15: High Hamstring Pain in Runners: Do You Need PRP or Is Rehab the Real Fix?

 Do You Need PRP or Is Rehab the Real Fix?In Episode 15 of the Interdisciplinary Case Miles podcast, we discuss a case involving a 40-year-old age group runner whose long-standing hamstring tendinopathy became acutely aggravated after a slip on ice revealing the layered challenges of acute-on-chronic tendon pain in runners.This case highlights why proximal hamstring injuries require precise diagnosis and an individualized treatment plan. Dr. Sara Raiser(MD) explains how to differentiate high hamstring tendinopathy from lumbar spine or nerve-related pain, when imaging such as MRI or diagnostic ultrasound is indicated, and how to determine whether a partial tear is present.The conversation also covers when regenerative medicine options like platelet-rich plasma (PRP) injections or percutaneous tenotomy may be appropriate, and why they are rarely first-line treatment.Dr. Kate Mihevc Edwards(PT) takes us through the rehabilitation process, including early integration after PRP, the role of blood flow restriction (BFR) training, and why eccentric strengthening remains the gold standard for tendon rehabilitation. She emphasizes addressing the entire kinetic chain hip mobility, lumbar and thoracic spine mechanics, neural tension, gait changes, and stiffness patterns that often contribute to chronic hamstring overload. You’ll also hear practical insight into return-to-run timelines, common pain spikes around the six-week mark post-PRP, and how to safely reload a healing tendon.Sports dietitian Kelsey Pontius rounds out the discussion by explaining how nutrition directly influences tendon healing and regenerative outcomes.The team discusses energy availability, protein targets, iron status, collagen-supporting micronutrients like vitamin C, zinc, and copper, and how fueling strategies can optimize recovery after procedures like PRP and during BFR training.If you’re dealing with chronic hamstring pain, considering PRP for a running injury, or navigating a return to running after a proximal hamstring tear, this episode offers evidence-informed guidance from a running medicine physician, physical therapist, and sports dietitian working collaboratively to support runner health and performance.If you’re enjoying these conversations, please follow the podcast and take a moment to rate or review it. Sharing it with a runner, coach, or healthcare provider helps us reach the people who can make the biggest difference in athletes’ lives. This podcast is for runners at every level, the coaches guiding them, and the healthcare professionals who care for them. We believe interdisciplinary care leads to better outcomes  and stronger runners.00:00 – Welcome to Interdisciplinary Case MilesHosts introduce the case-based, evidence-informed discussion format.02:00 – Case Presentation: High Hamstring Pain After a Slip40-year-old runner with chronic hamstring tightness that became acute after slipping on ice.05:00 – Why This Case Is TrickyChronic symptoms masked until an acute event; athletes often keep training through early tendon pain.08:00 – Medical Evaluation PrioritiesRule out lumbar spine and nerve involvement; assess for proximal hamstring tendon injury vs referral.12:00 – Timeline Matters: Acute on Chronic InjuryLong-standing tendon changes increase the likelihood of partial tearing with sudden load.15:00 – Imaging Decisions: When and WhyMRI used to confirm tendon involvement and rule out hip pathology that can mimic hamstring pain.18:00 – Why Rehab Comes FirstConservative care focuses on progressive loading, not rest, to restore tendon capacity.21:00 – Key Biomechanics: Hip Extension Drives LoadLimited hip extension shifts demand to the hamstring, increasing strain and injury risk.24:00 – When to Consider PRP or TenotomyProcedures introduced after failed rehab; choice depends on presence and size of tendon tear.27:00 – PRP vs Tenotomy: Clinical Decision MakingPRP for larger tears; tenotomy for smaller or degenerative tendon changes30:00 – Post-Procedure ManagementInitial protection followed by gradual return to loading and early reintroduction of rehab.33:00 – Rehab Progression After InterventionIsometrics → eccentric loading → return to running with controlled progression.36:00 – The Biggest Mistake Runners MakeRelying on passive treatments instead of structured strength and loading progression.39:00 – Final TakeawaysSara: Rule out spine and confirm diagnosis earlyKelsey: Recovery requires supporting the whole systemKate: Tendons don’t heal with rest—they need progressive load42:00 – Closing and Where to Learn MoreOutro and resources for runners dealing with hamstring pain.Become a supporter of this podcast: https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support.If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case.Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at [email protected].