Hamstring tendinopathy and rehabilitation
Proximal hamstring tendinopathy (PHT) is most common in athletes who have to perform at the end range of motion of the hip in the sagittal plane or in sports such as football, in which a change of direction is often required. PHT can be recognized by a deep pain near the ischial tuberosity, often exacerbating after sports activities. The pain can commonly be provoked through combined hip flexion and adduction. It is thought that tendon pathologies have their onset in training errors, such as increasing exercise intensity or frequency too quick.
This article describes progressive loading, while pain is being monitored, as the key to rehabilitation. Exercises should involve the whole kinetic chain. Progression of exercises is through patient reported outcome measures (such as a VAS scale).
Rehabilitation can be divided into 4 stages. Phase 1 is the resisted isometric fase in positions without tendon compression. Phase 2 involves isotonic exercises with hip flexion. In phase 3, hip flexion is increased. During this step progression towards hypertrophy and more functional training positions is made. Phase 4 involves energy storage loading, which means getting ready to return back to sports activities incorporating stretch shortening cycles.
Other treatments such as dry needling and soft tissue techniques have been utilized, but evidence is limited. It is thought that these techniques do not improve tendon loading capacity.
> From: Goom et al., J Orthop Sports Phys Ther 46 (2016) 483-493. All rights reserved to The Journal of Orthopaedic & Sports Physical Therapy.Click here for the Pubmed summary.