American physician Robert Gendler had been feeling pain in his buttocks for a long time, which made it difficult for him to sit or engage in physical activity. After learning about Hospital NEO’s reputation for excellence in treating hamstring injuries, Dr. Gendler applied for surgery in Finland under the care of orthopaedic surgeon Lasse Lempainen. Now, thanks to the surgery he is again able to enjoy physical activity and live a pain-free life.

Gendler says he has practiced all sorts of physical activities throughout his life.
“With age, I have developed several conditions that have made it more difficult for me to move as I once did. I was diagnosed with arthritis of the right hip, which is why I underwent hip replacement surgery in 2012. Thanks to this surgery, I was able to exercise normally again,” he says.

However, a few years after the hip replacement surgery, Dr. Gendler had to limit his movements once again because he began to feel pain in his right buttock. He felt the pain whenever he moved, as well as when he was just sitting. Approximately a month later, the pain spread to his left buttock.
“The pain was not unbearable, but it was constantly present. Even the slightest amount of physical activity made it worse. I was not able to hike, jog, or ride a bike properly. Sitting felt uncomfortable as well. Over time, I started to develop the symptoms of sciatic nerve irritation,” Gendler describes.

A hamstring condition was the cause of the pain

A solution to Gendler’s problem was eventually found, but it took several months to get the correct diagnosis because this type of condition is uncommon and its treatment is not yet well known among American orthopaedists. The cause of the pain was hamstring syndrome, which was finally confirmed through a magnetic resonance imaging (MRI) scan.
In the United States, Dr. Gendler was offered a treatment option to repair the tears in his hamstring tendons. It involved undergoing a major surgery that requires a long recovery period. When that particular surgery method is used, only one leg can be operated at a time, and recovery can take half a year. However, hamstring syndrome requires a different kind of approach. There is another surgical treatment for this syndrome, which involves a different technique and allows for a much shorter recovery period.

Surgical treatment in Finland

“I did some personal research concerning treatments for hamstring syndrome. It turned out that most of the studies related to hamstring syndrome were conducted by a Finnish research group. The latest articles on this topic were written by Dr. Lasse Lempainen. Encouraged by this, I contacted Dr. Lempainen and described my symptoms to him. I also sent him the results of my MRI scan for his review. After that, we had an email discussion about the possible surgery,” says Gendler.

Gendler and his wife traveled to Turku for the surgery, which was successfully carried out in November of 2015.
“I was impressed by how wonderful and functional Hospital NEO is. The staff was very friendly and professional. I met Dr. Lempainen the day before the surgery. The operation itself also went well, from my point of view. I was able to walk cautiously the day after the surgery, and in a few days, I could walk without crutches. I got back to work three weeks after the surgery,” he recalls.

In the hands of top experts

“Four months have passed since I was hospitalized at NEO. The healing has progressed well, and best of all, I can again do the things I did before my symptoms appeared. I am enjoying outdoors activities and living an active life once again,” Gendler rejoices.

Dr. Gendler has recommended the services offered by Hospital NEO to several patients and colleagues in his home country. He has also written an article about his experiences in the U.S. and Finland, and the cost of the surgery.
“Lasse Lempainen and Sakari Orava’s expertise in treating hamstring injuries is world-class. As a doctor, I had the advantage of being able to access this information relatively easily. I was able to find top surgeons and get specialized treatment for hamstring syndrome. Therefore, it is important to spread the word about Finnish expertise in this field so that it becomes more widely known in the United States.”

From a doctor’s point of view: Lasse Lempainen

The problem Robert Gendler was facing was a prolonged pain condition in his hamstring tendons, which is known as hamstring tendinopathy, or hamstring syndrome.
“The pain associated with hamstring syndrome is typically felt in the buttocks and the upper thighs. The symptoms manifest themselves when the patient is moving, as well as when he/she is sitting. This syndrome most commonly affects athletes and sports enthusiasts. However, people whose job requires them to stand for long periods may also develop the same problems,” says orthopaedic surgeon Lasse Lempainen.

Hamstring syndrome can be treated with physical therapy, but if the problem has persisted for a long time, surgery is often necessary.
“Of course, surgery is not necessarily the most appropriate option for all patients, so each case must always be evaluated individually. In Gendler’s case, his pain condition had been affecting him for a very long time, and other treatments had already been tried. Surgery helped significantly in his particular situation,” Lempainen points out.

Moderate therapy

“During the surgery, both of Robert Gendler’s posterior thighs were subjected to a hamstring-tendon release procedure, which helped relieve his pain. The recovery is usually quick, and therapy sessions can begin within a short time after the surgery,” Lempainen explains.

After the surgery, Gendler was given a physical therapy plan, which was carried out in collaboration with his own physician and physiotherapist.
“During physical therapy sessions, it is important to avoid excessive strain on the buttocks and stretching movements. The therapy is further enhanced if aquatic therapy techniques are implemented and used at a very early stage (up to 3-4 weeks after surgery). We also recommend core exercises to strengthen the hip, back, and abdominal muscles so that the patient is able to maintain a correct posture,” Lempainen describes.

“Sakari Orava and Jaakko Puranen had already developed the hamstring syndrome surgery technique in Finland back in the 1980s, and this is why Hospital NEO specializes in this type of treatment. We have conducted a lot of research on this topic, which is an important factor when it comes to sharing our knowledge and expertise with the rest of the world,” he says.

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Read more: Scandinavian Journal of Public Health - Debate article (pdf)