Proximal Hamstring Tendinopathy: Rehabilitation and Prevention

Proximal hamstring tendinopathy can be a painful and frustrating condition, but with the right knowledge and a strategic approach to rehabilitation and prevention, you can overcome it. In this article, we will explore the key stages of rehab and offer five essential prevention tips to help you manage this condition effectively.

Understanding Proximal Hamstring Tendinopathy

Proximal hamstring tendinopathy is a challenging condition that can affect athletes and non-athletes alike. It often causes pain in the upper hamstring region and can significantly impact your daily life and physical activities. In this podcast episode, Brodie Sharp, an online physiotherapist and experienced proximal hamstring tendinopathy battler, shares his insights on how to address this condition. Let’s dive into the stages of rehabilitation and prevention.

Stage 1: Avoiding Compression

The first stage in addressing proximal hamstring tendinopathy involves identifying and avoiding compression on the affected tendon. Excessive compression can exacerbate the condition and hinder the healing process. This principle is not unique to proximal hamstring tendinopathy and applies to various tendinopathies, such as Achilles, gluteal, or high hamstring tendinopathy.

If you are constantly irritating the tendon through activities or daily habits, such as the way you sleep or the shoes you wear, addressing compression is essential before starting the rehabilitation process. This stage may involve modifying your daily routines, such as changing your footwear or altering your sleeping position.

Stage 2: Applying Load

Tendons thrive on load, but it’s crucial to apply the right amount of load under the appropriate conditions. Starting with isometrics, a form of exercise where you hold a specific position without the tendon moving, can be an effective way to apply load without overloading the tendon. Isometrics can help you build strength and pain tolerance without causing excessive irritation.

After isometrics, you can progress to eccentrics, where the tendon is loaded as it lengthens, and then to concentrics, where the tendon is loaded as it shortens. These exercises should be performed under controlled conditions, and you should monitor your pain levels during and after each session. Slow, heavy resistance exercises have shown to be beneficial in reducing pain and improving tendon health.

Stage 3: Integrating the Kinetic Chain

As you progress through the rehabilitation stages, you should start addressing the entire kinetic chain. For proximal hamstring tendinopathy, this means focusing on hip and glute strength and ensuring that the joints above and below the affected tendon are functioning optimally. Strengthening the entire kinetic chain not only aids in injury prevention but also enhances your overall performance and capacity.

It’s important to note that these stages are not set in stone. The progression depends on the individual’s response and level of irritability. Some people may be able to skip certain stages and progress more quickly, while others may need more time at each stage. Working with a knowledgeable running coach or physiotherapist can help you create a personalized plan.

Five Prevention Tips

1. Understand Loading Factors: Be aware of the factors that contribute to your tendon’s load, such as distance, speed, terrain, and footwear. Avoid sudden spikes in your training that could lead to overuse injuries.
2. Prioritize Recovery: Focus on adequate sleep, nutrition, and a well-structured training plan. Avoid long-term use of anti-inflammatory medications, as they may mask pain and delay healing.
3. Cautious Return to Running: After a break from running, gradually reintroduce your training. Sudden, intense workouts can put you at risk for injuries. Pay attention to your body’s response and allow time for recovery.
4. Avoid Compression: Be mindful of factors that could compress the affected tendon outside of running. Make adjustments to your daily activities or habits as needed.
5. Avoid Complete Rest: Steer clear of the “pain-rest-weakness downward spiral.” Complete rest may seem like a solution, but it can lead to further weakening and a prolonged recovery. Maintain an active approach to rehabilitation.

In summary, proximal hamstring tendinopathy is a condition that can be managed with the right knowledge and approach. By addressing compression, applying appropriate load, and strengthening the entire kinetic chain, you can recover effectively and reduce the risk of future injuries. Additionally, understanding loading factors and prioritizing recovery will play a crucial role in preventing proximal hamstring tendinopathy. Remember that every individual is unique, so be patient and listen to your body throughout the process.