What is the condition?
This is a condition where the tendon of the upper hamstring muscle (at back of thigh) which attaches to the sitting bone (ischial tuberosity) becomes irritated. This is particularly common amongst middle and long distance runners.
Symptoms typically include pain deep in the lower buttock/ upper hamstring which can be aggravated by sitting on hard surfaces, stretching the hamstring and by accelerating or running uphill. The symptoms can feel very similar to sciatic pain because the sciatic nerve lies very close to the upper hamstring tendon.
How do I get the condition?
Generally this is an overuse type injury ie too much too soon with regards to physical activity. Typically this can be exacerbated by pre existing muscle imbalances such as weak gluteal, core or hamstring muscles.
The overall weekly load of somebody suffering from this injury should be studied closely to ensure that they are not increasing their overall weekly load by more than 10% from week to week. The risk of injury once we go over 10% weekly load increases rises exponentially. This 10% rule can refer to distance run, weight lifted, minutes played and so on.
How long will it take to Fix?
Upper Hamstring tendinopathies or Proximal hamstring tendinopathies as they are sometimes called are notoriously difficult to settle and generally take at least 3-4 months to resolve. Furthermore, there are rare occasions whereby upper hamstring tendinopathies do not resolve completely with physio alone. If this is the case, we recommend either an ultrasound scan (USS) or MRI scan of the upper hamstring. Findings on a scan can include:
– Fluid within the tendon
– Fluid at tendon/ bone junction
– Very rarely in chronic cases, increased numbers of nerves and blood vessels can develop in
the tendon (neurovascularisation)
– Chronic tear of hamstring tendon
– Scarring around sciatic nerve
Depending on the severity of the scan findings, a course of several Protein Rich Plasma (PRP) injections can be administered by a sports physician over a period of time. The purpose of these injections is to reduce pain and therefore allow the patient to perform their prescribed rehab exercises.
What do I do to Fix it?
Manual therapy- see your physio for soft tissue work (massage) of the surrounding areas which may be in spasm and as a result increase load through upper hamstrings. Even though the hamstring itself is the area of pain, areas higher up or lower down the kinetic chain such as the thoracic spine or calf muscles respectively may well be aggravating your upper hamstring symptoms
Exercise – A customised home exercise program focussing on strengthening gluteal muscles, core stabilisers and hamstrings themselves. It is crucial that you don’t stretch the hamstring muscle with an upper hamstring tendinopathy even though this is exactly what it feels like it needs as this can aggravate this injury.
i. Hamstring curl
ii. Bridge (2 up, 2 down/ 2 up, 1 down/ 1 up, 1 down)
iii. Plank with alternate leg lift
iv. Deadlift- 2 leg/ 1 leg
Assess running technique- Amongst other factors, a long stride length can aggravate an already irritated upper hamstring tendinopathy. If you live in Sydney, come in to Fix Physio to having your running technique assessed.
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