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High Hamstring Tendinopathy

High Hamstring Tendinopathy

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.

Please note. I can’t give a diagnosis online, If you live or work in the Glasgow area it may be an idea to book an appointment.  Click to book an appointment now.