What is Proximal Hamstring Tendinopathy?
Proximal Hamstring Tendinopathy (PHT) is a condition that affects the hamstring tendon where it attaches to the ischial tuberosity of the pelvis (sit bone). This injury is often associated with deep gluteal pain and is typically caused by repetitive stress or overuse, particularly in activities involving prolonged or forceful hip extension.
Common Causes of Proximal Hamstring Tendinopathy
Proximal Hamstring Tendinopathy usually results from repetitive loading of the hamstring muscles. Specific factors that contribute to this condition include:
High-impact activities: Sports like running, hockey, or sprinting that involve frequent hip extension.
Overtraining: A sudden increase in intensity, frequency, or duration of physical activity without adequate recovery time.
Biomechanical issues: Poor pelvic alignment or muscle imbalances that overload the hamstring tendons.
Prolonged sitting: Activities requiring extended periods of sitting can exacerbate symptoms.
Identifying Proximal Hamstring Tendinopathy early is essential for effective treatment. Symptoms include:
A persistent, deep ache in the buttocks area, often radiating down the back of the thigh.
Pain aggravated by activities such as running, lunging, or prolonged sitting.
Discomfort when bending forward or stretching the hamstring.
Recognising the Symptoms
Risk Factors for Proximal Hamstring Tendinopathy
Several intrinsic and extrinsic factors increase the risk of developing PHT:
Intrinsic Factors:
Previous hamstring injuries
Weak gluteal or hamstring muscles
Limited flexibility or tightness in surrounding muscle groups
Extrinsic Factors:
Sudden changes in training loads
Poor technique during physical activities
Inadequate warm-up or recovery routines
The Phases of Proximal Hamstring Tendinopathy
Tendinoapthies, including Proximal Hamstring Tendinopathy, can be divided into pain dominant and load dominant stages:
Pain dominant: Pain is the main issue. The tendon can be very irritable with a lot of morning stiffness. This is when we want to focus on calming the pain down and reducing swelling and inflammation.
Load dominant: In this phase, there is minimal pain with everyday activities but flair-ups with increased activity levels can still occur. In this case, we want to focus on increasing the tendon’s load capacity gradually.
How is Proximal Hamstring Tendinopathy Diagnosed?
A thorough diagnosis is essential to distinguish PHT from other conditions. Physiotherapists use the following methods:
Medical History: Understanding the onset and pattern of symptoms.
Physical Examination: Identifying tenderness, restricted movement, or pain during specific activities.
Imaging Studies: MRI or ultrasound may be used to assess tendon health and confirm the diagnosis.
1. Load Management: Reducing activities that exacerbate pain, such as sprinting or prolonged sitting, is crucial. Controlled loading of the tendon is gradually reintroduced during rehabilitation.
2. Targeted Exercises: Strengthening the hamstring muscles and improving flexibility are key to recovery. Exercise progression typically includes:
Isometric exercises: Early-stage exercises to reduce pain. These are exercises that strengthen the muscles without changing their length.
Isotonic exercises: Focused movements to build tendon resilience. These include eccentric strengthening (muscle lengthens) and concentric strengthening (muscle shortens).
Plyometric exercises: For advanced stages, we want to prepare the tendon for high-impact activities.
3. Manual Therapy: Techniques such as soft tissue massage or dry needling may help alleviate muscle tightness and improve circulation.
4. Emerging Treatments: Platelet-rich plasma (PRP) injections have been explored as a potential therapy to promote tendon healing, although further research is needed.
5. Adjunct Therapies: Supportive interventions like heat, ice, or kinesiology taping can be used to manage symptoms and enhance recovery.
A 2023 systematic review underscores the importance of gradual, progressive loading in tendon recovery. Emerging evidence suggests that individualised rehabilitation programs tailored to an athlete’s specific needs yield the best outcomes. However, treatments like PRP injections remain investigational, requiring more robust clinical trials to establish efficacy.
Treatment Strategies for Proximal Hamstring Tendinopathy
Preventing Proximal Hamstring Tendinopathy
To reduce the risk of PHT, focus on:
Gradual increases in training intensity and volume
Incorporating dynamic warm-ups before exercise
Strengthening the glutes and hamstrings
Ensuring proper form during physical activities
Early intervention is critical in managing Proximal Hamstring Tendinopathy effectively. If you’re experiencing symptoms, consult a physiotherapist to create a personalised treatment plan. With guided rehabilitation, you can return to your regular activities and reduce the risk of recurrence.