Proximal Hamstring Tendinopathy

This injury is a serious pain in the butt. Literally.

I actually suffered with for a few months myself and weirdly I have since seen about half a dozen women with the same issue.

Proximal hamstring tendinopathy (sometimes known as hamstring origin tendinopathy) is a painful condition that presents as pain in the lower buttocks which can refer down into the hamstring. Often it will warm up with activity only to return after exercise. It can linger around for several hours, or in more severe cases several days.

In almost all of my clients the onset of pain correlates with a change in volume or intensity of training combined with compression factors such as long periods of sitting and increased hamstring stretching. It’s not unusual for symptoms to appear quite suddenly, but unfortunately don’t tend to resolve quite so quickly.

The rehabilitative phase can take up to 12 weeks however rest assured our tendons are strong, adaptable and in most cases very responsive to a good strengthening program.

Management of hamstring origin tendinopathy can differ slightly between clients but the general principles of rehab are constant.

There may be an initial period of rest required, not from training altogether. I often encourage pain free cross training. Too much rest will actually be detrimental for the tendon when it comes to coping with load again.

I make a concerted effort to allow my runners to keep running, albeit with a modified load. For example reducing the speed, eliminating hills or a shortened stride length are all ways to facilitate overall load reduction on the tendon without stopping running altogether. In the gym one may reduce the weight of their squats & deadlifts or work through a smaller range. Using pain as a guide is important, a 2-3/10 is acceptable, anything more and you are in the no go zone (we call it the red zone)

Avoiding compression is really important. Sitting on softer surfaces instead of hard chairs and steer clear of stretching your hamstrings. Other gym related sources of compression include lunges and heavy deadlifts.

A strengthening program will often start with isometrics – an isometric is a contraction where there muscle is switched on but not moved through range at all. Such exercises have been shown to assist pain modification as well as preparing the tendon for both concentric and eccentric strengthening. The rehabilitative process can take several months so a little patience and perseverance is important.

There are also some hands on techniques that your physio can use which can be helpful. I use both active release and dry needling to target areas of tension both in the hamstring but also around the glutes and lateral hip.

If conservative management doesn’t seem to be working there may be some more invasive options such as PRP injections that your physio or sports doctor may discuss with you. You will most likely need an MRI scan to confirm the diagnosis as hamstring origin tendinopathy prior to this discussion.

Recovery from hamstring tendinopathy can be a slow process, and one that requires careful consideration of each individual case with regards to load management, training and strengthening. We strongly advise you seek guidance from your physio if you’re dealing with a pain in the butt, it may save you weeks worth of rest or self guided rehab that is targeting the wrong issue.

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