It’s also known as proximal hamstring tendinopathy or high hamstring tendinitis and refers to inflammation of the common origin (ischial tuberosity) of the hamstring muscles. The origin is where the muscle attaches to the bone.
Having a quick internet search there seem to be 3 main causes or reasons associated with the onset

1. Over use. This seems to be the most commonly written about on the internet. Specifically in relation to middle or long distance runners
2. After back pain. This seems to be due to the pain irritating the sciatic nerve, The cause of the sciatica nerve irritation doesn’t appear to be indicated
3. Traumatic or sudden onset. Possibly due to a slip or slide and sudden contraction of the biceps femoris pulling and irritating the tendon and where it attaches to the bone. There also seems to be where the fibrosis or sticking of the sciatic nerve to the muscle occurs.

Other causes are given below, but I think these are better thought of as maintaining factors.

• Adhesions between the sciatic nerve and one of the  hamstring muscles.
• The fascia covering the hamstrings is scared and bound to other structures and as a result may inhibit sciatic nerve function, and also shorten range of motion.
• Gluteal weakness can cause overuse of the hamstring muscles. This can cause shortening and tightness in the hamstrings and potentially lead to high hamstring tendonopathy.

Symptoms

High Hamstring Tendinopathy gives you pain in the lower buttock on the part of the pelvic bone you should be sitting on. The pain in the buttock has been described as very sharp or like a tooth ache all the time. There doesn’t seem to be any inflammation in the ischial tuberosity although it’s painful to pressure, most notably sitting. When I had this I wasn’t able to sit comfortably for about 6 months. The pain I had when driving was almost unbearable.

Contraction of the hamstring muscles causes pain in the buttock as does a hamstring stretch . Standing does not cause pain buttock although a slight pull maybe noticed in back of the knee on the outside. Tightness may also be noticed  in the upper hamstrings.

Management

• 1st stop running/exercising if this is the cause.
• Next, deal with any active inflammation. Ice around the insertion and tendon. Heat in the muscle belly feels good and may help release any tightness in the muscle itself.
• In the early stages do not stretch the hamstring muscles, as this will pull on the tendon and further irritate it. I found rollering ineffective.
• Get it examined so it can be diagnosed and treated as quickly as possible as this may shorten the duration of the condition.

Treatment

Treatment by an osteopath is always based on the needs of each individual patient, because of that it is hard to give a definitive treatment guide.

To manage the potential link between low back pain and sciatica nerve, treatments I have  in the past have included soft tissue techniques to the Iliolumbar Ligament, Lumbar Erector Spinae, and Multifidus. Sometimes manipulation on the lumbar spine may be necessary although articulation can be used instead. Also soft tissue to the gluteal area and the deep hip rotators (piriformis and it’s relationship with the sciatic nerve deserve extra attention), but taking care to avoid the ischial tuberosity and the proximal part of the hamstrings.

When treating the hamstring a variety of soft tissue/massage techniques are used. The techniques chosen depend on the goals for that particular stage of treatment. I normally take care to not stress or tension the upper hamstring tendon until the later stages of treatment.

Conclusion

High hamstring Tendinopathy is a debilitating condition that can affect many aspect of your life. Simple things that we take for granted such as sitting down and eating a meal to leisure activities like running can become excruciating. I don’t want that to happen to you.

Not only have I treated high hamstring tendinopathy, I’ve  suffering from it as well. I understand the frustration that it can give, so aim to get you back to your normal activities as quickly as possible. I have the experience to diagnosis, treat and also advise on a rehabilitation program to try and stop it reoccurring. Click to book an appointment now.

A diagnosis of ME/CFS is usually made by exclusion. If you have been diagnosed with ME or CFS you know what this means. If you haven’t or you’re waiting for a ME diagnosis it can be extremely frustrating. This piece of research is important because it could potentially be key to getting The Perrin Technique and it’s “instant” diagnosis through the NHS

An earlier very small scale study was performed by Professor Basant Puri using part of the diagnostic procedure developed Raymond Perrin. This earlier showed very promising results. Dr Perrin is trying to take this research further.

Over the coming weeks I aim to break the outline for this planned research down into small easily understandable chunks. Below is Dr Perrins summary account of the research.

SUMMARY OF NEW RESEARCH PROJECT 2013

Examining the accuracy of a physical diagnostic technique For Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

The novel manual system of diagnosis being examined was developed in 1989 by the principal investigator Raymond Perrin. The diagnostic procedure used in this technique focuses on certain physical findings, namely specific tender points in the chest and abdomen, the presence of palpable varicose lymphatic vessels in the chest, restricted and posturally dysfunctional thoracic spine and a disturbed cranial rhythmic impulse (CRI).

Illness behaviour can be defined as relatively distinct but subtle behavior, posture, mannerism and/or responses which may happen in patients with long term health problem. If the presence of physical signs were demonstrated  to be significant in CFS/ME  then this will demonstrate that one can tell that somebody has CFS/ME not only by  observing obvious illness behaviour.

Following the first oral hearing on Tuesday 18th April 2006 of the Gibson Enquiry at the House of Commons, it was generally concluded by those present that an earlier diagnosis would usually lead to a better prognosis when treating CFS/ME.  The published report from the Gibson enquiry of Nov 2006, described The Perrin Technique as “a useful and empirical method which although unorthodox should not be dismissed as unscientific and that it required further research”. The most recent survey carried out at The University of Bristol in September 2011 claimed that CFS/ME affects up to 2.6 per cent of adults in Britain. A quicker diagnosis would thus reduce the huge financial burden placed on the health service by reducing the need of some of the specialist services used and the pathological tests carried out at present.

The new research will evaluate a major principle behind the Perrin technique which is the presence of specific physical signs in CFS/ME patients. The research study, is a practical method to confirm or refute this main principle of the Perrin technique. Subsequently, this should inform the Perrin practitioners, CFS/ME patients and general clinicians about the role this technique may or may not play in the management of CFS/ME patients.

Aim

The aim of this study is to explore if there is validity in the use of specific physical signs as an aid to diagnosing CFS/ME

METHODS

Recruitment

100 participants will take part in the study which will consist of CFS/ME patients and healthy controls.

Groupings

Group 1 will be around 50 volunteers who have been selected consecutively by the research assistant from a larger group who have been diagnosed by consultant in the NHS and confirmed as suffering from CFS/ME using an informal interview screening tool based on the NICE guidelines.

Group 2 will be around 50 healthy controls again selected consecutively from a larger group of volunteers by the research assistant and who have been matched for age and gender with the patient group  and confirmed as not suffering from CFS/ME using an informal interview screening tool based on the NICE guidelines.

Health professionals involved the study

The examination of the participant using the Perrin Technique will be carried out by a trained chartered physiotherapist with a few years experience in this specific manual technique working with CFS/ME patients and the other a registered osteopath who has been recently trained in the manual technique specifically for this study with little or no prior experience of CFS/ME patients. Training of the osteopath in question should only take around two weeks working in The Perrin Clinic under the guidance of Dr Perrin. When the osteopath is having his/her training, he/she will only stay in the treatment room for Dr Perrin to demonstrate the physical signs and then leave to let Dr Perrin carry on with his consultation. This will be done to minimise the osteopath’s ability to use anything other than the Perrin signs to reach their final conclusions during the study. The third clinician involved in examining the participant will be a physician who will be selected due to a reasonable knowledge of CFS/ME and have had experience working in an NHS clinic for CFS/ME. They will not have had any experience regarding the physical aspects of the Perrin technique.

Examination of Participants

The participant will see all three practitioners on the same day. This will take place no later than 1 month of being accepted onto the study.

The examination of the participant by both the physiotherapist and osteopath will follow the same  protocol as developed by Dr Perrin.The NHS physician will examine the participant using a standard clinical neurological and rheumatological examination.

The basic method of this project is represented in the flow chart below:

RECRUITMENT

RESEARCH COMPLETED AND RESULTS PUBLISHED

Timetable

January 2013                                                           Recruitment of research assistant,

NHS physician and osteopath.

May 2013                                                                 Begin recruitment of volunteers and proceed with

diagnostic instruments.

December 2013                                                      Complete recruitment of volunteers and diagnosis.

January 2014 – April 2014                                   Analysis and documentation of results.

May 2014 +                                                            Publish results and dissemination of findings through

relevant conferences and patient groups.

 Costs

The costs of this research project have been calculated as being no more than £60,000 for the year and are being fully funded by the FORME Trust,  Charity No 104 5005.

Sciatica:

This is not a diagnosis, it’s really a description of pain in the distribution of the sciatic nerve. The sciatic nerve is the longest nerve in your body. It starts in your low back, then runs from the back of your pelvis, through your buttocks, and all the way down both legs, ultimately parts of it end at your feet. When something compresses or irritates the sciatic nerve, it can cause a pain that radiates out from your lower back into your buttock and can travel down your leg to your calf.   Sciatic pain can range from being mild to very painful.

Sacroiliac Joint:

This is sometimes shortened to  SI joint, S/I joint or occasionally SIJ. This is the joint between the triangular sacral bone at the base of the spine and the iliac or pelvic bone. Pain here can be caused by too much or too little movement. Some  people term these as Sacroiliac joint dysfunction. Certain types of Arthritis can also cause inflammation and pain at this joint. Weight changes and ligamentous laxity during pregnancy can also lead to pain at this joint.

Osteoarthritis:

Osteoarthritis is often called arthritis or OA for short. OA is really ‘just’ wear and tear of one of the body’s joints. OA in the low back, S/I joint and possibly in the hip could cause buttock pain. The pain, when spreading from an arthritic joint, is often non specific, by this I mean there may be an ache in the area. This ache can become more centered when the joint is inflamed in which case it’s the inflamation causing the pain rather than the joint. The muscles can also become involved, this is then a muscle pain rather than arthritic or joint pain.

Bursitis:

A bursa is a fatty sack. It’s purpose is to reduce friction where muscles pass across other muscles, ligaments or bones. Muscles that are overused or are too tight can rub and inflame a bursa which then causes pain. The two main bursa in the buttock area are the trocanteric bursa and the ischial bursa. One can can give you pain on sitting the other pain when laying on your side.

Coccydynia:

Sometimes written as coccyx/coccygeal pain. The coccyx is often described as the tailbone . If affected people complain of pain at the very base of the spine, just above their anus. The pain can sometimes be felt in the ligaments that help the coccyx maintain it’s position as these ligaments become strained  The sensation can vary from mild discomfort to extremely painful.

Iliolumbar ligament:

This is a really strong little ligament that holds the lumbar spine to the Ilium (part of the big “hip” bone). The iliolumbar ligament can be felt just around the dimples in the very low back.  This can get strained and stretched leading to inflammation. A common way of stretching this ligament is by sitting with your low back unsupported in a slumped position.  Pain can vary from a mild ache to a strong throb. Some sources say that a sciatic type pain can be caused by this ligament.

Piriformis muscle:

Piriformis is a small muscle that is located deep in the buttock region. The sciatic nerve  runs through this muscle. This muscle can become tense enough for it to squeeze the Sciatic nerve, producing symptoms including pain and numbness, that travel down the leg from the buttock region. When the nerve is trapped this way, it is called Piriformis Syndrome. Additionally, trigger points in the muscle may refer pain to other parts of the buttock and the hip joint region.

Trigger points:

Trigger points have been described as “a highly irritable localized spot of exquisite tenderness in a nodule in a nodule in a palpable taut band of muscle.” Another attribute of trigger points is they when the nodule is pressed or irritated it can trigger pain distant to the nodule. Trigger points in quadratus lumborum a back muscle and soleus a calf muscle can and do refer pain to the buttock.

Buttock Muscles:

The Gluteus maximus, medius and minimus are the three main buttock muscles. Gluteus maximus is biggest muscle in the body and some sources say it’s the strongest. All of these muscles may get tendon problems causing pain in the buttock. There are also a number of trigger points within these muscles that may give pain within the buttock. There are three trigger points commonly encountered in Gluteus max, another three in medius and 7 minimus.

High Hamstring Tendinopathy:

This gives you pain most noticeably when you sit and also a tight painful sensation in the hamstring. It’s also known as proximal hamstring tendonopathy or high hamstring tendonitis and refers to inflammation of the common origin (ischial tuberosity) of the hamstring muscles.This gives you pain in the lower buttock  on the part of the pelvic bone you should be sitting on. The pain in the buttock has been described as very sharp or like tooth ache all the time. More about High Hamstring Tendinopathy

Sports massage and sports therapy, When is the best time to be treated by your osteopath? Here we look at a couple of scenarios.

I suppose in conclusion the answer “to when is the best time in a training cycle to get sports massage treatment” is anytime. It just depends on what your looking for or what the aim is to your treatment.

Book an appointment online now

I’ve Ignored this part of the site too long time. Planning on a lot more content. I have some ideas for content, but I’d also like to know what would you like to read about. You can contact me with your suggestions by clicking here. Just use bullet points if you want.

This is to get you thinking

I have trouble Writing about ME/CFS. Everyone seems to have an opinion. Some are very vehment in defense of they’re diagnosis, view or treatment. That’s why I’m asking you what you’d like to read about.

First of all there’s the names ME/CFS, Myalgic Encephalomyelitis, Chronic Fatigue syndrome, NeuroME, CFIDS, Fibromyalgia. These are just the names I can quickly think of it’s endless.

Are these all the same condition?  Does it depend on who diagnoses it? What do you think about this?

Date written Thursday 26 April