Proximal Hamstring Tendinopathy (PHT) is a common condition in long-distance runners and athletes who perform sprinting or hurdles. It’s also common in athletes who participate in sports such as football and hockey that involve changing direction.
The condition is also known as hamstring origin tendinopathy or high hamstring tendinopathy. It can also affect people who don’t participate in sports.
What is Proximal Hamstring Tendinopathy?
It is a condition characterised by deep, localised pain around the sitting bones. The ischial tuberosity is an important bony protuberance that provides attachment to three different hamstring muscle tendons. The ischiogluteal bursa can also partially cause the symptoms.
The condition is characterised by deep, localised pain that usually gets worse during or after activities such as lunging, squatting, and sitting. It can include tendon degeneration, partial tearing, and peritendinous inflammatory reactions.
The condition is more likely to occur when the tendon is overused or overloaded. It can occur over many weeks or months or more rapidly with one highly intense activity. It can be aggravated by activities such as hill climbing, dancing, cycling, or long-distance running. Prolonged compression from driving or sitting can also cause it. If not treated properly, it can be a persistent and recurring problem.
What Causes Proximal Hamstring Tendinopathy?
Various factors contribute to the development of proximal hamstring tendinopathy. The exact reason is unknown, although research suggests that it is related to repetitive strain and overloading of the tendons, which can be caused by a sudden increase in running volume, intensity, and speed training. A sudden introduction of hill work due to increased hip flexion may sensitise the proximal hamstring tendons or the bursa.
These activities can subject the tendon to small micro-tears, which cause inflammatory chemicals and swelling. The mild trauma can quickly heal if appropriately managed with rest and reduction of the high-impact forces in what is called the reactive stage.
However, when the tendon is subjected to continuous repetitive forces, it causes increased micro-injury. The ongoing trauma in the tendon can exceed the rate of repair and lead to a disruption of the tendon fibres and an incomplete sub-optimal healing response. Over time, the damage can become worse, causing the tendon to become even more inflamed and thickened. This results in significant pain and dysfunction and, in severe cases, can result in larger tears or even tendon rupture.
What are the Symptoms of Proximal Hamstring Tendinopathy?
The main symptoms of Proximal Hamstring Tendinopathy is a dull, deep pain or aching in your buttock. The pain often extends down into the hamstring muscle.
The symptoms of the condition can present gradually without trauma over a few weeks or months of repetitive overloading.
In the first stages, you will experience the pain a short time after your exercise, and then it will settle down. But as time goes by, you may start to feel the pain during and after exercise. This can develop into constant pain even with regular daily activities. Sometimes, the symptoms can also come on more quickly if you have suddenly increased your training level quickly.
Other symptoms of hamstring tendonitis include:
- Dull ache in your buttocks, the back of your thigh, lower leg or knee
- Leg stiffness when walking or bending your knee
- Pain is made worse by stretching or exercising the hamstring
- Weakness in the hamstring muscles at the back of your thigh
- Pain with running, squatting or lunging
- Pain when sitting, especially on a hard surface.
What are the Treatment Options for Proximal Hamstring Tendinopathy?
Most people with hamstring tendinopathy respond to conservative management strategies. These include progressive loading exercise programmes designed and managed by a physiotherapist and other treatment modalities such as manual soft tissue techniques, shockwave and functional or sports-specific rehabilitation.
It’s essential to be aware that tendon complaints can be slow to improve and often take months to resolve, especially if you’ve had the problem for some time and the process requires patience and persistence.
Some of the standard methods of treating hamstring tendinopathy include:
Shockwave Therapy
This is an evidence-based treatment modality used in sports medicine to treat tendon pain. The treatment is designed to deliver a series of powerful sound waves that cause controlled trauma to the affected tendon. This initiates the body’s natural healing process. The treatment also desensitises the local nerve endings around the tendon, reducing pain and discomfort.
Ultrasound Guided Injections
This is another effective treatment used in musculoskeletal medicine to reduce pain and inflammation. It allows you to progress with physiotherapy treatment more effectively and rehabilitate your condition.
Steroid Injections
An ultrasound-guided injection would be appropriate for you. Steroids are strong anti-inflammatories used for many tendon complaints and help relieve inflammation and pain. We combine a small amount of local anaesthetic with the steroid to reduce the pain associated with the procedure. With the injection, you can get rapid relief within 3 to 4 days following the injection. You should also start your rehabilitation as soon as your pain has reduced.
Platelet Rich Plasma (PRP) Injections
Another type of guided injection available is PRP injection. These are combined with a local anaesthetic and steroid to reduce the pain associated with the procedure. It also provides rapid pain relief within 4 days following the injection.
Guided injections have a massive upside because they deliver treatment directly to the site for better effects without causing unnecessary pain and discomfort.
If you suspect you have Proximal Hamstring Tendinopathy, you can schedule a scan at The Scan Clinic to investigate and diagnose the condition. Our experienced clinicians can provide expert advice depending on the scan’s outcome. If a guided injection is necessary, we have a team that can care for you and get you back on your feet.
