Madeline Heiner

1. Name, country, sports activity / history and best achievements?

Madeline Heiner, Australia
Distance runner

PBs: 1500m (4.06), 3000m (8.44), 3000m Steeplechase (9.20), 5000m (15.04), 10,000m (31.41)
Achievements: 2016 Rio Olympics (7th 3000m steeplechase, 10th 5000m), 2014 Commonwealth Games (4th 3000m steeplechase), World Championships 2015/ 2017 (3000m steeplechase, 5000m, 10,000m), 2018 Commonwealth Games (5000m, 10,000m)

2. Hamstring injury; short history, how it all occurred, what kind of symptoms, treatment modalities before surgery?

Bilateral proximal hamstring tendinopathy

Minor symptoms experienced in 2015/2016 in right hamstring (hurdling lead leg) which settled by reducing running load, increasing strength training and ceasing hurdling. My symptoms returned in early 2018 and gradually worsened over the next 12 months. There was no acute trauma, just the onset of pain and hamstring restriction that was most apparent when running at pace and when sitting. I continued to run and train at an elite level until October 2018, though did so with significant pain and limitation.

Treatment prior to surgery included intensive physiotherapy and soft-tissue work (2-3 times a week for >9 months), reduced running load (from >100km per week to 15-20km/week), hamstring and glute specific strength work (daily), long term anti-inflammatories, removal of ‘’triggering’’ activities or movements (including biking, aqua jogging, specific gym exercises, prolonged sitting). Pain levels did not reduce (running or sitting) despite treatment and reduced running load.

3. Operation in Turku, Finland. How you find us? Experiences about hospital and our treatment here?

My coach (Craig Mottram, Australian Olympian) contacted Hakan Alfredson for advice (Dr. Alfredson operated on Craig) and he referred us to Dr Orava and Dr Lempainen.

We had consulted with several sports doctors and orthopaedic surgeons in Australia, who performed a different surgery to what was available in Finland and presented significantly longer rehabilitation time frames. They had minimal experience returning a distance runner to a high level of sport and were hesitant to operate on both hamstrings in the same surgery.

My father, a doctor in Australia, travelled with me to Finland and we were both overwhelmed with the facilities available at Hospital NEO, as well as the care provided. We had the opportunity to meet with Lasse the day before the surgery, as well as discuss a rehab program with Jari (physio). We both had complete faith that I was in the best possible care with Dr Lempainen and Dr Orava.

I was reviewed by Lasse 5 days post-surgery, prior to flying back to Australia and provided further advice on the recovery process. Both Lasse and Jari provided me with ongoing feedback (via whatsapp text and video) throughout the following months.

4. Rehabilitation, training and return to track again?

I followed a very gradual return to run program, guided by Jari and Lasse and overseen by my physiotherapist and sports doctor in Australia.

I commenced daily strength training almost immediately post surgery (progressing from minor movements to increased range of motion and heavier weights) and was walking without the aid of crutches within one-week post surgery. Sitting, due to the surgical incisions, was painful for up to 6 weeks, and so I avoided driving until this time.

My rehabilitation was

- week 2 - progress to pain free walking (up to 60 minutes/day)
- week 3- swimming with pull buoy (building to 60 minutes/day)
- week 5 – cross trainer / elliptical (initially minimal resistance / slow motion on alternate days, increasing the resistance, pace and duration gradually)
- week 6 – aqua jogging
- week 8 – stationary bike (delayed this due to surgical pain when sitting)
- week 11 – commence walk run (initially 6 x 30s jog with walk recovery). Running duration increased gradually – 30 minute slow jog by week 13).
- 4 months post-op – training load built to 70km/week of easy running with introduction of intervals (pace controlled and gradually increased)
- 6 months post-op – return to full mileage training (100km/week) but still avoiding hills / speed work

The only major set back I experienced was around the 10 month post-operation time, where we increased intensity/speed and reduced recovery between sessions (speed work 2 x per week), in an attempt to prepare for Olympic trials. I needed to take some time off running (1 week) and take oral Prednisolone to settle the inflammation. Sensible return to running post-flare up allowed me to find pain free running again in a few weeks.

5. Future goals / plans considering sports / running?

My primary goal post surgery was quite simple – to be able to run pain free and to run happy. I have achieved this and so am very grateful for my surgery!

My most ambitious goal post surgery is to return to the highest level of competition, with the Tokyo Olympics as the most immediate goal. The postponement of the 2020 Olympics due to COVID-19 allows me the opportunity to continue to sensibly reload the hamstrings over an additional 12 months. My goal continues to be to gain selection for the Tokyo Olympics, and to compete at the Paavo Nurmi Athletics meet in Turku, to visit Lasse and Jari and to say thank you 🙂

6. Anything else?

Running is my passion and fills me with so much joy. Regardless of what level of performance I am able to return to, I am forever grateful to have been given the gift of pain free running again.

Madeline Heiner


Lasse Lempainen
ortopedian erikoislääkäri
urheiluortopedian dosentti

Lasse Lempainen (Pihlajalinna)