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What Is Hamstring Tendinopathy?

We often feel aches and pains during and after exercise, especially when starting something new or upping the ante. But at what point do these aches and pains become something that a physiotherapist should assess and/or treat?

A common injury that we see here at NQ Physio Solutions is hamstring tendinopathy. Tendinopathy injuries often occur after a prolonged period of rest from exercise, a sudden increase in training intensity or tendons regularly used under high loads. Unlike muscle tears or other soft tissue injuries, the onset of pain and associated symptoms develop gradually or insidiously, often worse before and/or after exercise.  

What Is Hamstring Tendinopathy?

Tendons are an elastic tissue that provides structure and transmission of load between muscles and bone. Some well-known examples include the Patella tendon which connects your quadricep muscles to the tibia for movement of the knee; The Achilles tendon which attaches your calf muscles to the heel of your foot. Tendons transmit force from our muscle to the bone, one of the essential processes for movement.

The hamstrings muscle group consist of the semimembranosus whose muscle belly sits most medially, the semitendinosus which sits centrally and the biceps femoris with a long and short head that is most lateral in the posterior thigh. The tendons for these muscles originate from the pelvis on the ischial tuberosity and insert into the posterior aspect of the tibia via a long cord like tendon. 

What Causes Tendinopathy?

Tendinopathy injuries can result from overuse or overload of the tendon. The increased load to the tendon initiates an inflammatory response in the injured tissue. As most hamstring injuries occur during sprinting or other explosive movements, athletes involved in high speed running and jumping sports are more at risk of a tendinopathy injury.

A Tendinopathy can also occur during a stretch type injury such as high kicking or split movements where the knee is extended, and maximum load is at the hip joint. These Acute proximal tendon injuries or chronic hamstring tendinopathies occur most commonly in the semimembranosus.

Most commonly a tendinopathy occurs when individuals return to sport after prolonged rest or significant time off. Additionally, the condition can be caused by: 

  • Ageing, especially for middle-aged people
  • Auto-immune disorders (type 1 and 2 diabetes, Rheumatoid arthritis)
  • Obesity
  • A sudden change in training load or exercise (e.g., a sudden increase in running distance or intensity)
  • Weak glute muscles
  • Post-Menopausal Females

What Does Chronic Hamstring Tendinopathy Feel Like? 

  • Dull and deep aching pain
  • Muscle Weakness at the Hip and knee
  • Joint Stiffness through the hip
  • Swelling and inflammation

Hamstring tendinopathy is literally a pain in the butt! Most patients will feel the above symptoms deep in their buttocks and high in the back of their thigh, especially when sitting, driving, or walking for extended periods.

Pain is generally felt after activity or even in the days following. With a tendinopathy, most people feel pain and stiffness improve or subside after warming up and during activity, but soon after exercise is ceased it returns once cooled down.

Some individuals train with an asymptomatic tendinopathy in its early stages. However, as it gets worse, the pain increases, and it will generally force the individual to take a break from the activity.  

How to Heal Hamstring Tendinopathy?

When it comes to chronic hamstring tendinopathy, rest is essential. Almost as essential as a tailored management plan that will progressively load your hamstring and allow the tendon to heal and cope with future exercise loads. Hands-on treatment, stretching, and progressive strengthening of the hamstring are always part of a good rehabilitation program.

Depending on the extent of your tendinopathy, the rest you need, and the length of rehabilitation could range between weeks and months. If you want to resolve your tendinopathy completely, it is essential to follow a gradual tendon strengthening program and other exercises to improve your hip movement and core strength. 

Can You Run With Proximal Hamstring Tendinopathy?

It is possible to continue running with this injury, however, an altered training regime and intensity is recommended. Provocative exercises, running uphill or stair work will put increased load on the hamstrings and increase the risk of further injury.

Runners can successfully train with adjustments to the load and intensity of their schedule. For the best advice, it is essential to consult with a qualified physiotherapist who will advise on the management and treatment of your injury.

If you struggle with aches, pains or stiffness, and want to improve your movement, consult with a qualified physiotherapist. They will help to accurately diagnose what is causing your pain and develop an individualised rehabilitation program to improve your symptoms and quality of movement.

At NQ Physiotherapy Solutions, we complete detailed assessments for every individual we treat and develop tailored injury management plans to treat the symptoms and ensure long term results. Our expert physios will have you back at your best, providing you with the skills and knowledge to reduce your risk of recurring injury.

Contact our team today for more information on our services such as general physiotherapy, sports physiotherapyhydrotherapy, and dry needling.

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