The hamstrings are made up of three muscles that are responsible for the flexion at the knee and extension of the hip. There are two hamstrings on the inside of the leg at the back of the thigh and one on the outside. These muscles originate from the pelvis and insert at the knee/shin bone. Injury to the hamstrings are most common in athletes although anyone can be at risk. Tendon issues tend to occur at either attachment point of the hamstrings, this is where the muscle connects to bone. when hamstring tendons are overused small tears occur in the tendon causing inflammation and pain.
Symptoms of a hamstring’s tendinopathy will differ depending on which tendon is damaged. In most cases this is proximal (top of the hamstring). Typically, the main complaint will be a deep posterior hip/thigh pain with gradual onset that is provoked with activities such as biking running and often with prolonged sitting.
Other common symptoms:
- Pain when sitting
- Pain with sudden accelerating/sprinting
- Pain when bending from the hips
- Repetitive activity aggravates symptoms
- Muscle tightness/stiffness
- Sharp/burning pain
Symptoms tend to get worse with further exercise, often aggravated after long periods of inactivity like sleeping or sitting.
The proximal hamstring tendons connect the three hamstrings to the bottom of the pelvis this is located deep in the buttocks at the bottom of the pelvic bone. These tendons are prone to injury especially in activities that involve repetitive movements such as running or rowing. The tendon damage becomes worse over time if not rested in the correct way. It usually begins with one or more of the following.
- A previous injury in the hamstring that did not receive correct rehabilitation and failed to heal fully. This has left weakness in the muscle/tendon reducing the amount of load it can take.
- Repetitive stress/overuse injury that has not been addressed and has turned into an inflammatory tendon condition (tendinopathy) where in some cases it can cause degenerative changes to the tendon.
Conservative management (Treatment)
Conservative management will help to promote healing and reduce and risk of further injury. These techniques can be used at home with no physiotherapist or doctor intervention although to achieve best results consult with a physio or doctor for extra tips and guidance.
- Rest is important to allow the body to complete its natural phases of healing and offload the tendon that is overstressed. You should not continue any activity that aggravated your symptoms.
- A risk factor for tendinopathy is tightness in various muscle groups therefore addressing this early on will enable a fast recovery time. Although depending on what level of severity your damage is, will depend on whether you should stretch or not (contact a physiotherapist for more guidance).
- Strength is key to prevention and treating any tendon issue as the cause is relative to overuse. Therefore, by resting the overused structure and gradually strengthening back to its full capacity will reduce the risk of a second injury.
- Ice therapy can be used to address swelling and to reduce pain. Ice should be used for no longer than 15 minutes at a time and not placed directly on the skin. This should be used every 2-4 hours throughout the day.