Understanding Proximal Hamstring Tendinopathy

Proximal Hamstring Tendinopathy is a condition that impacts both athletes and non-athletes, causing persistent buttock pain. It is prevalent in sports like track and field, long-distance running, and field-based activities. The primary complaint is often lower gluteal or sit bone pain, with or without radiation along the hamstrings in the back of the thigh.

Causes

The condition is typically caused by overuse, often linked to recent changes in running activity such as increased volume, frequency, intensity, or variations in terrain. Activities like walking or running up hills, and prolonged sitting in a chair or car can provoke pain. In the early stages, the pain may warm up with activity but commonly worsens afterward.

Management Strategies

Modifying Load

Effective management involves modifying the load on the hamstring. This can include reducing running volume by half and focusing on slower runs. Opting for flat ground running can also alleviate strain on the tendons. Other strategies used include:

  • Avoid sitting for too long, less than 20 minutes ideal

  • Use a high chair or stool if possible 

  • Place a pillow on a chair if possible 

Avoid Compressive Loading Early

Early management aims to exclude compressive loading exercises like squats, deadlifts, and lunges. These exercises can aggravate the already irritated tendon

Instead, focus on exercises that strengthen the hamstring tendon without putting it in aggravating positions. Examples include:

  1. Bridges 

  2. Hamstring sliders 

  3. Bosch Holds

Gradual Progression

As symptoms begin to settle, start to introduce exercises that were previously provocative such as;

  1. Squats through a limited range

  2. Deadlifts through a limited range

Then really start to target these previously provocative positions when symptoms allow. This increases the resilience of the tendon. Late stage exercise examples include:

  1. Heavy Romanian deadlifts

  2. Glute-dominant nordic exercises

  3. Hip extension on a GHD machine.

Incorporating Plyometrics

Plyometric exercises play a vital role in the later stages of management. They facilitate dynamic strength and coordination, contributing to the overall recovery process.

Seeking Professional Guidance

For a comprehensive approach to overcoming proximal hamstring tendinopathy and enhancing performance, seek expert running physiotherapy. Specialized care is available in Sydney's Eastern Suburbs and London Battersea, providing tailored strategies for lasting relief and improved athletic performance.