High Hamstring Tendinopathy Injuries.

Push your leg backwards so that the movement happens from the hip – among other muscles, your hamstrings are now in action.

Now, with your knee hanging down, pull your foot up toward your glutes – your hamstrings are in action.

The reality is that these muscles work really hard, and are particularly prone to injury at their origin. An injury there is called either a high hamstring tendinopathy or a proximal hamstring tendonitis.

The injury doesn’t happen to many people, but those that have it have an uphill battle on their hands to get rid of the injury.

Hamstring_tendons

A little bit about your hamstrings.

I wrote a blog about your hamstrings a while ago. You can read more about it here – Know your muscles – Hamstrings.
To summarize, the muscle is attached to your tibia below and behind your knee. The muscles then run up your leg and attach to your hip on a bony prominence called the ischial tuberosity. Cyclists often refer to these two bones as the ‘sit’ bones. It is in this area that the injury takes place. Pain is often felt high up in the hamstrings and deep in the buttock.

The area may become irritated when sitting on hard surfaces, when pushing directly on the ischial tuberosity, when running and especially when accelerating while on the run.

A basic hamstring stretch – such as the one pictured below – should cause pain in the area. It is also possible that an MRI could spot a thickening of the tendon or swelling of the bone.

hamsrring stretch

How to treat it.

Soft tissue work is advised to break down scar tissue. Direct compression of the actual bone should be avoided.

Chiropractic adjustment is also recommended to correct any pelvic tilt abnormalities.

Hamstrings should be stretched daily. Stretching needs to be gentle.

How long will I take to get better?

You have a long road ahead of you for two reasons.

1. The area has poor blood supply.

  1. The tendonitis of the high hamstrings is degenerative as opposed to inflammatory. This means that the fibers have become frayed and disordered.

We have seen runners return to full training after 8 to 12 weeks. These runners have typically come in weekly for soft tissue release, and have been committed to a stretching and strengthening program.

According to Lasse Lempainen, an average recovery time of 5 months can be expected with some athletes taking up to one year to recover fully.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396672/

Is it worth getting a cortisone injection?

An injection into the tendon is not advised. However, it is possible to for an Orthopod to guide a needle toward the area via an ultrasound and thus not damage the actual tendon. I would only use this as a last resort though.

In some cases, athletes can resort to surgery. There are dangers involved with this, and you might want to discuss this move with an orthopedic surgeon first.

Getting the muscle strong again.

As you begin to recover you need to get strength back into the area. Exercises such as cycling and swimming can be looked at. Specific bridges, supermen and light therapy band work.

Running can be resumed when you can do a back plank and are able to do leg lifts on both sides. You need to resume running really slowly.

hamstring back plank

Hope this helps. Let me know if there is anything I can do to assist recovery.

Regards,

Mike Roscoe.
Kinesiologist.
Mike Roscoe

About sbrsport

SBR Sport specialises in Swimming, Biking and Running. On the medical side we are able to do intensive bike setups, leg assessments and soft tissue release. Follow us on twitter - www.twitter.com/swimbikerunshop and/or facebook - www.facebook.com/sbrsport.
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