One Injured Hamstring, a String of Treatments

The New York Times—New York—August 18, 2009

Last April, at a meeting of the American Medical Society for Sports Medicine, three experts in tendon injuries sat on a stage and talked about their preferred treatments.

The debate offered a revealing glimpse of an area of orthopedics that affects most athletes sooner or later. If it’s not a rotator-cuff injury in a swimmer, it’s an Achilles tendon injury in a basketball player, or, depending on the sport, a tennis elbow or — as happened to me — a hamstring injury.

As I tried to figure out why I might have gotten this injury and what might help it heal, I discovered that misinformation abounds. But there is hope. Somehow, I am much better. Not only does my hamstring hurt less, enabling me to run up to six miles with almost no pain every other day, but ultrasounds showed that my tendon was healing.

Of course, the question of why is the great unknown.

We would like to think we know why we get injured, or even that we know when we are injured. But tendon injuries can sneak up on people who did nothing they know of to bring them on, or who may not even realize they have them. For example, it turns out that about half of all middle-age people have a torn rotator-cuff tendon, and most of them have no idea about it.

In fact, as Dr. Ronald Adler, chief of the ultrasound division in the department of radiology and imaging at Hospital for Special Surgery in Manhattan, explained to me, patients who have had surgery — the gold standard — to repair torn rotator-cuff tendons sometimes think they are better and report that their pain is gone, but an MRI or ultrasound scan shows that their tendon has not healed.

Sedentary people get Achilles tendinopathy too, for unknown reasons.

One possibility, said Dr. Joseph Feinberg of Hospital for Special Surgery, the doctor who treated me, is that tendons degenerate because they did not get adequate blood flow. That might happen, he said, if there is excessive load on the tendon, compressing areas and preventing them from getting blood. It is thought that is a reason for the common injury to the rotator cuff in the shoulder and perhaps other tendon injuries as well, Dr. Feinberg said.

It’s not clear whether the treatments really work or whether one of the blood treatments is better than the other. In the case of platelet rich plasma, researchers are starting the sort of rigorous studies that might show whether it is effective. One, which is expected to start soon, will involve people with Achilles tendinopathy and will be directed by Dr. John Kennedy of Hospital for Special Surgery, the doctor who treated me for my stress fracture.

Read the full story at nytimes.com.