Proximal Hamstring Tendinopathy
Proximal hamstring tendinopathy is a condition that causes deep buttock pain. It is usually worsened by activities such as running, hurdling, sitting or sprinting. It results from overuse or excessive strain on the hamstring tendons, where they attach to the ischial tuberosity (sit bone).
Signs and Symptoms
- Deep, middle, or lower buttock pain that tends to aggravate during or after certain activities.
- Pain that is well-localised to the centre of the buttock.
- Symptoms that intensify with movements like bending forward, running, sitting or lunging.
- Discomfort that may be felt after rest but can improve with gentle motion or “warming up.”
Causes
As with other tendon-related conditions, proximal hamstring tendinopathy develops when the load placed on the tendon exceeds its ability to adapt and repair. Results of affected tendons show signs of unsuccessful regeneration. This indicates that the tissue struggles to handle continued stress. This can result in discomfort and weakness, particularly during activities that further strain the tendon. However, tendon “damage” is rarely evident, and medical imaging findings are not often linked to pain or functional limitations.
Risk Factors
A number of factors may increase the odds of having proximal hamstring tendinopathy. These can be classified as either external (extrinsic) or internal (intrinsic). However, having these risk factors does not guarantee symptoms will occur. They involve:
- Training errors: Abrupt alterations in training routines, such as suddenly increasing walking and running distances or lifting excessive weight when working out.
- Age: Tendon pain becomes more common with age due to natural tissue changes.
- Ergonomics: Prolonged sitting without sufficient breaks or using poorly designed seats.
- Bodyweight: Both excess weight and inactivity can increase strain on the tendons.
- Medical conditions. Conditions like high cholesterol, diabetes, or smoking are likely to make tendons more susceptible to strain.
Diagnosis
A musculoskeletal physiotherapist or a qualified physician can diagnose proximal hamstring tendinopathy by taking an in-depth history of symptoms. As part of the assessment, physical tests may be conducted to rule out other possible causes. These tests also help evaluate your functional abilities to ensure an accurate diagnosis.
Your clinician will also assess how the condition is impacting your daily life. This helps them develop a personalised treatment plan based on your specific goals. Progress will be monitored through regular reassessments, allowing for changes to your treatment as needed. While imaging studies such as MRI scans are generally unnecessary for diagnosis, they may be recommended in uncommon cases.
Treatment and Management
Many strategies can effectively help alleviate symptoms, with training adjustment being the most crucial first step. This may involve:
- Reducing the frequency, distance, or speed of running.
- Refraining from activities that require repeated forward bending.
- Minimising prolonged sitting or using cushions to reduce tendon compression and discomfort.
When pain becomes more manageable, targeted workouts can help strengthen the hamstrings and gluteal muscles. This can further reduce pain, improve function, and gradually restore participation in preferred activities.
Rehabilitation
Strengthening workouts tailored to the condition have higher success rates in treating tendon pain. However, recovery can be a gradual process, as tendons regenerate more slowly than other tissues. As a result, exercises might have to be adjusted or progressed with time.
Other treatment options:
While rehabilitation alone can greatly improve symptoms, persistent or severe cases may require additional or more invasive treatments, including:
- Non-steroidal anti-inflammatory drugs (NSAIDs). When prescribed by a qualified clinician, NSAIDs may help alleviate irritation and discomfort.
- Corticosteroid injections. These may be considered for cases that do not respond to conservative treatments. Nevertheless, research suggests they can have a negative impact on tendons in some instances, so their use should be carefully evaluated.
Conclusion
Managing proximal hamstring tendinopathy requires a combination of load management, targeted exercises, and, in some cases, additional treatments. With the right approach, symptoms can be effectively reduced, allowing you to regain mobility and return to the activities you enjoy.
Book an appointment today with our qualified physiotherapists to receive a personalised treatment plan and start your journey toward a pain-free lifestyle.