Home Sports Medicine Sports Injuries Hamstring Strain and Hamstring Tendinopathy

Hamstring Tendinopathy

About Hamstring Tendon Injuries

The three hamstring muscles at the back of the leg – semitendinosus, semimembranosus, and biceps femoris – act at two joints, helping to extend the hip and flex the knee. During the gait cycle the hamstrings help to stabilize the hip and knee joints while decelerating the tibia in the swing phase. The hamstrings and the quadriceps work together during physical activity to mediate force loads, promote stability and produce movement.

The hamstring muscle fibers grow collagenous near their ends, becoming tough fibrous tendons where they attach to bones. Hamstring tendon injuries are common in sprinters and runners, and in sports that require explosive bursts of power. Unless fully rehabilitated, injured hamstring tendons can degenerate over time, inhibiting gait and reducing mobility.

Dr. Lev Kalika

Clinical director & DC RMSK

About Tendon Specialist Dr. Lev Kalika

With over 25 years of experience treating tendinopathies, Dr. Kalika has formulated his own unique approach to diagnosis and treatment. As an expert in diagnostic ultrasonography, he has published multiple scientific publications that have helped to take diagnostic medicine to the next level. He has worked with some of the world’s leading radiologists in the field of musculoskeletal ultrasonography.

“My success in treating tendon injuries comes from a deep understanding of tendon pathologies, and from the ability to visualize each individual tendon. No two tendons are alike in their anatomy, biomechanics and function. Most tendons are superficial structures, and are much better visualized by high resolution ultrasonography versus MRI. A distinct advantage of diagnostic ultrasonography over MRI is its ability to visualize muscles and tendons in motion.” – Dr. Lev Kalika

Dr. Kalika has helped hundreds of patients to rehabilitate tendon injuries, restore functionality, and return to sports and physical activity. His expertise in musculoskeletal ultrasonography makes him one of the most sought-after specialists in NYC for tendinopathy diagnosis and treatment.

Accurate Diagnosis is the First Step to Successful Treatment

NYDNRehab features research-grade ultrasound equipment with the highest resolution available in New York City. Our equipment gives us capabilities for sonoelastography to test for tendon stiffness, and superior microvascular imaging (SMI) to assess inflammation and detect vascular neogenesis.

Sonelastography and SMI are the latest advancements in tendon imaging, and are not possible with other radiological modalities. In addition, NYDNRehab is among the first sports medicine clinics to feature dynamic ultrasonography using the USONO ProbeFix device.

ProbeFix attaches directly to the athlete, allowing us to visualize damaged tissues during sport-specific actions. ProbeFix renders accurate real-time images of the body’s structures in motion, and can even be synced with motion capture cameras to produce 3D images of muscles, fascia, bones and joints during physical activity. This game-changing technology gives us a huge advantage for diagnosing tendon injuries and restoring optimal sport-specific biomechanics.

Advantages of ultrasound imaging over MRI:

Much higher resolution
On-site imaging and interpretation – no waiting for lab results
Capabilities for dynamic assessment in real time
Ability to visualize fascia adhesions related to tendon degeneration
Capabilities for superior microvascular imaging (SMI) to assess the inflammatory component of tendinopathies
Capabilities for sonoelastography to assess tendon stiffness
Ability to track patient progress via dynamic imaging during treatment

Click here to learn more about our diagnostic approach to tendon injuries…

NYDNRehab is the only clinic in New York with a fully equipped motion and gait analysis laboratory. Our motion and gait analysis technology and proprietary software lets us measure and quantify muscle and tendon function in real time.

At NYDNRehab, we are dedicated to rehabilitating your injury, not just treating your symptoms. To accurately diagnose and treat your tendinopathy, we conduct a comprehensive evaluation consisting of:

Thorough health history
Review of physical activity at onset of pain
Manual physical exam
Artificial intelligence strength and range of motion assessment
High resolution ultrasonography and elastography
Surface electromyography
High-tech gait, running and motion analysis

For sport-specific injuries, we use the latest technologies to analyze movement mechanics and identify motor deficiencies. By eliminating movement and training errors, athletes and physically active patients are able to dramatically improve their performance while reducing their risk of injury.

Running Diagnostics

Our state-of-the-art running analysis lab enables us to identify biomechanical and neuromuscular deficiencies that are invisible to the naked eye, and to distinguish between injuries and compensation strategies.

Gait analysis enables us to:

Measure and quantify functional limitations, impaired movement and disability
Identify movement deviations that are undetectable during the clinical examination
Distinguish compensation patterns from their root cause, so that treatment interventions target the injury and not just the symptoms

Data from gait analysis equips us to design effective treatment strategies that address the source of tendinopathy, retraining the athlete to run more efficiently, prolong their running career, and prevent future injuries.

ForceFrame Max

ForceFrame is a comprehensive system for accurately testing and training isometric strength in various muscle groups throughout the body. Most people – especially physically active people – develop muscle imbalances and compensation patterns over time that reduce movement efficiency.

ForceFrame lets us test individual muscle groups on both sides of the body for strength and symmetry. By testing individual muscle groups isometrically, we eliminate the potential for compensation of weak muscles that could be masked during compound exercise testing.

The results of each test appear as objective data on a screen in real time, helping us to identify and correct muscle imbalances, asymmetrical muscle strength, inefficient muscle firing patterns, and compensation patterns developed from past injuries. We then use that data to create personalized rehab programs, to boost performance and reduce injury risk.

COLLAPSE

Tensegrity is the Secret to Pain-Free Mobility

Most people take everyday mobility for granted until an injury occurs or pain sets in. Sometimes pain and reduced mobility seem to arise out of nowhere, with no apparent cause of onset. Regardless of whether your pain is caused by trauma or by something less obvious, tensegrity plays a key role.

Tensegrity refers to tensile integrity – a state where a system of individual components is held together under continuous elastic tension. In the human body, tensegrity is created by the myofascial system, the network of muscles and fascia that work together to produce, control, and guide forces, and to hold the body’s various organs and structures in place during movement.

Tensegrity can be disrupted when myofascial tissues are injured or damaged in some way. When that happens, nerves and blood vessels can become entrapped, preventing them from gliding among other structures and producing pain. At the same time, the elastic tension that governs joint alignment and controls movement becomes compromised, creating motor deficits that undermine mobility and stability.

Factors that disrupt myofascial tensegrity include:

Traumatic injury that affects multiple tissue types
Overuse injuries from sports, exercise or occupation
Old injuries that were never properly rehabilitated
Sedentary lifestyle with excessive sitting
Obesity that overloads the body’s structures
Inadequate hydration that deprives soft tissues of water needed to function
Diet high in sugar and carbs that causes myofascial tissue glycation, making it dense and sticky

Many doctors do not understand the crucial role of the myofascial system in preventing pain syndromes, movement disorders, and disease. In fact, most medical doctors have no idea how to correct myofascial dysfunction or even recognize it as a factor. They simply treat pain symptoms with medications and eventually recommend surgery.

At NYDNRehab, we understand that the body’s systems work together as an integrated whole, and that treating pain is not enough to eliminate its source. We use dynamic high-resolution ultrasound to explore the myofascial system in real time. Ultrasound imaging lets us visualize muscles, fascia, nerves and other structures in motion, to identify places where tensegrity has been disrupted.

Once we identify the problem, we use the most advanced therapeutic approaches to restore myofascial integrity and promote tissue healing.

Why Physical Therapy Alone is Not Enough to Rehabilitate Hamstring Tendinopathies

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to pre-treat your condition can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

Obstacles to physical therapy success include:

Scar tissue and fascia adhesions
Neurogenic inflammation
Joint edema
Inflamed soft tissues

Myofascial trigger points
Compressed or entrapped nerves
Tendons that have degenerated and lost their elastic properties
Compensation patterns developed post-injury

At NYDNRehab, we use a broad range of regenerative technologies and integrative therapeutic approaches to resolve issues that can stand in the way of successful physical therapy. Our staff is certified in a diverse array of holistic treatment methodologies, and our one-on-one treatment sessions are personalized, based on your unique diagnostic profile.

Once we pre-treat your damaged tissues and eliminate compensation patterns, your body will be ready to begin physical therapy.

We Treat the Whole Patient, Not Just Your Symptoms

The human body is made up of integrated parts and systems, designed to work in harmony. Today’s modern reductionist approach to medical treatment fails to acknowledge the integral relationship between structure and function, focusing on the locus of pain without considering its broader implications.

Most injuries involve multiple structures and tissue types, and pain is only a symptom that signals your brain to protect and heal the damaged tissues. It is not uncommon for an injury to stop hurting while damaged structures remain dysfunctional.

At NYDNRehab, our diagnostic process takes into account the integrated nature of the body’s structures and systems, along with the unique anatomical characteristics of the individual patient. We use high resolution diagnostic ultrasound to visualize your injury dynamically, in real time, to determine whether structural (anatomical) changes are causing pain and dysfunction, or if dysfunction is causing structural changes.

Your ultrasound exam takes place on-site, on your first visit, so we can get right to work on rehabilitating your injury.

Our Regenerative Technologies Accelerate Healing

The human body has its own innate healing mechanisms, but tendons sometimes need a nudge to accelerate the healing process. Regenerative technologies help to jump-start tendon healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient

Regenerative Therapies At NYDNRehab

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave is a groundbreaking regenerative mechanotransduction technology that accelerates tissue healing. Its patented electro-hydraulic applicator delivers high-speed soundwaves that can penetrate up to six inches in depth. SoftWave’s defocused and linear focused shockwaves recruit maximum stem cells to the treatment site to promote healing. SoftWave’s wider and deeper penetration using defocused energy is a preferred treatment option for a broad spectrum of conditions, ranging from orthopedic injuries to pelvic health. SoftWave is the only unfocused shockwave technology currently available. According to recent research, SoftWave defocused waves combined with focused and radial shockwaves have maximum regenerative potential.

Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. MyACT transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Most injuries involve more than one tissue type. When used together, our advanced shockwave technologies enable us to specifically target multiple tissue types with the most effective shockwave treatment.

Myofascial Acoustic Compression Therapy (MyACT)

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT transmits high energy magnetic pulses to targeted tissues that synchronize with the body’s own magnetic fields, triggering a regenerative response. EMTT waves can penetrate deep tissues to target difficult-to-reach tendons, muscles, bones and nerves.

Extracorporeal Magnetic Transduction Therapy (EMTT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, sometimes called defocused shock wave therapy, is not a true shockwave. It uses mechanical pressure waves to enhance blood circulation, improving oxygen and nutrient delivery to muscle and fascia tissues, but has minimal regenerative properties.The mechanical properties of EPAT make it especially effective for fascial manipulation in combination with focused shockwaves. We combine EPAT with different types of shockwaves for holistic treatment, without additional cost to the patient.

High Energy Inductive Therapy (HEIT)

HEIT delivers high-intensity magnetic pulses to peripheral nerve tissues, to stimulate neuroplasticity. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, for enhanced motor control.

High Energy Inductive Therapy (HEIT)

INDIBA Radiofrequency Therapy

INDIBA is a form of TECAR therapy that helps to restore the ionic charge of damaged cells, for faster injury healing and rehabilitation.

NESA Neuromodulation Therapy

NESA generates a low-frequency electrical current of intermittent and cyclical stimuli that soothes hypersensitized nerves and restores optimal signaling between the autonomic nervous system and the brain. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, to enhance motor control.

NESA Neuromodulation Therapy

Click here to learn about regenerative technologies at NYDNRehab…

We Guide Our Needling and Orthobiologic Procedures with High-Resolution Ultrasound

Injection therapies use orthobiologic solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start tendon healing in chronic injuries and accelerate repair in acute injuries.

Alpha-2-Macroglobulin (A2M)

Alpha 2 macroglobulin (A2M) is a naturally occurring blood plasma protein that acts as a carrier for numerous proteins and growth factors. As a protease inhibitor, A2M reduces inflammation in arthritic joints and helps to deactivate a variety of proteinases that typically degrade cartilage.

Prolotherapy

Prolotherapy uses a biologically neutral solution to irritate stubborn tissues, triggering the body’s innate healing mechanisms to grow new normal tendon, ligament and muscle fibers.

Interfascial Plane and Nerve Hydrodissection

Hamstring injuries often involve fascial tissue that has become densified and/or formed adhesions, entrapping nerves and blood vessels, causing pain and restricting movement. Hydrodissection is a procedure where a saline solution is injected into densified fascia under ultrasound guidance. The solution works by separating fascial layers and freeing up entrapped nerves and blood vessels. We often use hydrodissection in conjunction with manual fascial manipulation.

More Advanced Therapies at NYDNRehab

SM Neuromuscular Electrical Stimulation (SMNMES)

SM neuromuscular electrical stimulation (NMES) dynamically interacts with the patient during therapeutic exercises, providing real-time sensory, auditory and visual biofeedback to the patient. This breakthrough technology helps patients to recalibrate muscle actions, to optimize joint function. SMNMES has helped numerous patients to avoid unnecessary shoulder, knee and ankle surgeries, even in complex scenarios.

Ultrasound Guided Percutaneous Neuromodulation (PENS)

During PENS treatment, filament-thin needles are inserted through the skin into muscle tissue adjacent to the targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate the dysfunctional nerve. PENS normalizes nerve activity, improves brain plasticity and optimizes muscle recruitment patterns. This therapy is so effective that patients typically need only 4-6 treatment sessions.

Factors that Increase Your Risk of Hamstring Tendinopathy

Certain uncontrollable factors can potentially increase your risk of a tendon injury:

Female sex

Women have smaller tendons, with a lower capacity for hypertrophy due to lower protein turnover, lower levels of insulin-like growth factor (IGF-1), and less collagen synthesis in response to exercise. In addition, higher estrogen levels in females reduce tendon stiffness, potentially increasing injury risk.

Age

The ability of tendons to store and release energy diminishes with age. Physical activities that load tendons to the point of fatigue have been shown to cause greater damage to the tendon matrix in older adults.

Preventing Tendon Injuries

There are several things you can do to reduce your risk of tendon injuries:

Optimize your nutrition for protein and collagen synthesis. Bone broth and collagen supplements provide the fundamental building blocks for post-exercise tendon recovery. High-quality protein from grass-fed, pasture-raised and wild-caught beef, poultry and fish are the best sources of amino acids essential to muscle and tendon repair.
Drink plenty of water. Dry tendons are less elastic and more likely to rupture.
Choose supportive footwear that provides shock absorption, and frequently replace worn athletic shoes.
Get a biomechanical analysis to trouble-shoot and retrain faulty biomechanics.
Allow for ample recovery time after sports and exercise, especially if you have delayed-onset soreness. Most people need at least 48-72 hours to recover from intense physical activity.

Get Personalized Hamstring Tendon Physical Therapy Designed Just for You

At NYDNRehab, we treat the whole patient, not just your symptoms. We never use one-size-fits-all rehab protocols or antiquated recovery timelines. We believe that every injury is unique, and treatment should be based on a holistic approach that factors in the patient’s unique profile.

Once we have successfully pre-treated damaged tissues, we can begin one-on-one physical therapy to restore strength and stability, optimize mobility, and re-establish optimal neuromuscular pathways and muscle coordination patterns.

Your physical therapy protocol may include a combination of the following approaches:

Stecco fascial manipulation, to eliminate densifications and adhesions and restore fascia’s gliding properties
Postural restoration therapy to optimize total-body joint alignment
Dynamic neuromuscular stabilization (DNS) to restore developmental motor strategies
Integrated systems model (ISM) to optimize function and performance
Anatomy in motion (AIM) to enhance movement quality
Neurodynamics, to restore communication pathways between the brain and body
Conventional eccentric loading and strengthening exercises

Your back-to-sports physical therapy protocol may include sport-specific training to optimize motor skills and restore peak athletic performance. We carefully monitor patient progress with ultrasound imaging to confirm complete recovery.

Our High-Tech Equipment Produces Superior Results

Advancements in technology are changing the game in rehabilitative medicine, enabling us to accelerate healing and restore performance at an unprecedented pace. The clinic at NYDNRehab features some of the most advanced therapeutic equipment currently available, and rarely found in private clinics.

Your tendinopathy therapy may include the use of high-tech equipment:

C.A.R.E.N Computer Assisted Rehabilitation Environment

Originally developed to rehabilitate injured soldiers, this multifaceted system gives us a broad range of tools for assessment, feedback and performance enhancement. Dr. Kalka has integrated his own unique selection of technologies to optimize the ways in which C.A.R.E.N helps patients to achieve their goals.

Blood Flow Restriction Training (BFRT)

Rebuilding muscle strength while joints and connective tissues are still healing is a challenge for athletes who need to return to sport in the shortest time possible. BFRT enables you to increase muscle size and strength at much lower training volumes, to reduce stress on still-healing structures while rapidly restoring muscle performance.

Kineo Intelligent Load System

We use the Kineo intelligent loading system to create customized training and rehabilitation programs for our patients. With Kineo, we can customize variable load protocols for functional training, core training, agility drills and more. The Kineo variable resistance system lets us design a personalized variable load curve based on the needs of the individual patient.

Cryotherapy

Cold therapy has long been used for injury treatment and recovery from sports and exercise. Modern cryotherapy has replaced ice baths and ice packs with a dramatically faster and more convenient technology using nitrogen gas, directed via a specialized device to target injured tissues.

Preventing Hamstring Tendon Injuries

There are several things you can do to reduce your risk of tendon injuries:

Optimize your nutrition for protein and collagen synthesis. Bone broth and collagen supplements provide the fundamental building blocks for post-exercise tendon recovery. High-quality protein from grass-fed, pasture-raised and wild-caught beef, poultry and fish are the best sources of amino acids essential to muscle and tendon repair.
Drink plenty of water. Dry tendons are less elastic and more likely to rupture.
Choose supportive footwear that provides stability shock absorption, and frequently replace worn athletic shoes.
Get a biomechanical analysis to trouble-shoot and retrain faulty biomechanics.
Allow for ample recovery time after sports and exercise, especially if you have delayed-onset soreness. Most people need at least 48-72 hours to recover from intense physical activity.

Leverage Our Innovative Approach to Tendon Rehabilitation

Recent evidence-based methodologies have dramatically changed the way tendinopathies are treated and rehabilitated. At NYDNRehab, we steer clear of invasive surgeries and pharmacological approaches. Our innovative and non-invasive therapies work with the body’s own self-healing mechanisms to optimize treatment outcomes and restore pain-free functional movement.

Our personalized approach to patient care ensures you get the best one-on-one Physical Therapy, custom-designed based on your unique profile. Our expertise in tendon rehab combined with our advanced technologies and methodologies make the NYDNRehab your clinic of choice for hamstring tendinopathy treatment in NYC.

Our Awards

Clinical Case Studies
NYDNRehab

Case Study: Resolving Chronic Sit Bone Pain in a Female Runner

Our Patient Our patient is a 45 year-old female runner complaining of left sit bone pain when running and sitting. She has a history of proximal hamstring tendinopathy, and had been treated with plasma injections about 5 years prior, along with physical therapy. Her pain was initially resolved by the injections, and she continued to […]

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Case Study: Hamstring and SI Joint Dysfunction in Female Runner

Our Patient Our patient is a 52 year-old female runner who came to us after unsuccessful treatment elsewhere, complaining of mild low back pain shooting down her right leg. She explained that she had never had low back pain before, and that her locus of pain was slightly lower than her lumbar spine and closer […]

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How can I tell if my tendon injury is serious enough to seek treatment?

If you have chronic pain near the musculotendinous junction that never goes away or has gotten worse, it’s a good idea to see a tendon specialist. Failure to treat an injured tendon can result in degeneration of the tendon tissue, leading to reduced performance and undesirable compensation patterns.

Can an old hamstring tendon injury be rehabilitated?

Tendon injuries that were never properly rehabilitated can cause additional problems anywhere along the kinetic chain. Regenerative therapies have the potential to stimulate tissue healing and restore function, even when the injury is several years old.

Can I return to sports after a serious hamstring tendon rupture?

Prior to getting back on the playing field, you should make sure your tendon is completely rehabilitated. Not only do you need to fully heal damaged tissues, but you should also restore neurodynamics that were disrupted by your injury, to reestablish coordinated muscle firing patterns and reduce your risk of re-injury.

My hamstring tendon stops hurting once I warm up. Is it OK to work out?

Absence of pain does not always indicate that the tendon is functioning properly. If the pain returns once you cool down, you may have serious tendon damage. Loading a ruptured tendon can make it worse. Best to see a specialist.

What is the treatment for a detached tendon?

When a tendon tears away from bone, it must be surgically re-attached, followed by intensive physical therapy to restore its mechanical properties and strength. The clinic at NYDNRehab features some of the most advanced technologies available for rehabilitating tendon injuries.

Certificates and Postgraduate Education

Physical therapy and rehab can be time consuming,

and a faulty diagnosis can make treatment a total waste of time.

Failure to accurately diagnose a condition in its early stages can lead to chronic
problems and sometimes devastating results

Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.

Below is a prime example of how ultrasound can take the guesswork out of diagnosis.

Learn more »

Accurate Diagnosis Is the ONLY way to

Successful Treatment

A bad physical therapy experience is one of the primary causes of unnecessary surgery

At NYDNR, we believe in

medical innovation

We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.