Hamstring Tendinopathy

Hamstring tendinopathy can literally be a pain in the butt. Afflicting runners, walkers, gym-goers & even non-exercisers, this condition can get so bad that exercising & even the simple act of sitting can become very painful.

What are the symptoms of hamstring tendinopathy?

The main symptom is pain felt high in the back of the thigh near the buttock. The pain can sometimes radiate down the thigh, but most of the time remains localised around the sit bone (ischial tuberosity).

The pain is often aggravated by sitting for a prolonged period of time (especially on harder surfaces). Runners will often find the pain may warm up with exercise, only to return later in a run or afterwards. Hillier & faster walks/runs can also aggravate the pain. For those who exercise in the gym, the pain can be aggravated by exercises such as squats & deadlifts.

What else could it be?

There are a number of conditions that need to be considered with buttock pain as can be seen in the image below. A thorough assessment by your sports chiropractor or physiotherapist will perform a thorough examination to reveal the cause of your pain.

What causes hamstring tendinopathy?

Hamstring tendinopathy is due to the irritation of the hamstring tendon as it attaches into the buttock.

There are a number of things that can cause hamstring tendinopathy. These can include:

Sudden changes in training load or exercise (ie increasing distance, speed or hills)
Increased sitting time
Increasing in stretching activities i.e. yoga, deep lunges or squats
Various other factors including genetics, hormonal influences & medication use

To read more about what causes hamstring tendinopathy, click here

Managing Hamstring tendinopathy

Firstly get a DIAGNOSIS from a health practitioner that deals with runners! It’s important to know exactly what has been injured. Once you have a diagnosis, then get a PLAN moving forward! A thorough assessment will ensure that treatment and rehabilitation can address any issues identified, and reduce the chances of you suffering another injury, and get you back out there as soon as possible.

It’s vital to see your health practitioner to firstly assess and diagnose your problem and secondly to create an INDIVIDUALIZED rehabilitation program.

What is our unique approach to Hamstring tendinopathy?

At Health & High Performance we pride ourselves on a thorough examination to ensure an accurate diagnosis to then lead to targeted treatment, allowing you to get back to sport as soon as possible.
Firstly it is important to have a thorough discussion about your problem and some of the factors that may have contributed to it. This can include training errors (doing too much too soon & inconsistent training) or insufficient recovery (ie. high stress and poor sleep).

Using our state of the art technology, the AxIT system, we are able to assess for any relevant muscle weakness which may be contributing to your issue. It’s common to see a loss of hamstring strength, but we also often find a loss in glute max strength & other muscles of the leg. Read more about the AxIT system here or this video here on strength testing for hamstring tendinopathy.

Consideration of the role that other areas played in your injury: for instance, foot strength, low back pain, hip problems, or even previous ankle sprains may contribute to your injury. Your examination with us will cover all these areas, and your management plan will include solutions to these additional issues.

Rehabilitation & return to sport

“Every injury is unique, treatment should be too”

Immediately commencing rehabilitation: from Day 1 there will be exercises you can perform to hasten your recovery. These exercises are prescribed according to criteria (what you can/can’t do) not just based on time. In a 2017 study by Bayer et al, they compared commencing rehab at 2 days versus 9 days, and found that those starting rehab 1 week earlier, returned to their sport a staggering 3 weeks earlier! Click here to read more

Below is a guide to some exercises that can be used for the rehabilitation of hamstring tendinopathy. Your sports chiropractor or physiotherapist should individualize these exercises after a thorough assessment.

Rehabilitation

A loss of hamstring strength is frequently seen in those with hamstring tendinopathy, so a large focus of rehab should target this muscle group.

It is also important to assess the whole kinetic chain in those with hamstring tendinopathy. In our experience, it is not uncommon to see a loss of strength in the hip muscles in those with hamstring tendinopathy.

A thorough strength assessment will determine if you have the required strength in these areas, which will then allow for a tailored strengthening program to be implemented to address any deficits.

For irritable tendons, isometric exercises can be useful. Read more about these here. Options include:

Prone hamstring curl
Supine isometrics
Standing heel drive
Bench bridge isometric
Glute ham raise holds
Nordic isometrics

Early progressions to strengthen include the following which involves only small amounts of hip flexion:

Prone hamstring curl (either with a band or machine)
Nordics
Prone superman
Standing banded hip extension
30-degree bridge
Hip thruster
Sliding bridge
Step up (low)

As the tendon becomes less irritable, it can be further challenged with movements that require a higher degree of hip flexion:

90-degree bridge
Arabesque (single leg deadlift): gradually increase range
Glider
Standing banded knee flexion
Lunge: start shallow & progress depth
Rear leg elevated split squat
Deadlift: start shallow with rack pulls & progress to lifting off the floor
Step up: increasing height
Glute ham raise
Roman chair extension

Once tolerated, more ballistic & plyometric exercises can also be introduced including:

Hamstring tantrums on Swiss ball or Band
Kettlebell swings
Countermovement jumps
Step jumps: progressing to high box jumps with hip in higher degrees of flexion
Broad jump, bounding
Jumping lunges
Running drills: B skip drill

Running

Suddenly changing running volume, speed or hill runs can increase the risk of developing hamstring tendinopathy.

Some tips on returning to running for those with hamstring tendinopathy:

Avoid hill running
Start with slower running initially as this involves less hip flexion

Running technique

There are a number of technique modifications that may help with hamstring tendinopathy. Read more about this in our blog here

Things to modify with hamstring tendinopathy

Sitting: whilst sitting won’t be damaging your tendon, it can often aggravate it. As such, when the tendon is particularly irritated, you need to limit your time sitting. Also try and avoid hard chairs: sit on more cushioned chairs where possible.
Stretching: stretching the hamstring can often irritate the tendon

For tips on managing hamstring tendinopathy, check out our video presentation below

Need further help?

Please don't hesitate to contact us for a thorough assessment of your hamstring & to formulate a plan to get you back to health & high performance!

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