What is proximal hamstring tendinopathy and why should I care?

WHAT IS PROXIMAL HAMSTRING TENDINOPATHY?

There are 3 muscles that make up the hamstrings. The muscles and their tendons have a common insertion on the ischium of the pelvis, which is the boney bit that you sit on. When the tendon experiences an increase in load, for example more than it is used to tolerating it can become irritable and painful. Increases in load can be due to compressive or exercise load. This is commonly seen in runners and weight trainers.

WHAT IS THE FUNCTION OF THE PROXIMAL HAMSTRING TENDON?

The proximal hamstring tendon attaches the hamstring muscles to the pelvis bone. At the pelvis the hamstrings extend the hip during running. the demand is placed on the muscle and tendon push the ground away during stance phase.

WHAT ARE THE CAUSES OF PROXIMAL HAMSTRING TENDINOPATHY?

The main cause of proximal hamstring tendinopathy is an increase in load exposure to the tendon. This is often seen with an increase in running activity or hill running. Additional factors include:

• It is commonly seen with new runners who increase their activity too quickly, or experienced runners who increased mileage, speed or hill sessions too quickly.
• During running the tendon experiences increase load in stance phase (pushing the ground away).
• It is often seen in people who weight train. For example heavy squatting will increase load to the tendon and also increase compressive tendon load when in deep squatting position.

WHAT DOES TREATMENT PROXIMAL HAMSTRING TENDINOPATHY TREATMENT LOOK LIKE?

Initially the aim is to reduce the irritable activity. This is likely to include a reduction in running volume (e.g distance / hills) or depth of range during weight training exercise. Strength exercises are vital to build up tolerance in the tissue and these will need to be done in positions of reduced irritation. As the tolerance increases then strength is added to positions of increased hip flexion to expose the tendon to the compressive component. Explosive exercises are added when tolerable such as forward jumps to train the push required for stance phase. Running progression is encouraged as comfort is tolerated.

MISCONCEPTIONS

There are a couple of common misconceptions regarding proximal hamstring pain:

• Stretching doesn’t have a significant impact on the recovery and in some circumstances can irritate the pain due to the compression in certain stretch positions.
• Massage or foam rolling will not change the structure of the tendon. It may help desensitize the hamstring area but it doesn’t have an impact on recovery. It can potentially irritate the tendon due to the compressive nature of massage.
• You cant run a tendinopathy off! You can reduce the running volume to a tolerable level, but you cant keep pushing it as this will progress the irritation.  

Summary

Proximal hamstring tendinopathy is caused by compression / increased load as a result of increased running or weight training activity. The increased demand on the tendon during activities such as pushing the ground away during stance phase of running or compression in a deep loaded squat can irritate it. Activity modifcation is vital for recovery alongside strength training, plyometrics and a gradual increase of running exposure!

By Chris Wilson – https://www.reactphysiotherapy.co.uk/