A 2023 Review of PHT Treatment

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This episode reviews a 2023 paper titled: Comparison of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation

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Title: Understanding and Treating Proximal Hamstring Tendinopathy: A 2023 Review


Proximal hamstring tendinopathy (PHT) can be a debilitating condition that affects athletes and non-athletes alike. In this podcast episode, we delve into a 2023 review of PHT treatment strategies, providing you with valuable insights into the condition and evidence-based treatment options. Whether you’re an athlete or someone dealing with PHT, this article will empower you with the right knowledge to tackle this condition effectively.

The Host’s Background

The podcast is hosted by Brodie Sharp, an online physiotherapist and recreational athlete who has battled chronic proximal hamstring tendinopathy himself. Brodie is the creator of the Run Smarter series, dedicated to helping individuals overcome PHT by dispelling misconceptions and offering evidence-based solutions.

Explaining the Paper

Brodie discusses a specific research paper titled “Comparisons of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation.” He breaks down the title, explaining that the paper aims to evaluate conservative (non-surgical) treatments for PHT by conducting a systematic review of existing studies. The goal is to provide recommendations for PHT rehabilitation based on the collected evidence.

Inclusion and Exclusion Criteria

The paper’s authors conducted an extensive search in various databases to identify studies assessing the effectiveness of conservative interventions for PHT. They focused on adult participants between the ages of 18 and 65, excluding cases of complete rupture or avulsion greater than two centimeters. After screening, 13 studies were included in their review, consisting of five exercise interventions and eight multimodal approaches.

Key Findings

Brodie highlights that among the 13 studies, only five were considered high-quality randomized controlled trials (RCTs), while the rest were case cohorts or case reports. This scarcity of high-quality research underscores the limited available evidence on PHT. Nevertheless, the paper’s findings offer valuable insights into effective treatments for PHT.

Pain Reduction Strategies

The paper suggests that progressive loading exercises are crucial for reducing pain in PHT. Patients should aim for a minimum effort level of five out of ten (RPE) during exercise, focusing on increasing muscle length simultaneously. Additionally, exercises should be performed at least five times a week for a minimum of eight weeks. Isometric exercises, which involve activating and holding a muscle without movement, were also found to be effective in reducing pain.

Function Improvement

To improve functional outcomes, patients can tolerate up to three out of ten pain during exercises, as long as the pain returns to baseline within 24 hours. Strength training, core stabilization exercises, and progressive endurance training (such as running or cycling) should be included in rehabilitation programs. The paper emphasizes that clinicians should not shy away from introducing controlled discomfort during rehabilitation, as long as it is well-tolerated.

Conclusion and Recommendations

The paper concludes that a comprehensive multimodal and individualized approach to PHT management is essential. This approach should consider intrinsic and extrinsic factors that influence the patient’s condition. Shockwave therapy can be used as an adjunct treatment alongside exercise-based rehabilitation but should not be relied upon as a standalone solution.

Final Thoughts

While the review highlights the limited high-quality research available for PHT, it reinforces the importance of progressive loading exercises, isometrics, and controlled discomfort in rehabilitation programs. Tailoring treatment plans to individual needs is crucial for achieving optimal results in managing proximal hamstring tendinopathy. Remember that PHT management requires patience and commitment, but with the right approach, you can overcome this challenging condition.