Proximal Hamstring Tendinopathy (Mastering Tendon Rehab)

A proximal hamstring tendinopathy is a pathology of the high hamstring tendon where it attaches to the ischial tuberosity (sit bone of the buttock). Typically, we see this condition in runners who have suddenly increased their training volume/intensity, or started hill running.

Proximal Hamstring Tendinopathy Rehab Proximal hamstring tendinopathy (PHT) is common among distance runners and athletes performing either primarily sagittal plane (eg, sprinting, hurdling) or change-of-direction activities (eg, various football codes and hockey). PHT is characterized by buttock pain (i.e. deep, localized pain in the region of the ischial tuberosity - hamstring common origin) localized to the hamstring attachment at the origin, with an area similiar to 2 finger tips. PHT concomittantly can have 1) pain over ischium +/- posterior thigh pain or tightness, +/- spinal nerve symptoms (assoc ischial tunnel entrapment?) and it is often aggravated by activities with compressive load on the hamstring tendon, when the hamstring is working with the hip flexed, including periods of sitting and driving, deep lunges, hamstring stretches and running at higher speeds and uphill. Patients will have a history of increased load such as more hill running, deeper lunges, deadlifts or stretches in yoga. It doesnt necessarily need to be "energy storage" (e.g. running, jumping, hopping pivoting etc) loads leading to tendinopathy. Pain and dysfunction are often long-standing and limit sporting and daily functions. Evidenced based guidelines highly recommend load management and progression (i.e. exercise) as best practise for this condition.

 

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