Proximal Hamstring Tendinopathy
What is a proximal hamstring tendinopathy?
Proximal Hamstring Tendinopathy is a common condition encountered by mid to long-distance runners, as well as sprinters. Symptoms usually present during sports, with a gradual onset of pain around your sitting bones. The anatomical name for the “sitting bone” is ischial tuberosity, which is an important bony protuberance that provides attachment to three different hamstring muscle tendons. Between these and the ischial tuberosity, lies the ischiogluteal bursa, which can also be partially responsible for the symptoms.
What are the possible causes?
A sudden increase in running volume, intensity, and speed of training may be the cause of symptoms. Particularly, the sudden introduction of hill works, due to the increased amount of hip flexion, may sensitise the proximal hamstring tendons or the bursa. An easy way to prevent this is to allow enough time for tendons to adapt to new training stimuli. Cross-training and consistent planning of recovery weeks are considered best practice.
Pain is usually located just at the bottom of one of your ischial tuberosities. The onset is gradual: whilst it may improve with warm up, it may bother you again at the end of the running session. In more irritable presentations, symptoms may be present at rest and affect your daily activities, like walking and sitting at your desk.
Conservative treatment is warranted for a Proximal Hamstring Tendinopathy. As for any tendinopathy, a progressive loading program is critical to re-establish strong and pain-free proximal hamstring tendons. In the case of a recalcitrant condition that fails to resolve with a stages loading program, an ultrasound-guided injection to the ischiogluteal bursa should be performed. Shockwave therapy is another viable option. Surgery is rarely performed.
Proximal Hamstring Tendinopathy Exercises
At the initial stages, long-held hamstrings and glutes isometric contractions should be preferred, in order to provide an analgesic effect whilst loading the tendons. Contractions should be held for around 30-40 seconds, whilst intensity of the exercise should be increased as pain allows. Minimal pain should not be feared during the exercises, provided it settles quickly after the session. Examples of these are:
- Isometric double leg bridge
- Isometric double leg bridge with elevated feet
- Isometric double leg bridge on a Swiss ball
- Isometric single leg bridge
Consequently, heavier exercises involving hip flexion should be commenced. These can include:
- Good morning exercise with weights
- Double leg Romanian Deadlift
- Single leg squats
Lastly, plyometrics and power activities should be performed. These may involve hopping, landing, high knee drive and heel flicks.
Can I run with proximal hamstring tendinopathy?
The answer is: yes, but it can depend on the circumstances. In irritable cases, with symptoms at rest or during simple walking, it is smarter to cease running for a couple of weeks to allow symptoms to settle. In less irritable presentations, with pain that comes along 30 minutes into your run, it is ok to run for 20 minutes at a slow speed and on a flat surface. In fact, hills may be aggravating your pain by further sensitising the bursa and the tendons.