Hamstring Origin Tendonitis
(Also known as Hamstring Tendonitis, Hamstring Tendinopathy, Hamstring Tendinitis, Hamstring Origin Tendonitis)
N.B. Although research suggests that ‘hamstring tendinopathy’ is the more appropriate term to describe overuse injuries to the hamstring tendon, we will use the term ‘hamstring tendonitis’ in this document as it is more widely known.
What is hamstring origin tendonitis?
Hamstring origin tendonitis is a condition characterized by tissue damage and inflammation of the hamstring tendon (at its attachment to the pelvis) causing pain in the buttock.
The hamstring muscles originate from the pelvis and insert into the top of the lower leg bones. The hamstring muscles attach to the pelvis via the hamstring tendon (figure 1).
Figure 1 – Anatomy of Hamstring Origin Tendonitis
The hamstring muscles are responsible for bending the knee and straightening the hip during activity and are particularly active during running, jumping and kicking. During contraction of the hamstrings, tension is placed through the hamstring tendon. When this tension is excessive due to too much repetition or high force, damage to the hamstring tendon occurs. Hamstring origin tendonitis is a condition whereby there is damage to the hamstring tendon with subsequent degeneration and inflammation.
Causes of hamstring origin tendonitis
Hamstring origin tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the hamstring tendon. This typically occurs due to repetitive running, jumping or kicking activities. Occasionally, hamstring origin tendonitis may occur suddenly due to a high force going through the hamstring tendon beyond what it can withstand. This most commonly occurs during rapid acceleration whilst running or when a footballer performs a long kick.
Signs and symptoms of hamstring origin tendonitis
Patients with hamstring origin tendonitis typically experience pain in the lower buttock. In less severe cases of hamstring origin tendonitis, patients may only experience an ache or stiffness in the buttock that increases with rest following activities requiring strong or repetitive contraction of the hamstring muscle. These activities typically include running, jumping or kicking. The pain associated with hamstring origin tendonitis may also warm up with activity in the initial stages of hamstring origin tendonitis.
As the condition progresses, patients with hamstring origin tendonitis may experience symptoms that increase during activity and affect performance. Patients with hamstring origin tendonitis typically experience pain on firmly touching the hamstring tendon (figure 1). Occasionally, a feeling of lower limb weakness may also be present particularly when attempting to accelerate whilst running.
Diagnosis of hamstring origin tendonitis
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose hamstring origin tendonitis. Occasionally, further investigations such as an Ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity of the hamstring origin tendonitis.
Prognosis of hamstring origin tendonitis
Most patients with hamstring origin tendonitis heal well with appropriate physiotherapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had hamstring origin tendonitis for a long period of time. Early physiotherapy treatment is vital to hasten recovery in all patients with hamstring origin tendonitis.
Treatment for hamstring origin tendonitis
The success rate of treatment for hamstring origin tendonitis is largely dictated by patient compliance. One of the key components of treatment is that the patient rests from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage to the hamstring tendon. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a ‘no pain, no gain’ attitude is likely to lead to the hamstring origin tendonitis becoming chronic. Immediate, appropriate treatment in patients with hamstring origin tendonitis is essential to ensure a speedy recovery. Once the hamstring origin tendonitis is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
Patients with hamstring origin tendonitis should follow the R.I.C.E. Regime in the initial phase of injury. The R.I.C.E regime is beneficial in the first 72 hours following the onset of hamstring origin tendonitis or when inflammatory signs are present (i.e. morning pain or pain with rest). The R.I.C.E. regime involves resting from aggravating activities, regular icing, the use of a compression bandage (where possible) and keeping the affected leg elevated. Anti-inflammatory medication may also significantly hasten the healing process in patients with hamstring origin tendonitis by reducing the pain and swelling associated with inflammation.
Patients with hamstring origin tendonitis should undergo a graduated flexibility and strengthening program of the hamstrings to ensure an optimal outcome. The treating physiotherapist can advise which exercises are most appropriate for the patient and when they should be commenced.
In the final stages of rehabilitation for hamstring origin tendonitis, a graduated return to running program is required to recondition the muscle for running in a safe and effective manner. This should include the implementation of progressive acceleration and deceleration running drills and should be guided by the treating physiotherapist.
Contributing factors to the development of hamstring origin tendonitis
There are several factors which can predispose patients to developing hamstring origin tendonitis. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:
- joint stiffness (particularly the hip)
- muscle tightness (particularly the hamstrings and quadriceps)
- inappropriate or excessive training
- inadequate warm up
- muscle weakness (especially the hamstrings and gluteals)
- poor pelvic or core stability
- inadequate rehabilitation following a previous hamstring injury
Physiotherapy for hamstring origin tendonitis
Physiotherapy treatment for hamstring origin tendonitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
- soft tissue massage
- electrotherapy (e.g. ultrasound)
- joint mobilization
- ice or heat treatment
- exercises to improve strength, flexibility and core stability
- clinical Pilates
- anti-inflammatory advice
- activity modification advice
- a gradual return to activity program
Other intervention for hamstring origin tendonitis
Despite appropriate physiotherapy management, some patients with hamstring origin tendonitis do not improve adequately. When this occurs the treating physiotherapist or doctor will advise on the best course of management. This may include further investigations such as X-rays, ultrasound, MRI or CT scan, pharmaceutical intervention, corticosteroid injection or referral to appropriate medical authorities who will advise on any interventions that may be appropriate to improve the hamstring origin tendonitis.
Exercises for hamstring origin tendonitis
The following exercises are commonly prescribed to patients with hamstring origin tendonitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 1 – 3 times daily and only provided they do not cause or increase symptoms.
Hamstring Stretch for Hamstring Origin Tendonitis
Begin this exercise for hamstring origin tendonitis with your foot on a bench or chair. Keep your back straight and your knee bent slightly. Lean forward at your hips until you feel a stretch in the back of your thigh / knee (figure 2). Hold for 15 seconds and repeat 4 times at a mild to moderate stretch pain-free.
Figure 2 – Hamstring Stretch for Hamstring Origin Tendonitis
Hip Extension vs. Resistance Band for Hamstring Origin Tendonitis
Begin this exercise for hamstring origin tendonitis standing at a bench or chair for balance and a resistance band around your ankle as demonstrated (figure 3). Keeping your back and knee straight, slowly take your leg backwards tightening the back of your thigh (hamstrings). Then slowly return to the starting position. Perform 10 – 20 repetitions as far as possible provided it is pain-free.
Figure 3 – Hip Extension vs. Resistance Band for Hamstring Origin Tendonitis (left leg)
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View more Hamstring Flexibility Exercises.
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