Are you an older athlete with buttock pain? Do lunges or hill running stir things up? Are you unable to work or drive without sitting pain? You may have proximal hamstring tendinopathy – and if you’ve been stretching your hamstrings to alleviate the pain – stop now!
What is Proximal Hamstring Tendinopathy?
Proximal hamstring tendinopathy (PHT) is a condition of painful tendon changes in the hamstring tendons where they attach to the pelvis. Patients with this condition often present with well localised lower buttock pain that warms up with activity but which may return afterwards, often lasting for several days. Importantly, in athletes, pain levels clearly correspond to changes in the volume and intensity of training. Compression of the hamstring where it attaches seems to be the key: stirred up by changes in training or by stretching the hamstrings, and then further aggravated with sustained sitting (on the tendon). Although often quick to aggravate, tendon pain can take quite a while to settle and will require strengthening and modified training. But the good news is that tendons are strong and adaptable and rehabilitation is supported by good quality evidence.
Why have I developed this problem?
As with so many musculoskeletal pathologies, PHT is largely determined by “what you have” (intrinsic factors) and “what you do with it” (extrinsic factors)
“Intrinsic” risk factors are the things we’re often stuck with! And the more risk factors we have the greater the impact. These include increasing age, our genetics and family history, as well as the impact of hormonal changes at menopause, some auto immune conditions and diabetes.
“Extrinsic” risk factors, including training errors, are more modifiable. Usually, pain follows a provocative change in training: for example, an increase in hill running or speed work, extra training sessions (and reduced recovery) or an increase in overall distance. In the older population, pain could follow unaccustomed power walking. What really matters is if these changes occur suddenly and/or how quickly you add high forces such as hill sprints. A change in the gym can also have big consequences: significant compressive loads on the tendon can occur with the sudden addition of deep and heavy squats or dead-lifts, or with strong hamstring stretching. Once the tendon is painful, a driving holiday or time spent on a hard chair can really stir things up.
How do I manage the pain?
Researchers in the field agree on several key points:
Assessment of the intrinsic and extrinsic contributions to the development of PHT, and the careful rehabilitation of this condition takes care and attention to detail. No wonder that many self guided attempts fall short of the mark. An assessment by an APA Sports Physiotherapist or Sports and Exercise Physician may be the best way to get the ball rolling.
Learn more about Andrew Stephens by visiting http://www.opsmc.com.au/person/andrew-stephens/