Achilles Tendinopathy… What is it?

Tendinopathy is a common condition that can affect any tendon in the body. The most common which you are likely to have heard of are Achilles, Gluteal (check out our blog on this) and Biceps tendinopathy.

We see Achilles tendinopathy on a pretty regularly basis.

What is Achilles Tendinopathy? What are the symptoms? How did you get it? How can you get it better?

What is Achilles Tendinopathy

The Achilles tendon is the thickest in the body – formed by a blend of the gastrocnemius and soleus tendons as they unite to attach into the back of the heel.

Tendinopathy itself occurs when the cell matrix (which is what makes up the tendon) undergoes certain changes. This can result in disruption of the cells organisation & number with associated increases in blood vessels and nerves in the tendon. There are three stages of tendinopathy:

  1. Reactive Tendinopathy: Some small cell changes where the tendon has the capacity to return to normal tendon makeup & structure.
  2. Tendon Dysrepair: Larger cell changes and disorganisation where the tendon won’t fully return to normal however shouldn’t result in any activity limitations.
  3. Degenerative Tendinopathy: Cell death, trauma and disorganisation throughout the tendon. The tendon will be constantly thickened, often painful and usually results in ongoing activity limitations.

What are the symptoms?

Often pain will develop in the lower third of your calf down into the Achilles tendon.  Traditionally pain will be worse in the morning – those first few steps upon waking can be the most painful! Pain often improves over the course of the day or during an activity (such as running) but then be worse the following day or after periods of prolonged rest.

Depending on the phase of tendinopathy that you are in simple tasks such as walking up and down stairs can be painful. There may be obvious thickening of the tendon and it can be tender to the touch in some cases.

How do you get it?

Tendinopathy normally occurs with an acute overload of the tendon that comes with changes or sudden increases in intensity, frequency, quantity or type of training. The classic case we see so often is someone who signs up for a running event and rather than slowly building up their running distance they get a little over excited and do too much too soon.

There are several other factors that can predispose people to Achilles related problems including biomechanics, age, gender, tightness of the calf, strength of the calf, footwear and running style.

How can you get it better?

  1. Loading – Complete rest is NOT the way to go! Gradual strengthening and loading is needed, in fact the tendon will respond well to load, but not overload. A strengthening program should be part of your recovery but the key is finding a balance. Your physio will often play a crucial role in guiding you with this.
  2. Relative Rest – Again complete rest is not the way to go about it. You should however avoid activity that makes the tendon feel worse at the time or worse the next day (sometimes it takes a day for the pain to develop).
  3. Improve mechanics – Figuring out what’s tight or weak is important to the longer term management of Achilles tendinopathy. Maybe you need to work on big toe flexibility (yes that’s a thing!), calf strength or endurance, your foot arch, or even lack of pelvic stability due to weakness of your glutes! There are many biomechanical issues that might be contributing to this injury and we would recommend visiting your physio to make sure you address the underlying causes.

Do you think you may be suffering from Achilles tendinopathy? Feel free to send us a email with any questions you might have.

Knee Ligament Injuries

Winter is usually a time where we tend to see an increase in knee injuries, especially knee ligament injuries. This is largely thanks to the variety of ‘change of direction’ sports that are played during this time of year. Rugby league, union, AFL, netball, soccer and skiing are all sports that are multidirectional and/or have contact involved with huge forces going through the knee joint.

The aim of this blog is to take you through the four major knee ligaments, their roles, how they might get injured and how long you might be on the sideline if you are unlucky enough to find yourself nursing one of these.

ACL (Anterior Cruciate Ligament)

We’ll start with the big one and the one that can quickly end your favourite sports star’s season. The ACL’s role is essential to stop you shin from coming forward and medially (internally) rotating. It’s important as it plays a huge stabilising role in your knee. Often the ACL is actually injuries in a non-contact scenario  such as pivoting,  landing, or changing direction but can also occur (must less likely) in a contact situation. ACL tears will often result in a person needing to undergo surgery which will see them out of non-contact sports for 6-9 months and contact sports for 12 + months. Rehab plays a vital role to strengthen the graft (replacement ligament) and ensure full recovery. More on this in a latter blog.

PCL (Posterior Cruciate Ligament)

The PCL’s role is essentially the reverse of the ACL,working to prevent backwards and lateral (external) rotation of the shin. It is much less frequently injured than the ACL and typically comes from contact where a direct blow occurs on the shin in a bent knee position. They can also occur when the knee is forcefully hyperextended. Generally PCL injuries are treated non-operatively with a comprehensive rehabilitation program, More severe injuries can sometimes be placed in a brace for the first two weeks. Isolated PCL tears, even if completely torn, have good non-surgical outcomes despite some ongoing laxity. They will however sideline an athlete for 6-8 weeks. If a PCL is combined with damage to other structures or if significant instability is present surgical reconstruction might be appropriate.

LCL (Lateral Collateral Ligament)

Probably the least common knee ligament to be injured is your LCL.  The LCL’s role in the knee is stabilise the outside of the knee. Injuries to the LCL are usually due to a direct and forceful lateral stress (contact injury) to the knee. Complete tears will often be associated with other injuries (often PCL rupture) and will result in the need for surgery. Incomplete tears may require a period of bracing if severe enough, however the majority shouldn’t. A specific rehabilitation period will be required nevertheless but it shouldn’t see you out of action more than 6 weeks.

MCL (Medial Collateral Ligament)

MCL injuries are common in the rugby codes. The MCL’s role is to stabilise the inside of the knee. Injuries here occur when there is a medial force to the knee and can occur in both contact and non-contact incidents. More often they are treated non-operatively, however there will be a period of bracing that can last from 6-10 weeks depending on the severity of the tear. For mild injuries bracing may not be required. All people suffering an MCL injury will need a strengthening program and modified training to reduce stress on the healing ligament. Many will return to sport with supportive strapping.

The extent of the damage to a ligament will significantly impact the management and recovery time. Rehabilitation, strengthening and activity modifications are going to be necessary in all forms of these injuries and play a vital role in return to play as well as  reducing the risk of re-occurrence. The best thing you can do is make sure you get a diagnosis and start on the road to recovery as soon as possible. As physio’s we have a variety of tests that we can do to determine the integrity of these ligaments. An MRI may be required in cases where surgical intervention may be necessary but your physio may also suggest a scan to assess other structures within the knee that can also be damaged.

Em & Nick are both experienced in dealing with acute knee ligament injuries. If you have any questions or have an injury you would like assessed feel free to contact us to make an appointment.

Are you sabotaging your recovery?

Coming back from an injury can be difficult, continuing to train through your injury though is even more difficult. At Active RX Physio we believe you should be able to train (in some capacity) whilst injured and we try to encourage active rehabilitation. With that said we certainly see some people that aren’t just pushing the envelope when it comes to training with an injury but are bursting through it.

We are hoping to provide a couple of pointers things you may be doing that are potentially sabotaging your rehab/recovery and keeping a little niggle around longer than it should be.

Training Through High Level Pain

When recovering, in most instances a little pain is something to be expected and not feared. However continuing to train when experiencing high levels of pain (not that good hard workout type of pain) is certainly not a good approach and its a sure way to keep an injury hanging around . We often will advise pain levels to stay around a 2-3/10 pain. Monitor how you  feel during, after and the next day, if you don’t feel any worse then you get the green light to keep training.. Most times too if you are truly honest with yourself you know when you’re pushing yourself too far.

Not Altering Your Workout

If you are finding that every time you back squat your hips hurts – don’t just keep doing them, there are literally over 10 + variations of the squat you could do to achieve a similar result. This can be extrapolated for nearly all training and it isn’t just limited in the gym – running, cycling etc. All have variations that could be used in the short term whilst you recover. Learn how to adapt, ask someone if you don’t know a alternative but altering a workout to keep you training should be something you can do. What’s that definition of insanity – doing the same thing every single day but expecting a different result?

Not Doing Rehabilitation Exercises

I know physio/rehab exercises sometimes aren’t the most exciting part of training, but if you’re injured they might be essential to your recovery. Remember you shouldn’t have to do these for the rest of your life they are a short term necessity for a quicker return to what you want to do. Not only do they help in recovery they also might be the missing link to make your future (uninjured) self run fast, lift heavier, move freer, jump higher, swim smoother, cycle further, breathe easier… I think you get the point. Physio’s don’t dream up boring exercises for no reason, most of the time they have a specific purpose related to your recovery goals.

Returning to What Injured You Too Soon

Yes we all want to get back to doing what we love to do as fast as possible BUT going back too soon to an activity that caused your injury in the first place may be a recipe for disaster.  You should be able to get back to whatever you like after most injuries (there are always exceptions to the rule) but slowly re-introducing yourself will be the key to making sure you don’t sabotage your recovery. Build the foundations for whatever you are training, whether that be running shorter distances before that marathon, lifting lighter weights before going for a PB – the key is to expose your body to the old movements hopefully with new found strength, mobility and resiliency.

The majority of injuries we see have the potential to recover 100% but I think 80% of injuries take a little longer than we may like thanks to one of the above mentioned factors. Yes it can be frustrating BUT short term self control and diligence will pay off in the long term.

Common mistakes in gym based exercises

Working as a Physio inside a gym has been an eye opening experience. Sure when you train at a gym you see the odd person doing an exercise a bit wrong but when you’re here all day you get to see all sorts of ‘modifications’ to common exercises. A lot of the time they are injuries waiting to happen, you might not get the pain straight away but it might be the reason for your nagging shoulder pain, tight back or stiff neck.

Today’s blog isn’t going to highlight the common culprits you would expect to read about like a deadlift or squat but rather mention a few exercises you might not realise you are compensating on.

Incline/Flat Dumbbell or Barbell Bench Press

I’ll start with the one all the guys love to do. The bench press, in its many forms,is a great way to build a big chest. I often see people lift the back of the head off the bench either throughout the movement or as they push up. This chin poke position will compromise your form and may end up being a contributor to  nagging neck pain.  If you find yourself suffering from a constant stiff neck, check in with your positioning next time you bench press.

Leg Press

Many people regard the leg press as a simple controlled leg exercise where form can’t really be sacrificed. Well unfortunately I disagree. The one error I want to focus on is range – are you going too deep for what your body can control? Of course I’m not encouraging people to do half reps (seriously one of my pet hates is when people only care about how many plates they can put on this machine!!!!) but you also don’t want to go too deep if you don’t have the mobility and strength too do so. Going too deep can irritate the front of your hip and/or your lower back. You should work in a range where your glutes and lower back stay in contact with the seat your hips don’t pull forward and up.

Shoulder Press or DB Seated Shoulder Press

In the pursuit of improving and lifting heavier weights often one will compromise form & it’s often seen in shoulder press movements. I regularly see people arching their lower and mid back to improve their chances of getting the weight above their head. In the short term you will probably get away with it, however the repercussions can be a stiff thoracic spine (upper and mid back), pain in the lower back and neck irritations.  Keep the back flat against the bench or think about keeping our rib cage over your pelvis and use appropriate weights that allow you to control this position.

Step Ups

When doing a step up the leg that should be working and taking the most load should be the leg on the step itself. How many of you feel like the leg on the ground pushes you up just as much? This may not  necessarily be a huge deal from an injury risk perspective but it’s a common mistake we see being made.  The second issue is probably more cause for injury and it’s usually the result of a step that is too high or a weight that is too heavy resulting in lack of control of the movement. We tend to see collapse of the knees especially which places undue stress on the hip and knee joints. Ideally we want too keep that knee over the foot or even have the knee drive out to the side as you step up.

Just so we are clear I am by no means suggesting that any of these exercises are inherently bad. Quite the opposite in fact. They are all very effective exercises that I have in my own gym program. At the end of the day it comes down to how the exercise is done. You will only get away with bad form for so long before something in the system becomes overloaded, tight or weak. I believe your goal should always be to  maintain form, in the long term this approach will make you stronger and more durable.

 

Sever’s Disease

Aches and pains are relatively common in growing children, especially these days where it seems to be the norm for kids to play multiple different sports during the one season. Often it can be tricky for parents of younger kids, some aren’t sure if they are being completely over protective while others feel they may not be empathetic enough to their child’s complaints of musculoskeletal pain.

We see kids regularly in our practice and 90% of them are suffering from a form of ‘growing pain’ with one of the most common areas being pain around the heels. This condition is known Severs Disease.

What is Severs Disease and what are the symptoms?

Severs disease is characterised by pain where the Achilles tendon attaches onto the heel bone (calcaneus). In children who are still growing this is a soft area of the bone where the growth plate has not yet closed. During periods of growth the skeleton grows slightly faster than the soft tissues, resulting in a ‘pulling’ of muscles at their attachment sites, in this case the Achilles into the heel bone. This results in pain right at this junction between tendon and bone or in some cases higher up in the tendon.

Quite often the symptoms can occur on both sides and can include;

  • Heel pain during exercise – traditionally this is increased with jumping and high velocity activities
  • Increased pain or ache after exercise
  • Limping or toe walking as they try to take pressure off the heal
  • Localised heel pain on palpation

Factors that contribute to Severs Disease

  • Growth Spurts – sometimes difficult to gauge as a parent that sees their child every day but kids tend to go through some noticeable spurts where they may jump a shoe size or shoot up a few cm in a short period.
  • Physical Activity Level – Sports that involve running & jumping. Kids that play multiple sports may be at a higher risk.
  • Shoes – Poor footwear choice can place extra strain on the Achilles Tendon.
  • Foot Posture – tight muscles, ankle joints, foot and calf strength can all contribute.

TREATMENT

Severs is an activity related and ‘self-limiting’ condition. For this reason parent & patient education play a very important role as the solution for Severs related pain is not to simply stop sport altogether. Relative rest, load management and activity modification will be important to reducing symptoms and improving recovery.

Potential contributing factors should be addressed by your physio such as;

  • Stiff joints: in this case the two ankle joints – subtalar and talocrural should be assessed
  • Tight muscles – especially the gastrocnemius & soleus muscles (aka the calf) may benefit from massage
  • Muscle weakness around the ankle joint.
  • Other biomechanical factors such as pelvic stability & proprioception.

Generally physiotherapy management will incorporate a strengthening and stretching program that will need to be performed on a regular basis.  Your physio may also offer heel raises / inserts which can be placed inside sports shoes – these work to unload the Achilles tendon and can be a useful aid during painful periods.

Analgesic strategies such as cold packs and medication can provide short term symptomatic relief.

Sever’s Disease can be painful and quite debilitating. We think its definitely worth getting on top of early it as early as a proper diagnosis combined with correct treatment strategies can greatly assist with pain levels and performance.

Diastasis Recti

What is Diastasis Recti?

A common occurrence during pregnancy. As the abdomen expands the skin,
connective tissue and muscles need to stretch to accommodate the growing baby. The rectus abdominus, the most superficial abdominal muscle, is held together in the midline by what’s called the linea alba, a piece of connective tissue. A growing belly places stress on this tissue causing it seperate. This is a normal part of pregnancy and research suggests that the majority of women will experience a degree of separation in their final trimester.

What can you do?

Firstly you don’t want to obsess over your tummy muscles during pregnancy. As mentioned this is a completely normal part of pregnancy.

It’s important to be aware of the changes that can occur and learn to monitor them which can be done quite easily just by feel.  Place your fingers just above your belly button during activity, feel (and look) for any bulging at the midline during activity. It will usually appear as a ridge running down the midline between your abdominals.

If you do notice bulging or ‘doming’ during certain activities I would encourage you to either modify your technique (this may I evolve reducing the weight or changing the position of the exercise) or alternatively eliminating it altogether.

Do you need to see someone?

If you have any concerns by all means ask a professional with knowledge and training in this area such as a physiotherapist.

For some women Diastasis Recti can manifest as pelvic or back pain. Weakening of the lines alba may reduce the ability for the abdominals to provide stability to the pelvic joints which may result in pain. This is very individualised and you physiotherapist will be able to assess this for you.

Can Diatasis Recti be avoided?

A common question and one to which there is no definitive answer!!

The best way to approach Diastasis Recti is to understand what it is, know how to check and feel for it during activity, modify or eliminate movements that place greater strain on the abdominals to potentially assist in reducing the severity of abdominal separation.

What happens in the post partum period?

The majority of women will experience a degree of Diastasis Recti in the third trimester.

In the post natal period for some women their separation will heel with little to no intervention.

Research does show that 1/3 of women have a mild separation at 12 months post partum.

It’s important to note here that in the post partum period it’s not simply a measure of the ‘separation’ but rather we look at your ability to create tension in the linea alba. Regaining control of the abdominal wall is important for longer term stability and postural support. Most women will require some retraining of the abdominal and pelvic floor muscles in the postnatal period to help restore optimal function.

Women should have a post natal visit with their womens health physio prior to returning to exercise.

If you have any questions about any of the above information feel free to contact Em at activerxphysio@gmail.com 

Sciatica. How do we treat it?

As discussed in part 1 there are numerous causes of sciatica, so if you missed part 1 you can read it HERE.

Part 2 of this blog will be discussing some of the treatment options that are available to help relieve sciatica. Remember these are only a guide and we always recommend you see your Physio for a thorough examination to ensure the exercises are appropriate for you.

Trigger Balls

Trigger Balls or foam rolling are both great tools to help provide short term pain relief. Our suggested focus areas would be the lower back, glutes and hamstrings. We always recommend these should include an active component to get the muscles moving. The reasoning behind the effectiveness of a trigger ball is still a bit of a mystery but studies have suggested that it can have a short term analgesic response. Reduction in pain may enable you to complete further exercises that will be effective in creating longer change.

Stretching and Mobility

Light stretching and mobility can also be beneficial in providing short term relief. Stretching should be pain-free and gentle to begin with, again focusing on the lower back, glutes and hamstrings. In certain cases some stretching positions can actually further aggravate sciatica so if you are unsure make sure you check with your physio!  Mobility work should be about controlling movement of joints through pain-free range of motion. Avoiding positions that create pain should be paramount during these exercises.

Neural Gliding

Neural gliding is essentially a stretching exercise that focuses on ‘sliding the nerves’. We use the analogy of the nerve being a piece of string traveling from the base of the skull down the spine out into the leg and down too the foot (this is the route of the sciatic nerve). Along its path it crosses underneath, between and over certain muscles. In order to function efficiently this nerve slides freely along this path. Sometimes with Sciatica the neural pathway gets ‘stuck’ and this sliding mechanism is affected. A neural gliding exercises aims to restore the smooth sliding of the nerve along its path. These exercises are different to static stretches, should be pain free and form an important part of the rehabilitation for neural irritations that are causes by muscles and joints. Due to their ability to aggravate symptoms further we would recommend checking with your physio before you begin.

Strengthening

Re-estabilishing strength shoulder be the long term focus of treatment. It is vital to firstly figure out why the nerve is irritated. Not all lower back pain and sciatica comes from weak core and glutes so focusing only on these two common areas to strengthen may not be  the solution for everyone with Sciatica. Addressing other muscles like the hips flexors, hamstrings, obliques or lats may be what you require.

Movement Patterns

Another treatment that is critical towards long term recovery is correcting movement patterns. Potentially the way you run, squat, deadlift and move in general might be contributing to your sciatica. If you get pain every time after you run, your running style may needs to be checked – and the same goes for other forms of exercise. People with chronic lower back pain or siactica also often pick up poor patterns as a response to long term pain so sometimes movement retraining is required. Most commonly individuals become very stiff in their back and develop fear avoidance patterns where never bend their back which will only contribute to further stiffness. Slow exposure to bending and moving the spine may be a way to get rid of this chronic irritation.

Ultimately to treat sciatica there needs to be a diagnosis and from there a longer term management plan that addresses strengthening what is weak combines with mobilising what is stiff. This will be totally dependent on the individual and one should seek a health care provider’s advice.  There are cases where conservative intervention may fail and more invasive treatments may need to be explored.

If you have any questions about Sciatica, it’s management or any other physio related question feel free to email us activerxphysio@gmail.com or head to our instagram page and send us a message!

Sciatica. What is it?

The word SCIATICA seems to instil fear in patients when it first gets mentioned. Everyone knows a person that has suffered from sciatica at some point in their life, which means that most people have heard the term Sciatica, and whole most people know it has something to do with leg pain very few people actually understand what Sciatica really is.

It’s not uncommon for people to be given the diagnosis of Sciatica, however Sciatica is not a diagnosis but rather a set of symptoms that can include buttock, leg and foot pain that originates from the back.

The goal of this blog is to give you a better understanding what Sciatica is, explain why one might get it and to explore some strategies to prevent it from returning.

What is Sciatica?

As mentioned sciatica is a description of symptoms rather than an actual diagnosis. What that means is – any pain/symptoms that travels from the glute, down the back of the leg to the foot that originate from the back is termed ‘sciatica.’

There are other potential musculoskeletal injuries that can cause a similar pain pattern, clients with these conditions do not have sciatica, even though their symptoms may present like so.

The term sciatica is derived from the sciatica nerve which is the largest single nerve of the body.  It is this nerve that gets ‘irritated’ resulting in this specific set of symptoms. As a result of this irritation one might experience one of more of the following:

  • Sharp pain or a dull ache in the back, glute, back of leg, foot with or without back pain
  • Burning, tingling, pins and needles down the back of the leg
  • Weakness or difficulty moving the leg, foot or toes
  • Pain with sitting (pain may be reduced with the use of a pillow)
  • Pain aggravated by coughing or sneezing

Why do people suffer from Sciatica?

There are numerous reasons why people get sciatica and to cover them all would require countless blogs, but let’s touch on a few in a broad sense.

It’s probably important to mention that sciatica ranges in severity and so too do the conditions that can cause sciatica.  From complete compression of the sciatic nerve which may cause alterations in strength and sensation of the leg to a more localised inflammation which may cause dull radiating pain into the leg. Part of our job is to determine the underlying cause which will ultimately guide the course of treatment.

  • Nerve Root Issues: The nerve root is the exiting portion of nerve that leaves the spinal cord. There are nerve roots for each level of the spine with one exiting each side. Compression and / or irritation of the nerve roots by surrounding structures can result in sciatica.
  • Spinal Stenosis:  This refers to the narrowing of the spinal canal which can place pressure on the sciatic nerve. This is a degenerative condition usually related to osteoarthritic changes of the spine.

    Image highlights a few of the intervertebral disc injuries that can contribute to sciatica
  • Injury of the intervertebral disc: The discs are the shock absorbers in the spine. Injury to these structures can vary from disc degeneration, disc irritation, disc herniation (commonly known as a disc bulge), or a disc rupture all of which have the potential to place pressure on the sciatic nerve.
  • Spondylolisthesis: A condition where one vertebrae slips forward in relation to another. This can often be the result of a stress fracture left untreated in a younger athlete.
  • Neural Irritation: After the nerves exit the spine they have a somewhat complicated pathway as they travel down, under and between all our anatomical structures to supply all the areas of he leg. If the nerve gets irritated or impinged at any point on this pathway you may see sciatic symptoms occurring.

They are just a few very brief descriptions of some issues that can lead to sciatica.

The key to treating sciatica lies in determining the underlying cause. That’s our job. How do we do that? Keep an eye out for next weeks blog which will touch on this.

In the meantime…. any questions? Feel free to email us or contact us via social media.

Self management for long term pain relief

At Active RX one of our main aims is to give our clients the basic knowledge and understanding of how the body is put together in the hope that one will have the ability to SELF-MANAGE their problems and a visit to the physio becomes a complementary appointment.

At the end of taking a new clients history I will ask – What are the goals of your treatment? Often the first reply will be “to have no pain”  and the second most common answer being self-management strategies.

To achieve long term pain relief self-management strategies are vital and this blog post focuses on a few simple ways that you can start to help manage your own pain and dysfunction.

Strengthening

It’s our belief that strengthening is the key to long term pain relief. Of course there are many other factors that contribute but overall weakness is one that simply cannot and should not be overlooked. When we talk about strength it’s all relative, you don’t have to be the strongest person in the gym but what is required is the strength for you to complete your activities of daily living. For example a labourer who loves to lift weights, surf + run will require different strength to a grandmother who like to go on walks and read BUT both need to be strong in their own right. The key is be aware of where you might be lacking and implement exercises that target such weaknesses. It’s also important to remember that the need for strengthening doesn’t mean you need a gym membership, for many simple resistance exercises can be very effectively done at home.

Mobility

Being flexible and pliable is also extremely important, but the term mobility fits the bill a bit better as to be mobile you need to have strength in your flexibility. It’s all well and good to be flexible but if you can’t control that range of motion of your joints and muscles then you may well find yourself on the physio table. Self management requires awareness of flexibility and the ability to be strong through your entire range of movement.  Too often we see someone who has taken up a vigorous stretching program only to find themselves more injured than before. Why? Because they have not learnt to control their complete range of movement. Mobility requires a balance between strength and flexibility. Too little or too much of one just can easily be a contributing factor to longer term pain.

Recovery

Looking after yourself seems like a no-brainer but it’s actually a part of training many people neglect. Recovering from your workouts, games and even everyday life is another step towards long term pain relief. If you’ve put yourself through a grueling training week, slow down for just a moment– have a dip in the ocean, go get a massage, do some stretching. You can check out our blog on ‘there’s no such thing as over training just under recovering’ for some good ideas. Recovery also applies to every day life situations, if you’re a breastfeeding mother a 10 minute trigger ball session can go a long way to release the upper back and shoulder tension. If you’ve just put in a 60+ hour work week to hit a deadline, go for a long walk & swim on the weekend. Then there is recovery in forms you wouldn’t expect; like nutrition, hydration, adequate sleep, sunshine + Vitamin D.  A body that is physically + mentally worn out will be more sensitive to pain, and this is a conversation we often have with clients because their pain may not necessarily be solely musculoskeletal so for a  long term recovery these other holistic factors need to be addressed.

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.