Hamstring Tendinopathy, commonly referred to simply as Tendonitis, occurs when you bend your knee against resistance. Symptoms typically worsen at the start of training session before gradually lessening through out and returning towards its completion or later in the day or week.
Early on, isometric exercises tend to be better tolerated than movements; try beginning with prone bridges, foot-elevated long lever bridge or the seated hamstring curl as examples of isometric exercises.
Stretching
Hamstring injuries can prevent you from running, cycling, swimming and walking – and stretching exercises may help to alleviate them – but only when performed properly and under guidance by an expert such as a physical therapist who can teach proper techniques to avoid further injury.
The hamstring muscle at the back of your thigh is essential to movement and balance, yet tight hamstrings can restrict mobility and lead to injuries elsewhere in your body, such as your knees and lower back. Stretching can keep these long and flexible hamstrings long-lean and flexible enough to tolerate exertion without damaging their tendons.
A physiotherapist will guide you through a gradual tendon loading exercise program that begins with isometrics and progresses to slow resistance exercises for your hamstrings and surrounding muscles, including gluteal, hip, and abdominal muscles. Your training schedule may include high load days which increase demands on the tendon while other days allow the tendon to rest and recover in response to higher loads.
Proximal hamstring tendinopathy is a relatively common injury among runners and endurance athletes, particularly sprint, middle distance runners, that typically results from repetitive overload and overstretching. While other hamstring injuries, like pulled hamstrings can usually result in sharp pain that is readily identified through physical examination, tendinopathy often presents as a progressive chronic condition which gradually worsens over time.
Painful symptoms are believed to be caused by shearing forces acting against the proximal hamstring tendon at its attachment point on the sit bone (ischial tuberosity). Most symptoms appear on the inside of the seat bone but can also occur deep within the buttock; pain often intensifies during activities or positions that require greater shear forces or compressive loads, such as long periods of sitting, sprinting or movements requiring deeper hip flexion like RDL or hip hinge exercises.
That is why establishing an effective warm-up and stretching routine, including eccentric exercises like the plyometric bridge, hamstring curls and reverse plank/kneeling Nordic leg curl, is so crucial. These will prepare your hamstrings to take the higher loads when training resumes.
Flexibility Exercises
Hamstring tendinopathy often results from overuse. This could include one training session, race or match that exerts strain beyond what the tendons can tolerate; or over time due to not allowing enough rest between intense sessions. Both primary and secondary low hamstring tendonopathy can be difficult to heal, though reducing aggravating loads is key to speeding recovery through rehab exercises.
Exercise that require hip flexion (knee to chest), like lunges, may exacerbate lower hamstring injuries in their reactive phase. This is because lunges compress tendons as they contract eccentrically during this position; instead it may be beneficial to perform prone hamstring curls or exercises that avoid the final 30 degrees of knee straightening until your injury has fully recovered.
As your walking and running requires eccentric contraction of hamstring muscles, exercises which involve eccentric contractions like squats and deadlifts may be better tolerated than ones which involve hip flexion such as bridges.
Higher speed runs or hillier runs will put undue strain on your hamstrings and are likely to aggravate existing injuries more readily than jogging which tends to be gentler on them.
Symptoms of injury may include sharp or deep ache in the back of your thigh and buttock area, often worsening after running, walking, or exercising and making sitting for extended periods difficult.
Progressive loading programs can help treat hamstring tendinopathy; the specifics will depend on its cause and severity. Such a plan should incorporate both high-load days to challenge your tendons, and low-load recovery days for recovery between challenges; your physiotherapist can help tailor one specifically tailored to you and your injury’s severity.
Isometric Exercises
The hamstring muscles are responsible for knee flexion and hip extension, making them crucial in running, skiing, and sports that require quick changes of direction. Sprinting and short distance running often utilize eccentrically loaded hamstring muscles; this loading pattern may be problematic for people suffering from high hamstring tendinopathy.
Most forms of high hamstring tendinopathy can be resolved with simple exercises and consistent work, providing enough load that is bearable without increasing pain or damaging tissue. Setting goals or creating workout plans must take this into consideration to avoid overtraining or reinjury. Start small and increase slowly so as to avoid overtraining or reinjury.
Research suggests that isometric exercises – those where muscle fiber doesn’t shorten or lengthen — may provide a protective effect and ease pain from hamstring tendinopathy. Nordic curl is one such isometric exercise proven effective by scientific investigations.
Rehab can help hamstrings recover by gradually loading them through various exercises and progressions, starting from isometrics and moving up through isokinetics to heavy slow resistance through increasing hip range of motion before switching over to plyometric training with increased rates of loading.
Escentric loading exercises play a pivotal role in treating hamstring tendinopathy, but concentrically contracting your hamstrings to bend the knee is also crucial. Therefore, taking an integrated approach to rehabilitation with both eccentric and concentrically loading exercises is critical.
Start off your rehabilitation program with bridges, prone hamstring curls and foot-elevated long lever bridges; these exercises should be performed bilaterally or unilaterally. When you have mastered these exercises, add in other seated hamstring isometrics like the hamstring slider and foot-elevated hip abduction; once these have become second nature to you, progress on to more challenging resistance exercises such as the squat, deadlift and step-ups.
Strengthening
Once the pain has subsided, it’s important to start performing low load controlled exercises to regain full hamstring functionality. Bridges and hamstring curls could help get them moving again while gradually increasing loading (how hard your tendon have to work) until it matches your sport or training demands. Alternate days with higher loading exercises with days dedicated to recovery.
Proximal Hamstring Tendinopathy can often be brought on by exercise and positions which place extra load, stretch or compression on the proximal hamstring tendons such as running uphill, sprinting, movements that require deep hip flexion such as squatting or lunging and sitting for prolonged periods of time. It often presents as deep, aching pain in both buttock and back of thigh that doesn’t ease with physical activity or sitting longer periods. It typically presents as deep aching discomfort in both locations which doesn’t improve with exercise or sitting longer periods – usually followed by pain relief after exercise or sitting time!
Though this process may feel time consuming, it is crucial that you remain committed to your plan and continue exercising without worsening symptoms. Otherwise, your injury may turn into a chronic issue which takes much longer to resolve.
Traditional medical opinion regarding this injury was that of tendonitis; however, medical opinion is now shifting towards tendinopathy due to it no longer having a large inflammatory component and thus shifting treatment towards specific guided activity that assists the body’s natural healing processes.
These techniques often combine gradual load building exercises to help your hamstrings return to action and prepare them for whatever task they will soon face. If you are a runner, switching activities such as walking or swimming may help as these allow your knees to keep moving through their full range of movement whilst being much less dependent on hamstring support for support. It might also mean making slight modifications to your running technique such as decreasing overstriding or increasing forward trunk lean in order to lessen how much loading occurs on these muscle groups.
