Once we’ve determined that you’re dealing with a proximal hamstring tendinopathy (PHT), it’s time to get to work! For purposes of this blog, we will assume that our client has been dealing with a chronic hamstring tendinopathy ongoing 8+ weeks, and has to take a brief pause from running. Here is a glimpse of the steps in our rehab journey:

Step 1: Relieve

The goal of this step is to minimize or temporarily stop activities that aggravate symptoms. Not only are we referring to running, but we also want to take a look at your daily life and note what other activities could be aggravating our symptoms. The chart below has some common examples and recommended suggestions. Remember, these are only TEMPORARY changes. Once we’ve made the necessary adjustments to your daily activities, it’s time to lay the foundation for a gradual loading program.

Step 2: Reinforce

The goal of this phase is to reinforce your capacity to perform through a gradual loading program. Before diving into the specifics we need to have a common understanding of three things:

1. Your baseline symptoms on a scale of 0-10 (0=no pain, 10=worst pain imaginable)

2. Monitoring progress (pain) using a daily load test:

   Perform a short lever bridge (refer to picture below) hold of 30 seconds every morning at the same time on both the affected and unaffected side. Monitor pain levels on a scale of 0-10.

3. Some pain is okay!

   It’s okay to have some pain (0-3/10) during and after exercise as long as symptoms return to baseline in 24 hours.

Now we are ready to dive into some of the details of an exercise program! The irritability level of each person will determine which exercises they begin with. However, it’s always wise to be conservative, assess a person’s response, and progress accordingly. Below are the four stages we want to progress through with example exercises in each stage:

Isometric hold: Short lever bridge

Isotonic with minimal hip flexion: Supine leg curl

Isometric with increased hip flexion: Deadlift

Energy storage & loading: A-skips

Here are some key things to remember:

• A good sign of isometric exercises is an immediate reduction in pain following exercise

• Use daily load test to monitor progress and determine readiness to progress

• Once you can perform exercises at each stage with minimal pain (0-3/10) it’s time to re-test with higher loading tests (RDL—refer to prior blog) and assess readiness to progress exercises

In the next blog, we will be discussing how to incorporate a walking/running program into your rehab plan! If this sounds like something that you might be dealing with and you’d like to learn more about how to rehab a proximal hamstring tendinopathy and come back a stronger, more resilient runner 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