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Hamstring tendonitis, also called hamstring tendinopathy, is a painful condition of irritation of the hamstring tendons. The hamstring has proximal tendons, at the ischial tuberosity of the pelvis, and distal tendons behind the knee. Tendonitis at the distal tendons is often called a low hamstring tendonitis, and at the ischial tuberosity it is called a high hamstring tendonitis.
Tendonitis is a degenerative condition where the tendon has been overloaded, either overloaded to a low level over a long period of time, or a sudden large overload. Recovery after overload is when the muscle and tendon can repair. This must be in balance with the overload. Some overload with sufficient recovery time will cause strengthening, too much overload or insufficient recovery will cause a breakdown or degeneration of the tendon and can lead to tendonitis. While there are many similarities to the pathology and recovery, due to their distinct locations each needs to be treated individually. Here, we will answer the commonly asked questions regarding low hamstring tendonitis.
Low hamstring tendonitis will present as pain and possible stiffness at the back of the knee, with pain to press or squeeze the hamstring tendons on the inside or outside of the knee. Sometimes the tendons may feel thicker than the same tendons on the opposite leg. In most cases, tendonitis starts after a period of increase in activity, that might be an increase in volume or intensity, or taking up a new sport. For a confirmation of your suspected diagnosis, you should see a physical therapist or sports doctor. They will do a physical examination and may wish to get additional confirmation from diagnostic imaging.
Treatment to reduce pain from hamstring tendonitis is varied depending on the severity of your symptoms and how long you have had the symptoms for. For some acute cases, complete rest and ice is needed to bring down the pain intensity. For other, more chronic cases, some targeted activation of the hamstring muscles in the form of isometric contraction (a static hold) can reduce pain (Rio et al, 2015).
Hamstring tendonitis will usually settle and symptoms will resolve in 6 weeks. However, if there is severe pain or symptoms are chronic, and have persisted for more than 2-3 month, it will take longer. A tendon can take 4-6 months to fully recover. General health of the individual will affect healing time as well as specific lifestyle factors, drinking alcohol and smoking will both increase recovery time. Additionally, if the tendon is not given the appropriate reduction of activity and relative rest, as well as the optimal stimulation for recovery, it will be a slower recovery process.
Strengthening for a hamstring tendonitis can be done in many ways, and depending on what phase of recovery you are in, will affect your selection of strengthening style. Early hamstring tendonitis strengthening may be in the form of static resistance, also called isometric holds, such as a bridge position hold. Later stages may use slow movements through the inner range of the muscle (the short position of the muscle), such as a hamstring curl. Then building up to movements through the full range, including the outer range (lengthened position) such as a straight leg deadlift. Final stages may work on faster movements or more powerful contractions, as well as functional movements. You should follow the guidance of an experienced physical therapist to ensure you get the most out of your time and effort rehabilitating.
A bridge exercise with your knees at 90º is a great way to work your hamstrings and glute muscles. It can strengthen the hamstring while keeping it is a short position and is unlikely to irritate the tendon.
A long lever bridge is a great progression, still keeping the hamstrings in a relatively short position, so it is unlikely to irritate the tendons. But with more load as the knee is at a smaller angle of flexion.
If it is taking longer than expected to heal, then firstly check that your expectations are correct. Tendons are slow to fully heal. While it might only be a few weeks for an acute injury on a health strong body, it can take much longer for a chronic injury on an older and/or weaker body.
Factors that will increase the healing time of a hamstring tendon include: general health of the individual, the tendon health prior to injury, the duration of symptoms, severity of symptoms, consumption of alcohol, smoking status and, quality and duration of sleep. That is, along with the physical loading of the tendon and the relative rest of the tendon. In many cases, the balance between loading and rest is not there, and this is the prime reason for the recovery taking longer than hoped.
Massage is used for reducing the tone and relaxing muscles, and often used for these benefits with musculoskeletal injuries, to improve healing and speed up recovery time. Deep tissue massage is effective for relaxation and reducing tone. Deep transverse friction massage can be helpful for short term pain relief.
Foam rolling has benefits similar to massage, but the bonus that it is possible to do at home, more frequently, and at a fraction of the cost. Deep pressure moving through the muscle or held on tight points along the muscle can help to reduce tendon and tone. This can help tendonitis be reducing the load on the tendon at rest.
For many individuals with a chronic hamstring tendonitis is it possible to keep running. In most cases they will be restricted as to how much running, how fast, and what terrain they can run on. Faster running and uphill running puts more load on the hamstrings, as does some running styles. If you plan to continue running with your injury, you should consult your physical therapist, to check this is sensible in your case. They can assess that your running style and ensure this does not negatively impact your recovery time.
Essentially, it depends on how running affects your symptoms. Here are 3 good rules to follow:
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.