I love working with tendons because as long as you give them some TLC (time, load, & care), often times you can continue training while rehabbing! Tendons attach muscles to bone, so you’ve thousands of them! Let’s think of a tendon as a spring. When a muscle contracts the “spring” (tendon) stores the energy, and when it releases, BAM that’s when we get movement. Tendons that repeatedly store and release energy are susceptible to developing tendinopathy (pathology and pain in a tendon).

The most common tendons to get irritated in runners are:

• Hamstring (on your sit bones)

• Achilles (above your heel)

• Gluteal (on the outside of your hip)

• Patella (below your kneecap)

Now, tendons are built to tolerate high tensile loads meaning being pulled from opposite sides. But they also experience compressive forces where they pass over boney ends. Again, tendons should be able to tolerate this, but we get into trouble when we ask tendons to deal with these two forces over and over again and they aren’t ready to handle the stress.

And what do we ask a runner to do, to deal with the same repetitive motion over and over again! In this blog, we will be talking about proximal hamstring tendinopathy, this is literally a pain in the butt! The hamstrings play a big role in running especially at faster speeds. When I first see a runner that’s been dealing with this, they tend to say yeah you know I really feel like my hamstrings are “tight” and so I stretch them daily. Okay, great does this help to relieve your symptoms? Actually, not really. Okay, so let’s talk about why it might actually be aggravating the problem.

In the case of your hamstrings, the tendon attaches to your sit bones. Now, I want you to imagine your anatomy, and think of the typical hamstring stretch. As you bend forward, what’s happening to the tendon? It’s being further compressed against the bone! This is known as a position of compression. If you’re dealing with a tendon issue, the first step in the rehab process is to identify all the positions of compression and temporarily avoid them.

Think about all the other activities that you do during the day that would further compress the tendon. Sticking with the hamstring tendon example, this would include any position that requires increased hip flexion, such as, sitting, sleeping curled up, crossing your legs. And in the case of hamstring tendinopathy, people experience the majority of their symptoms when in these static positions, not necessarily when they’re running. In the first phase of rehab, we need to temporarily offload the tendon to promote healing, and gradually re-introduce your tolerance for all these activities!

Doesn’t it make sense, that if we temporarily change what we do on a regular basis throughout the day, we will see progress much more quickly? Remember, exercise is probably only 5% of our day, so we have to look at what can we be doing with the other 95% of our time to improve our symptoms and get back to running injury-free? In the coming blogs, we will be diving more into the rehab for proximal hamstring tendoninopathy.

If this sounds like something that you might be dealing with and you’d like to learn more about dealing with this “pain in the butt” schedule a complimentary call today!

REFERENCES

Cook JL, Purdam CR. The challenge of managing tendinopathy in competing athletes. Br J Sports Med. 2014 Apr;48(7):506-9. doi: 10.1136/bjsports-2012-092078. Epub 2013 May 10. Erratum in: Br J Sports Med. 2014 Sep;48(17):1333. PMID: 23666020.

Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management. Thomas S.H. Goom, Peter Malliaras, Michael P. Reiman, and Craig R. Purdam. Journal of Orthopaedic & Sports Physical Therapy 2016 46:6, 483-493