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Proximal Hamstring Tendinopathy (PHT) is a condition that affects the tendon attaching the hamstring muscles to the pelvis. It is common in athletes and people who engage in activities involving repetitive or intense lower body movements. Left untreated, PHT can result in chronic pain and dysfunction, making it crucial to seek appropriate treatment early. Here, we explore the nature of the condition, its causes, symptoms, and how physiotherapy can offer relief and recovery.
What Is Proximal Hamstring Tendinopathy?
Proximal Hamstring Tendinopathy refers to the irritation and degeneration of the hamstring tendon where it attaches to the ischial tuberosity, also known as the "sit bone," located at the bottom of the pelvis. Unlike an acute injury, PHT tends to develop gradually and is often associated with overuse. The condition can become chronic if left untreated, causing ongoing pain, especially during physical activities such as running, cycling, and sitting for extended periods.
Anatomy of the Hamstring
The hamstring is made up of three muscles:
- Semimembranosus
- Semitendinosus
- Biceps femoris
These muscles are located at the back of the thigh and play a critical role in hip extension and knee flexion. The proximal hamstring tendon attaches these muscles to the ischial tuberosity in the pelvis. This tendon is susceptible to injury, particularly when subjected to excessive strain or overuse. Athletes who engage in activities like sprinting, rowing, or cycling, which require repetitive lower body movements, are especially prone to hamstring injuries.
Symptoms of Proximal Hamstring Tendinopathy
The symptoms of PHT can vary in severity and progression. Common signs include:
- Deep buttock pain: The hallmark symptom of PHT is a deep, localised pain in the buttock region that may radiate down the back of the thigh.
- Pain when sitting: Prolonged sitting, especially on hard surfaces, can aggravate the condition.
- Pain during activity: Activities that involve bending at the hip, such as running, cycling, squatting, or lunging, often exacerbate the pain.
- Weakness or stiffness: Patients may experience weakness in the hamstrings and stiffness in the hip or thigh area.
If you notice any of these symptoms persisting over time, it’s important to seek advice from a physiotherapist for a proper diagnosis and treatment plan.
Causes of Proximal Hamstring Tendinopathy
PHT is often caused by overuse and repetitive strain on the hamstring tendons. Some common factors include:
- Sudden increases in training intensity or volume: Athletes who rapidly increase their training load—such as runners adding hill sprints or cyclists increasing their mileage—may be at risk.
- Improper biomechanics: Muscle imbalances, particularly weak glutes or tight quadriceps, can lead to excessive strain on the hamstrings, causing tendon irritation.
- Pelvic positioning: Improper pelvic alignment during exercise or everyday activities can place undue stress on the hamstring tendons.
- Previous hamstring injuries: Individuals who have previously injured their hamstring may be more susceptible to developing tendinopathy due to underlying weakness or scar tissue.
Treatment for Proximal Hamstring Tendinopathy
Treating PHT requires a multi-faceted approach, and physiotherapy plays a key role in recovery. Here's how physiotherapy can help:
- Activity Modification: Your physiotherapist will likely advise you to temporarily avoid or modify activities that aggravate the condition, such as running, cycling, or prolonged sitting. Offloading the tendon reduces strain, allowing it to heal.
- Isometric Exercises: In the initial phase of rehabilitation, isometric exercises—such as the single-leg bridge—can help build load tolerance in the tendon without putting it under excessive compression.
- Strengthening Exercises: As pain decreases, isotonic exercises will be introduced to restore hamstring strength and function. Exercises like Nordic hamstring curls and eccentric hamstring curls are often used in this phase.
- Manual Therapy: Soft tissue techniques, including deep tissue massage and myofascial release, can reduce muscle tension and improve blood flow to the area.
- Stretching and Mobility: A physiotherapist may also guide you through targeted stretches to improve hamstring flexibility and reduce the risk of reinjury.
- Plyometrics and Functional Training: In later stages of rehab, plyometric exercises and functional training are introduced to prepare the tendon for the demands of everyday activities and sports. This phase is crucial in preventing recurrence and ensuring long-term recovery.
Conclusion
Proximal Hamstring Tendinopathy can be a frustrating and painful condition, especially for athletes and active individuals. Early recognition of the symptoms and appropriate treatment are essential to prevent chronic pain and further complications. Physiotherapy offers a comprehensive approach, focusing on activity modification, progressive strengthening, and manual therapy to relieve pain and restore function.
If you’re experiencing persistent pain in the buttock or thigh area, it’s important to consult with a physiotherapist. They can provide a tailored rehabilitation plan that addresses your specific needs, helping you recover faster and safely return to your favourite activities. Don't let PHT hold you back - contact Ground Up Physio or book online.
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