Case Study: Hamstring Tendinopathy In Professional Distance Runner

There are too many abstract discussions in the performance space these days about how to train and rehabilitate athletes. These circular arguments usually yield nothing substantive or actionable because providers spend too much time defending their ideology and trying to articulate why they are in the right instead of just being transparent and “showing their portfolio”. As an example, investors should demand that financial advisers share their own portfolios instead of pontificating about macroeconomic theory. Words matter but what people do when they have skin in the game reveals more about them than their explanatory justifications for said actions. 

The point of these case studies is not to suggest that what we did in any of these situations is particularly good. If we’re being honest, we don’t always have robust outcome measures to suggest that what we do really “works”. More often than not, we default to the eye test. We coach and own our decisions. The intent here, therefore, is to be completely transparent about what we did when an athlete’s time, money, and readiness was at stake in hopes that other providers share their experiences and contribute to a more genuine collective conversation.

Background

Female professional distance runner (event withheld to protect identity) with left hamstring tendinopathy x 2 months that kept her from running more than 10 miles a week during that period. Athlete also works full time as a medical researcher and is currently applying to medical school. Athlete had substituted running volume with swimming and biking to avoid symptom provocation and maintain training load. Athlete reported for her initial evaluation with us in late March 2019 with the goal of competing at the USATF Championships in July. She had received treatment (mainly manual therapy) from other providers prior to her evaluation with us and reported transient relief but nothing that allowed her to increase her running volume to normal levels.   

Constraints

• Time: 4 months to prepare for nationals after not running more than 10 miles/week at low intensity for the previous 2 months
• Financial: Athlete did not have out of network insurance benefits so paid completely out of pocket for treatment. Regular treatment sessions were not within her budget (nor were they particularly necessary in our opinion) so we saw her as the last patient of the evening but only charged her for a single hour to achieve all the treatment and programming objectives in a single session. We created a home program and corresponded completely via email or text for the remainder of the plan of care.
• Interpersonal Factors: Model athlete in terms of enthusiasm and motivation to prepare and compete. The biggest obstacle here was convincing her that she wouldn’t necessarily benefit from seeing multiple providers for specialized forms of treatment as she had done in the past when a more global approach, perhaps one that included some forms of manual therapy, was likely warranted instead.

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