A common running injury we see here at Bend + Mend is proximal hamstring tendinopathy. Patients generally come in complaining of deep buttock pain or upper thigh pain. This pain originates from where the hamstrings attach onto the “sit” bones (aka your ischial tuberosities) of your pelvic bone. This deep pain usually comes on gradually and over a period of time.
What causes proximal hamstring tendinopathy?
It is usually caused by repetitive or prolonged activities that strain the hamstring tendon such as running, jumping or kicking activities, and is aggravated by prolonged sitting. These activities lead to tendon degeneration, partial tearing and/or an inflammatory reaction. Although a tendinopathy may occur from a tendon tear that hasn’t healed properly, it is more commonly an overuse injury. There are number of risk factors that may pre-dispose someone to developing a hamstring tendinopathy:
– muscle imbalance in strength between the hamstrings and quadriceps muscles
– decreased flexibility
– gender – female
– age – as you get older, reduction in muscle mass, as well as collagen weakening
– core instability/weakness
– pelvis dysfunction
– leg length discrepancy
Symptoms of proximal hamstring tendinopathy may include:
– gradual onset of pain, no actual mechanism or incident
– deep buttock or upper posterior thigh pain
– the pain may also radiate down the back of the thigh and/or around the sides of the knee
– pain increases with repetitive activity such as running
– pain may increase with prolonged sitting as the hamstrings are on stretch and under load
– in more severe cases, pain may occur when the hip is fully flexed – i.e. when tying your shoes or bending at the waist to pick something up
How is it managed?
Treatment can vary depending on the stage of the tendinopathy. The initial priority is to settle the pain and any inflammation down. Your Physiotherapist can achieve this with manual therapy and inflammation management strategies including ice and activity modification. Your physiotherapist will then start you on a basic strengthening program to help improve strength of any muscle imbalances or weakness, and to help improve the loading of the injured tendon. In combination with this, you’ll be started on some muscle lengthening exercises utilising a combination of lower limb stretching and soft tissue release techniques such as using using a foam roller or trigger ball. The strengthening program is usually progressed from two-legged training to one-legged training, and static to plyometric type training. After sufficient strength is achieved, a monitored return to running program can be incorporated.
Proximal hamstring tendinopathies can take anywhere from a few weeks to many months to rehabilitate depending on the severity of the condition. In the more severe cases or where conservative treatment measures have failed, cortisone or platelet-rich plasma (PRP) injections may be considered to help regenerate tendon healing.
Proximal hamstring tendinopathies can sometimes be confused with other pathologies such as referred pain from your back (sciatica), a deep gluteal muscle tear and an ischial ramus stress fracture. It’s important to have the correct diagnosis so the correct treatment and rehabilitation can be implemented. If you’ve got an injury or a running injury, be sure to make an appointment at Bend + Mend in Sydney’s CBD to ensure a speedy recovery!