Seeing as I’m currently injured myself and I am missing training & games, this blog post will focus on the injury in question-

Hamstring Origin Tendinopothy

Like most tendonopathies a Hamstring Origin Tendinopothy can be a troublesome injury with a prolonged recovery time.

 

hamstring origin tendinopothy

Part one will focus on causes, symptoms and diagnosis of a hamstring origin tendinopothy and part two will focus on treatment and rehabilitation.

 Causes of a Hamstring Origin Tendinopothy:

Hamstring Origin Tendinopothy will usually happen gradually as a result of overuse. It is common in middle and long distance runners and it’s also common in field based sports like GAA, soccer and rugby. Several factors can contribute to the hamstring tendon being overloaded.

  1. Compression:

The tendon is on load in any position where the hamstring is on tension.

  • Anterior pelvic tilt
  • Standing in forward leaning/running in forward leaning
  • Uphill running

In these positions you’ve to use your hip extensors a lot more to push which can overload the hamstring tendon.

  1. Muscle Imbalances:

The hamstrings can be overloaded if there is an imbalance between your hamstrings and glute max. The lower fibres of glute max extend the hip, if they aren’t doing their, job the hamstrings have to do more work.

  1. Poor pelvic stability:

If you have for example weak or inactive glute medius then you don’t use your glutes to control your pelvis. Your hamstring and thigh muscles are then needed to do this job as well as their primary functions like extend the hip. This again can lead to overload of the hamstrings.

  1. Poor rehabilitation from a previous injury:

If you have poor ankle mobility of knee function this can alter your squatting pattern. (We squat regularly throughout the day)  For example if you don’t use your knee and only use your hip, this can lead to excessive load. Likewise a stiff lumbar spine can lead to overload at the hip.

Symptoms of a Hamstring Origin Tendinopothy:

People can have several or only some of these symptoms. If required confirmation can be achieved by MRI scan although as with most injuries, clinical findings are far more important.

  • Lower buttock pain often described as a ‘global ache’.
  • Pain on sitting, especially on hard surfaces.
  • Pain referring down the posterior thigh. (Can often be misdiagnosed as a lumbar spine issue.)
  • There can be paraesthesia and pain into the foot in some cases as the sciatic nerve can be involved due to its proximity to the attachment at the ischia tuberosity.

Testing:

  • Passive bent knee stretch- puts tendon on compressive load.
  • Static muscle test in bent knee position. (Leg on shoulder and push heel down).
  • Palpation around the tendon is often tender. (Better done in side-lying).
  • Supine Plank (See pic above) Lye on your back with your bum up resting on your elbows and heels. Try to lift one leg up. This can also be done resting on your hands.

 

  • Muscle Patterning; Supine Bridge and Prone Hip Extension. Palpate to access timing of glute activation. If it’s slow or not happening at all, then you’re using your hamstrings as a primary hip extender.
  • Functional Tests: Squat, Lunge, Step-up, Single leg squat. If pelvic control is poor – pelvis dropping, knee falling in-then you’re using your thigh muscles to try to control your pelvis.

 

 References

  • Sherry, M., Examination and Treatment of Hamstring Related Injuries. Sports Health: A Multidisciplinary Approach 2011.
  • Fredericson, M.; Moore, W.; Guillet, M.; Beaulieu, C., High hamstring tendinopathy in runners: Meeting the challenges of diagnosis, treatment, and rehabilitation. Physician and Sports medicine 2005.
  • Dr Alison Grimaldi. Hamstring Tendinopathy. Physioedge Podcast with David Pope
  • Brukner, P & Khan K Clinical Sports Medicine Revised third edition 2009.