The hamstrings are a group of 3 muscles that are found at the back of the leg running from the hip/sits bones to the back of the knee. The hamstrings help with functional movements such as squats, lunges, walking, bending the knee and tilting the pelvis.
What is Tendinopathy?
A tendinopathy is an umbrella term for tendon dysfunction that causes pain and/or swelling.
The risk factors according to Ahmad, Parker, Shepherd and Rushton (2019) for tendinopathy:
Intrinsic Factors
- Age (40-year-old and above)
- Increased range or flexibility at the hip.
- Weakness of the glute muscles and hamstring muscles.
- Gender (Females>Males)
- Obesity/being overweight esp. weight around girth.
- Low oestrogen Levels
Extrinsic Factors
- Occupation (increased sitting, driving, physical work)
- Overload such as an increase in training intensity through running hills, deadlifts and overloading the tendon
- Sport (Jumping, hurdles, sprinting etc.)
- Training errors (“too much too soon”)
- Environmental conditions (stairs/hilly terrain)
Proximal Hamstring Tendinopathy
The most common site of pain is deep, buttock pain after walking, running or sitting for a long time. The pain has been described as “throbbing”, “aching” and “annoying” in some of our patients. The pain can also start to refer down the leg towards the back of the knee.
When a tendinopathy at the proximal hamstring tendon occurs, it is usually due to compressive and tensile loading on the upper part of the muscle.
Compression is caused by:
- Stretching the hamstrings (as the tendon presses against the sits bone
- Increased intensity/load with running
- Increased hill running/climbing stairs
- Sitting and driving
Tensile forces occur when the tendon itself is stretched and contracting – causing the fibres in the tendon to elongate and contract. The tensile forces increase the most at the heel strike position when walking or running which places strain on the tendon.
- Pain over the upper hamstring/glute region following walking/running/sitting for long periods of time.
- Increased intensity/load with running
- Pain “warms up” and eases during the workout and then worsens when the body cools down, or few hours afterward.
- Stiffness in the morning.
- Stiffness in the morning.
The upper hamstring pain needs to be investigated as this can be from the lower back, sacrum or pelvic region. Seek medical attention from a Physiotherapist who will assess you in detail in order to determine the correct diagnosis.
Hamstring Tendinopathy Rehab Program
The program is designed to reduce your pain levels, restore strength in the hamstring and through adaptation at home/work/school and sport for a holistic approach tailored to your goals.
Pain gives a good indication if you are ready for harder exercises or increased running/jumping exercises (The Green Zone) or if the load is too much (The Red Zone).
What you should avoid
- Stretching the hamstrings
- Deadlifts
- Sitting for long periods of time
- Sitting on hard surfaces
- Bending forward when climbing stairs or walking uphill.
- Sprint/jump workouts
Early Physiotherapy Management:
- Stretching the hamstrings
- Deadlifts
- Sitting for long periods of time
- Sitting on hard surfaces
- Bending forward when climbing stairs or walking uphill.
- Sprint/jump workouts
During all exercises and activities: the pain must be no more than 3-4/10 and no worse 24 hours after the activity. Pain is our friend as it guides us as to how much we can safely do.
Start with these 3 exercises described below:
Glute max wall: Static
Build up contraction slowly to a fairly strong intensity.
Hold each position for 15-45 seconds. 30 second rest between isometrics.
Glute max over pillows
Go into holding position.
Sustain the ‘Hold’ position for 10-15 seconds.
DO: 8-10 Reps. Then rest for 30 sec. Then Repeat
[1] Isometric = There should be no movement whilst performing the exercise. Proven to help with tendon pain and shown to get neural changes (Neuroplasticity) associated with the muscle adaptation.
Bridge: Resisted abduction Tubing
Hold the bridge position and push the knees outward (against the elastic band).
Perform exercise slowly & controlled, including the return movement (2 sec out, 2 sec hold, 2 sec return) so that each rep takes 6 seconds.
DO: 3 sets of 8-12 reps with a 30 second rest between sets.
Physiotherapy Management
Your physiotherapist will assess and identify any biomechanical factors that you have that contribute to your pain and/or dysfunction. The exercise program is then tailored specifically to your needs and will involve increasing tendon loading, to relieve pain and improve function.
BRH Physiotherapy can assist in providing an in-depth assessment and treatment for joint and tendon related pain.
We also offer state-of-the-art shockwave therapy to assist in the treatment of tendinopathies, which has great benefits.
Contact us today to book an appointment to see a Physiotherapist.
References
Images of Exercises courtesy of:
Ahmad, Z., Parkar, A., Shepherd, J. and Rushton, N., 2019. Revolving doors of tendinopathy: definition, pathogenesis and treatment. Postgraduate Medical Journal, 96(1132), pp.94-101.
Lempainen, L., 2015. Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy. Muscles, Ligaments and Tendons Journal.
Pepper, J., 2022. Hamstring Tendinopathy | How to Manage that “Pain in the Bottom” – Sport & Spinal Physiotherapy. [online] Sportandspinalphysio.com.au. Available at: <https://sportandspinalphysio.com.au/hamstring-tendinopathy/#:~:text=What%20is%20Hamstring%20Tendinopathy%3F,intensity%2C%20or%20started%20hill%20running.> [Accessed 16 March 2022].