with the strap. The resting leg is slightly bent. Actually the Mattes book on AIS describes several hamstring stretches, but this is the basic one.

tChuck, the vitamin D is very interesting info. I have had a proximal hamstring partial tear ("partial thickness origin tearing) with pain down the leg for 3 years now. Weirdly the MRI said both sides with the left worse, but only the left hurts ever and I did have an injury on the left, but not the right. The orthopod wants to do surgery on that left side, but I am not willing to go through 4 months of rehab (with 6 weeks non-weight bearing!). I am thinking of trying PRP and investigating the different machines different practitioners use as I understand the higher the platelets might account for the varied responses. I also tested my Vitamin D, which is at 32 and so started taking 10,000 i.u. in the last two weeks.

I am wondering how long between when you did the PRP injections and when you began your Vitamin D3 therapy? I heard it takes about 3 months for the PRP to help. You say it took 6 months for the PRP to help, but were you also on D3 at the time? Or did you go on that afterwards so you know that it wasn't the PRP?  Never had an injury that did not heal and this is causing a lot of grief, especially when training uphill or having to negotiate trail running over uneven surfaces where I have to brace with that area more.

Thanks.

I feel for you and had issues for 6 plus years . I had a tenotomy on right side upper hammy. I only took week off. It didn't help much so I went to another doc with more training. 6 months later (Dec 2012) I had it done under ultrasound in both proximal hammy tendons with PRP injections too.  I was instructed to not run 2 weeks but could cross train in a few days. I gradually got back at after that. I was diagnosed with micro tears and severe tendonosis on right and mild tendonosis on left. There was no inflammation at all. I had chronic pain for 5 -6 years at the time. Tendonosis causes pain even without inflammation.  I did have cortisone injections back in 2007 because at that time I was in acute phase with inflammation from tendinitis and bursitis from overtraining. 30 days of no running and NSAIDS did not help so I was desperate.

 

It took a while but PRP helped improve it about 30-50% after 6 months. I swear though, when I went on high doses Vit D3 about a year ago and started doing more glute work and a bit more stretching (it was always painful to stretch so I limited it) and I became virtually pain free. I never thought it would ever happen. It may be a combo of things or delayed effect of PRP but I swear the Vit D3 made a big difference as I was doing a lot of strength work and rehab over the years anyway. This is only thing I changed.

 

If you have tendonosis go for it but if there is inflammation in tendon, I am not so sure I would do tenotomy.