Understanding Proximal Hamstring Tendinopathy: Exploring Buttock Pain

Proximal hamstring tendinopathy (PHT) can be a debilitating condition causing discomfort and pain in the buttock region. In this episode, we delve into the world of buttock pain, exploring various potential causes and conditions that may mimic PHT. We’ll discuss the importance of accurate diagnosis and understanding the different sources of buttock pain.

Introduction

Welcome to another episode of the Run Smarter Podcast. I’m your host, Brody Sharp, an online physiotherapist, recreational athlete, and a chronic PHT sufferer. Today, we’re going to bust some common misconceptions surrounding buttock pain and shed light on alternative diagnoses that may be confused with PHT.

Addressing Misconceptions

First, a quick apology – I might sound a bit under the weather, but the show must go on. A big shoutout to Syed for sharing a valuable 2023 paper with me, titled “Bionic Pain in Athletes: A Narrative Review.” This paper delves into potential reasons for buttock pain and offers insights into conditions that may mimic PHT.

The Purpose of the Paper

The primary goal of this review is to systematically evaluate and diagnose sport-related buttock pain. Buttock pain is a common yet challenging complaint for athletes, and this paper aims to provide an overview of common diagnoses using an anatomical framework.

Exploring the Lumbar Spine

One of the key areas to consider in cases of buttock pain is the lumbar spine. Lumbar spine pathology can frequently refer pain to the buttocks, with or without associated low back pain. Differentiating lumbar spine pathologies involves assessing lumbar range of motion and directional preferences. Detailed neurological exams can also help identify the cause of pain.

Treatment for Lumbar Spine Issues

In the absence of red flag symptoms, conservative treatment is the first line of approach for lower back disorders. This includes activity modification, physical therapy, heat, ice, and anti-inflammatories. Physical therapy focuses on improving mobility, strengthening, and stabilizing the lumbar spine and its surrounding structures.

Sacral Bone Stress Injury

Sacral bone stress injuries, often seen in endurance runners, can also be a source of buttock pain. These injuries are linked to overtraining and under-fueling. Diagnosis may require palpation, and treatment includes rest and a gradual return to activity.

Hip Joint Issues

Intraarticular hip pain originates from the hip joint itself, including the femoral head, acetabulum, cartilage, labrum, and ligamentum teres. Common causes of intraarticular hip pain include labral tears, femoral acetabular impingement (FAI), and femoral neck stress fractures. Tests for these conditions involve hip flexion, internal/external rotation, and may require MRI scans for confirmation.

Treatment for Hip Joint Conditions

Treatment options for labral tears and FAI include physical therapy, trigger point injections, dry needling, and manual therapy. Femoral neck stress fractures require immediate attention and thorough evaluation due to their severity.

Gluteal Region

The gluteal region, which includes the gluteus medius and minimus muscles, can be affected by muscle strains, myofascial pain, and gluteal tendinopathy. Muscle strains often result from eccentric contractions and occur in sports involving explosive movements. Myofascial pain can be identified through palpation and treated with physical therapy, trigger point injections, dry needling, and manual therapy.

Gluteal Tendinopathy

Gluteal tendinopathy involves degeneration of the gluteal tendons. It is frequently seen in long-distance runners due to the repetitive loading of tendons during running. Treatment focuses on physical therapy to strengthen and improve hip mobility.

Piriformis Syndrome/Deep Gluteal Syndrome

Piriformis syndrome is often confused with PHT. It occurs when the piriformis muscle compresses the sciatic nerve, leading to buttock and posterior thigh pain. Diagnosis involves increased resting tone of the muscle and a history of pain during specific movements. Activities like running, lunging, and kicking can provoke symptoms.

Conclusion

In conclusion, buttock pain can stem from various sources, and it’s crucial to accurately diagnose the underlying condition. While PHT is a common cause, other conditions like lumbar spine issues, sacral bone stress injuries, hip joint problems, and gluteal region disorders can mimic its symptoms. Seeking professional evaluation and tailored treatment is essential for effective pain management and recovery. Remember, not every buttock pain is PHT, so keep an open mind and consult a healthcare provider for a proper diagnosis and treatment plan.