Proximal Hamstring Tendinopathy Rehab-Part 1
How can you tell that I might be dealing with a proximal hamstring tendinopathy (PHT)? We listen to your story and then we listen some more! The most important part of our examination is listening to your symptom presentation as that’s not only going to point us in the right direction but will also help us to create your treatment plan. Here are a few things that we are LISTENING for:
Site specific pain around sit bones (ischial tuberosity)
Symptoms worsen with running, squatting, lunging, sitting, or any activity that requires increased hip flexion
Pain that tends to “warm-up” with activity—for example, pain improves after a few minutes of running
Stiffness that occurs in the morning or after prolonged rest
In essence, symptoms tend to be localized near the tendon insertion on the sit bones and don’t really spread out to other areas. If that were the case, we would start to suspect that something else might be going on and we’d investigate that further.
After we hear your story, we can perform further testing to help use determine if you’re dealing with a PHT. Here are a few things that we are LOOKING for:
Increased tenderness with palpation at sit bones (ischial tuberosity)
Pain that worsens with loading tests
The idea behind the loading tests is to reproduce pain by gradually exposing the proximal hamstring tendons to increased compressive and tensile loads. We start with a low load test and progress to a higher load test, if appropriate. If you’re dealing with a PHT, your symptoms will tend to worsen as we move from the low load test to the high load test.
Low load: Single leg bent knee bridge
Moderate load: Long lever bridge
High load: Single leg deadlift
We are not just LISTENING and LOOKING for ONE thing, we are combining what you tell us plus what we DO find and DON’T find to help guide our treatment! We aren’t chasing a diagnosis, BUT we do want to make sure that we are ruling out anything serious (example, a pelvic stress fracture) that would require referral for further testing. Of course, these are not the only things we test, but they are key in helping us differentiate between different conditions. We will also use these “load tests” to help us tailor your rehab plan and to monitor our progress. Stay tuned to the next blog as we dive into some of the details of creating your plan back to running! 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