RS Podiatry Clinic

Hamstring Tendinopathy

What is Hamstring Tendinopathy?

Hamstring tendinopathy is a common condition that affects the tendons of the hamstrings, which are the muscles located at the back of the thigh. This condition is often seen in athletes, particularly those involved in sports requiring rapid acceleration, deceleration, and changes in direction, such as football, rugby, and sprinting. However, it can also affect non-athletes who engage in activities that place repeated stress on the hamstrings.

Anatomy of the Hamstrings

The hamstrings consist of three muscles: the biceps femoris, semitendinosus, and semimembranosus. These muscles originate from the ischial tuberosity of the pelvis and insert into the tibia and fibula bones of the lower leg. They play a crucial role in hip extension and knee flexion, which are essential movements in many sports and daily activities.

Causes of Hamstring Tendinopathy

Hamstring tendinopathy is primarily caused by repetitive strain and overuse of the hamstring tendons. Factors that can contribute to the development of this condition include:

  1. Sudden increase in physical activity: Rapid escalation in training intensity, duration, or frequency can overload the tendons.
  2. Poor biomechanics: Abnormal gait patterns, muscle imbalances, and improper running or training techniques can increase the stress on the hamstrings.
  3. Inadequate warm-up: Failing to properly warm up before exercise can leave the muscles and tendons vulnerable to injury.
  4. Weak core muscles: A weak core can lead to poor pelvic stability, increasing the strain on the hamstrings.
  5. Previous injuries: A history of hamstring strains or lower back issues can predispose individuals to tendinopathy.

Symptoms of Hamstring Tendinopathy

Symptoms of hamstring tendinopathy can vary in severity and may develop gradually over time. Common signs include:

  1. Pain: Pain is typically felt deep in the buttocks or at the back of the thigh. It may be more pronounced during activities such as running, jumping, or sitting for prolonged periods.
  2. Stiffness: Morning stiffness and discomfort after periods of inactivity are common.
  3. Weakness: Affected individuals may experience weakness in the hamstrings, making it difficult to perform activities that require strong hamstring contraction.
  4. Tenderness: Palpation of the hamstring tendons may reveal tenderness and swelling.

Diagnosis of Hamstring Tendinopathy

Diagnosing hamstring tendinopathy involves a thorough clinical evaluation by a medical professional, typically a sports podiatrist or physiotherapist. The diagnostic process may include:

  1. Medical history: A detailed history of the patient's symptoms, activity levels, and any previous injuries.
  2. Physical examination: This involves assessing the range of motion, strength, and flexibility of the hamstrings, as well as palpation of the tendons to identify areas of tenderness.
  3. Imaging studies: In some cases, imaging techniques such as ultrasound or MRI may be used to confirm the diagnosis and rule out other potential causes of pain.

Treatment of Hamstring Tendinopathy

The treatment of hamstring tendinopathy focuses on reducing pain, promoting tendon healing, and restoring function. A combination of conservative treatments is often effective:

  1. Rest and activity modification: Avoiding activities that exacerbate symptoms is crucial. This may involve temporarily reducing training intensity or switching to low-impact exercises.

  2. Strength and conditioning plan: A structured rehabilitation programme designed by a podiatrist can help strengthen the hamstrings, improve flexibility, and correct biomechanical issues. Eccentric exercises, in particular, are beneficial for tendon healing.

  3. Biomechanics assessment: Evaluating the running and walking gait can identify abnormal movement patterns that place excessive stress on the hamstrings. Correcting these biomechanical issues with targeted exercises and gait retraining can significantly reduce symptoms and prevent recurrence.

  4. Orthotics: Custom orthotics may be recommended for individuals with excessively pronated or hypermobile foot types. These devices can provide better arch support, improve foot alignment, and reduce the strain on the hamstring tendons during movement.

  5. Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) and ice therapy can help alleviate pain and reduce inflammation in the early stages.

  6. Corticosteroid injections: In cases of severe pain, corticosteroid injections may be considered, but these should be used with caution due to potential side effects and the risk of tendon rupture.

  7. Platelet-rich plasma (PRP) therapy: PRP injections involve using the patient's own blood, which is processed to concentrate the platelets and injected into the affected tendon. This can promote healing by delivering growth factors to the injured area.

  8. Shockwave therapy: Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that uses high-energy sound waves to stimulate tendon healing and reduce pain.

Prevention of Hamstring Tendinopathy

Preventing hamstring tendinopathy involves addressing the risk factors associated with the condition:

  1. Gradual progression: Increase the intensity, duration, and frequency of physical activity gradually to allow the tendons to adapt.
  2. Proper warm-up: Engage in a comprehensive warm-up routine that includes dynamic stretching and activation exercises for the hamstrings and surrounding muscles.
  3. Strength and conditioning: Incorporate strength training exercises that target the hamstrings, glutes, and core muscles to improve overall stability and reduce strain on the tendons.
  4. Biomechanical assessment: Regular assessments by a sports podiatrist or physiotherapist can help identify and correct any biomechanical issues that may contribute to tendon overload.
  5. Flexibility training: Regular stretching of the hamstrings and surrounding muscles can help maintain optimal flexibility and reduce the risk of injury.