Hamstring Tendinopathy occurs at the common origin point of the hamstring muscles, at the ischial tuberosity (sitting bone) of the pelvis, which is the site of injury in Proximal Hamstring Tendinopathy. The injury is classified as a tendinopathy rather than a tendonitis due to its degenerative nature rather than being an inflammatory pathology.
Sufferers will complain of pain local to the ischial tuberosity /lower buttock when running, especially when accelerating and sustained faster paced running. The pain will most likely be an intense ache in nature, rather than sharp or stabbing, though stabbing can occur when it is very aggravated. Due to the anatomical proximity to the common hamstring origin, the sciatic nerve can occasionally be affected, which can cause referred pain into the posterior thigh. Once aggravated, sitting on solid surfaces can also be uncomfortable, as can direct palpation and pressing onto the ischial tuberosity manually.
Differential diagnoses for similar symptoms can include piriformis syndrome, pelvic stress fractures and low back injuries. Thus, a proper assessment from a musculoskeletal physiotherapist is advisable.
Is on an individual basis, and generally involves a graded loading and strengthening program. Research shows that stretching can have negative effects and that massaage alone won't fix the symptoms. The only current proof we have is gradual loading via a specific and monitored exercise routine.
The tendon is aggravated by compressive and tensile loads, so these loads need to be managed in order to control pain and allow healing and strengthening of the tendon. With the hamstring tendon, compression occurs during sitting and activities that cause hip/trunk flexion, such as sprinting and sitting. This causes compression loading, so aiming to reduce time in these positions can assist recovery.
Stretching needs to be limited and running limited to an acceptable pain level. Jogging is generally encouraged and not aggravating.
Tendinopathy will cause weakness in the hamstring so it is essential to perform strengthening exercises in a manner where load is controlled.
In the initial stages isometric (no movement) strengthening exercises will help with pain and then the exercises will be progressed as able to isotonic, eccentric, functional strengthening exercises, plyometrics and sports specific exercises.
Pelvic & Core Control
Your therapist will assess your movement and strength at your lower back, pelvis and hips to see are they contributing to your problem and address them in your exercise program. A lack of gluteal power and endurance can force unnecessary load upon the proximal hamstring tendon, leadin to tendinopathy.
Soft Tissue Treatment
May form part of your treatment to address pain and soft tissue changes in your hamstring. This will determined at your initial assessment.
For people with persistent hamstring pain and dysfunction that is not recovering in 4-8 weeks, it is important that you receive a proper sports physiotherapy assessment, as the symptoms in your hamstring may be referred pain, and not actually be the hamstring as the source. In these cases, it is usually the lumbar spine and neural tissue that are generating the pain.