When Is It Okay to Stretch with Proximal Hamstring Tendinopathy

Proximal hamstring tendinopathy, also known as high hamstring tendinopathy, is a painful condition that affects the hamstring tendons near the sit bone. One common question that arises in the management of this condition is, “When is it okay to stretch?” In this blog-style article, we will explore the misconceptions surrounding stretching for proximal hamstring tendinopathy, the evolving beliefs, and the middle ground for safe stretching.

Introduction

Proximal hamstring tendinopathy (PHT) is a condition that has gained recognition in recent years. While it was relatively unknown a decade ago, it has become a more prevalent issue, especially among athletes. Initially, the advice for individuals with PHT was to stretch to alleviate symptoms. Stretching the hamstring was believed to provide relief and reduce pain. However, this advice has evolved over time as our understanding of PHT has deepened.

The Misconception of Stretching

In the early stages of recognizing PHT, individuals were often told to stretch their hamstrings as a means of reducing pain and promoting recovery. Stretching the hamstring tendons, especially in the seated position, was commonly practiced. People would bend forward while sitting or extend their legs and reach for their toes, targeting the sore area.

This stretching approach did provide short-term relief for some individuals. The momentary soreness experienced during stretching was often mistaken for a positive sign of targeting the affected area. However, this relief was short-lived and did not address the root cause of PHT. In fact, excessive stretching over time could worsen the condition, contributing to more irritation of the tendons.

The Shift in Beliefs

As our understanding of PHT has deepened, the advice regarding stretching has evolved. We now know that stretching an irritated hamstring tendon can lead to further irritation, especially in cases where the tendinopathy is near the tendon’s insertion point on the sit bone. This is similar to how Achilles tendinopathy near the insertion point on the heel requires a different approach to stretching compared to mid-portion Achilles tendinopathy.

The narrative around stretching for PHT has shifted from “stretching is helpful” to “avoid stretching altogether” in cases of severe soreness. However, this extreme shift in beliefs might not be entirely accurate. Stretching is a normal part of everyday life, and avoiding it completely may not be practical or beneficial.

Finding the Middle Ground

The truth about stretching for PHT lies somewhere in the middle. Every individual’s tendon is different, and the tolerance to stretching can vary significantly. It’s important to recognize that different tendons have varying tolerances to different movements. Therefore, a personalized approach to stretching is crucial.

If you’re unsure when it’s okay to stretch with PHT, consider the following factors:

1. Your Level of Tolerance

• Recognize that your tolerance for stretching will be unique.
• Start with short sessions of stretching and gradually increase duration if symptoms remain manageable.

2. Your Goals

• Consider your specific goals. Do you want to return to everyday activities, sports, or activities that require extensive stretching?
• Tailor your stretching routine to align with your goals.

3. Trial and Error

• Experiment with short sessions of stretching to gauge your body’s response.
• Pay attention to how you feel during and after stretching and assess any changes in symptoms.

4. Gradual Progression

• If stretching is a part of your daily routine, gradually increase the intensity and duration.
• Allow your tendon to adapt to stretching over time.

Addressing Fears and Anxieties

It’s common to experience fears and anxieties related to stretching when dealing with PHT. The fear of pain or exacerbating the condition can be overwhelming. However, it’s crucial to understand that stretching, even if it causes temporary soreness, does not worsen the pathology. It’s more like pressing on a bruise; it may be uncomfortable but doesn’t hinder the healing process.

Avoiding stretching altogether can lead to deconditioning of the tendon, making it even more challenging to reintegrate stretching into your routine in the future. It’s essential to address fears and anxieties, recognizing that stretching, when done sensibly, can be part of the rehabilitation process.

Conclusion

In summary, the question of when it’s okay to stretch with proximal hamstring tendinopathy doesn’t have a one-size-fits-all answer. The key is to find your own tolerance level and gradually incorporate stretching into your routine if it aligns with your goals. Stretching sensibly and monitoring your symptoms will help you build resilience and promote healing over time.

If you’re struggling with PHT and need personalized guidance, consider consulting a physiotherapist who specializes in this condition. They can provide tailored advice and rehabilitation strategies to help you on your journey to a pain-free future.

Remember, knowledge is power when it comes to managing proximal hamstring tendinopathy, and finding the right balance with stretching is a crucial part of the process.