Proximal Hamstring Tendinopathy
Do It Yourself Proximal Hamstring Tendinopathy Assessment and Treatment
A Proximal Hamstring Tendinopathy (PHT) can be difficult to diagnose because of other conditions it can mimic in this region, such as a sacroiliac joint dysfunction, piriformis, sciatica, avulsion, hamstring tear and disc bulge or herniation.
A PHT is different from a classic tendinitis that has inflammation associated with it and lasts greater than 3 months. Another characteristic of PHT is it is found in both long distance runners and especially those who sit for extensive periods of time. Since sitting is a common trigger for both patients with sciatica and piriformis, it can often be confused with these conditions. Most patients describe pain in the region of the buttock on one side around the base of the glute, where the posterior of the thigh begins, that is described as deep in nature.
Anatomically, the region of concern is located at the attachment of the hamstring tendon complex on the bony region called the ischial tuberosity of the pelvis. Above this complex is the gluteal musculature making up the gluteus maximus, gluteus medius, gluteus minimus and piriformis, to name some of the major muscle groups in the area. The “pain generators” are thought to be the attachment point of the tendon complex at that ischial tuberosity.
What are the risk factors?
Several factors can lead to this condition, but most times it is related to overuse due to activity and inadequate recovery or extensive sitting. A brief list of risk factors include:
• Gluteal muscle weakness
• Core weakness
• Poor hip flexibility
• Biomechanical issues
• Poor warming up
• Sudden training load changes
• Previous injury or lower extremity injuries that still present
How to determine if you have a PHT?
This is a quick checklist to look at before you do the exercises we recommend, separated into “dos” and “don'ts”:
DON’T do exercises if any of these apply:
• If you have progressive weakness in the one or both of the lower extremities.
• If you are experiencing abnormal bowel and bladder signs. (If you have difficulty having a bowel movement or inability to hold back your urine since developing this problem.)
• Extreme night pain that does not vary with position or activity.
• Experience severe pain upon sneezing, coughing or laughing.
• Notice progressive severe balance problems of recent onset.
• Don’t report a recent fall or trauma since starting to have problems.
If you “Do” have any of these experiences:
• Do have a history of extensive sitting.
• Do have a history of running or jogging that appears to get worse when doing.
• Do have a past history of injuries on the same side as your problem.
• Do have a past history of hamstring injuries.
• Do report a recent increase in training volume.
• Do have a chronic “stiffness” and “soreness” in the lower extremity and hip girdle.
If you have noted any of the “DON’TS” listed above, you CANNOT try the following exercises.
A few guiding principles for doing these exercises: You should do at least 23 sessions of these exercises for 3 sets, 1015 repetitions. It is normal to have a slight increase in mild pain after and during these exercises that shouldn’t last greater than 24 to 48 hours. Everyone should wait until this discomfort resolves prior to doing another session. This will vary according to the level of fitness. For some, these exercises will be too easy or too difficult. We will discuss the necessary modifications in the video below.
The three most common exercises I give patients with this condition are as follows:
• Forward Lean or Forward Reach
• Pelvic Bridges (either unilateral or bilateral)
• Hamstring Curl using exercise ball
You should expect improvements in 23 weeks, but this can be a difficult condition to selftreat or even by some professionals. Good Luck!