Did you know that proximal hamstring tendon pain is one of the most common reasons for persisting hamstring problems?
It is quite literally a pain in the b*tt. The symptoms of proximal hamstring tendinopathy (PHT) are typically located at the top of the hamstring where it attaches to the ischial tuberosity (sitting bone of the pelvis). The local anatomy shows how the hamstring tendon and sciatic nerve run close together and referred symptoms to the back of the thigh can co-exist with PHT. The symptoms often develop gradually over time, so many people continue their sport and exercise routines until their performance and health are really limited. A delayed diagnosis and management can contribute to the extended recovery that is often required in these cases. Many people also find that sitting at work, in the car or at home worsens their symptoms. For many, sitting is more painful than sport and exercise.
The first symptoms often involve mild upper hamstring/buttock tightness and soreness with sport or prolonged sitting. Therefore, people commonly start stretching their hamstrings in the hope that the tightness and soreness will go away. The paradox to this is that stretching tends to make the symptoms worse which might perpetuate the recovery.
In addition to the symptoms experienced, proximal hamstring tendinopathy changes the structure, mechanical and functional properties of the tendon over time. This might lead to longer times away from sport and exercise, sometimes greater than 12 months.
Did you know that resting from sport and exercise alone is not effective in overcoming proximal hamstring tendinopathy?
Absolute rest is rarely indicated in load related tendinopathy management since tendon health relies on appropriate load stimulus. Relative rest, load management, can however be important to settle symptoms to a level where tendon loading can be reintroduced successfully. Successful proximal hamstring tendinopathy rehabilitation involves loading of the muscle and tendon with exercises that restore mechanical and functional properties. Without tendon loading and a sport & exercise reconditioning phase, the symptoms tends to reappear quickly when running or sport are resumed. This loading/pain paradox is why rest alone (until pain-free) is generally an ineffective hamstring tendinopathy strategy in returning to sport and exercise.
What can I do?
The cause and risk factors associated with hamstring tendinopathy is believed to be multifactorial. There is no “vaccine” for sport and exercise related hamstring problems. A combination of a balanced training plan that includes hip, hamstring and calf exercises are important factors for your tendon health and function. Early detection and management of proximal hamstring tendinopathy signs and symptoms are linked with shorter rehab times.
Key take home messages
→ Do not ignore the early signs and symptoms of hamstring tendinopathy (stiffness/soreness).
→ Clinical signs of proximal hamstring tendinopathy include local symptoms (and tenderness) at the ischial tuberosity linked to sitting, stretching, running, cycling and in the gym squatting, lunging or deadlifting.
→ Stretching of the hamstring might compress the tendon and increase symptoms.
→ Evidence based treatments include individual management plans with focus on exercise rehab, graded tendon and sport specific loading programs.