Overview
This video provides a comprehensive guide to understanding and managing proximal hamstring tendinopathy, focusing on causes, symptom management, and an evidence-based rehabilitation framework, including load modification and progressive exercises.
Causes and Contributing Factors
- Proximal hamstring tendinopathy involves persistent pain around the sit bone, often worsened by running, squatting, or sitting.
- Overloading the tendon with activities like uphill running, sprinting, deep stretching, or sudden increases in intensity may trigger symptoms.
- Systemic and lifestyle factors such as sleep, stress, and overall activity impact tendon recovery and load tolerance.
Clinical Signs and Diagnosis
- Pain is typically localized to the lower gluteal region and worsens during or after activities involving hip flexion or tendon loading.
- Imaging is generally unnecessary since similar tendon pathology can appear in asymptomatic individuals.
Current Treatment Recommendations
- Surgery and injection therapies show limited utility and are not routinely recommended.
- Physiotherapy is as effective as surgery for pain and function.
- The mainstay of management is load modification and progressive exercise.
Load Management and Activity Modification
- Temporarily modify or minimize painful activities (e.g., use cushions when sitting, reduce running intensity or frequency, avoid uphill sprints).
- Adjust running technique (increase cadence, maintain upright posture) to reduce hamstring load.
- Substitute intolerable activities (e.g., running) with low-impact alternatives like cycling or swimming.
- Stretching is not necessary for recovery and may worsen symptoms in some cases.
Rehabilitation Exercise Framework
- Monitoring pain is crucial: keep pain tolerable (set an individual 0–10 pain threshold), track immediate and next-day response after exercise.
- Use a self-assessment test (e.g., single leg foot elevated bridge) to gauge symptom response and guide exercise progression.
Stage 1: Isometric Exercises (Optional)
- Start with isometrics if symptoms are severe (e.g., bridges, hamstring curls) for 3–5 sets of 30–45s holds, up to three times daily.
Stage 2: Heavy Slow Resistance
- Gradually load the hamstrings with full range movements (bridges, hip thrusts, deadlifts, hamstring curls).
- Progress exercise difficulty and add weight as tolerated.
- Include exercises for lateral hip and calf muscles.
Stage 3: Energy Storage and Release (Plyometrics)
- Introduce jumping and plyometric drills when able to tolerate advanced resistance exercises with minimal pain.
- Gradually build up to sport-specific or higher-demand activities.
Return to Activity and Case Examples
- Return to running or sport is gradual, with slow increases in intensity and volume based on symptom tolerance.
- Modify activities or substitute with alternatives during painful phases; progressively reintroduce higher loads as symptoms improve.
- Routine daily function improvement is a goal for non-athletes, with general activity increases over time.
Recommendations / Advice
- Be patient; recovery often takes 3–6 months or longer.
- Set realistic expectations and avoid rushing the process.
- Consistently monitor symptoms, adjust activities, and progress exercises according to tolerance.
Questions / Follow-Ups
- Consider tracking which specific activities provoke symptoms for more precise modification.
- Seek professional guidance if progress stalls or symptoms worsen significantly.