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Hamstring Tendinopathy

What is hamstring tendinopathy?

Hamstring tendinopathy, also known as high hamstring tendinitis, is a common overuse injury that affects the tendons at the top of the thigh where they attach to the sitting bone. The hamstring muscles, which consist of the semimembranosus, semitendinosus, and biceps femoris, are responsible for flexing (bending) the knee and extending the hip (bringing the leg backwards). The tendons attach these muscles to the bones in the pelvis and knee.

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Who is affected by hamstring tendinopathy?

Hamstring tendinopathy is most common in individuals who participate in activities that involve repetitive hamstring movements, such as running, jumping, and sprinting.

What are the main symptoms of hamstring tendinopathy?

 

The main symptoms of hamstring tendinopathy include:

Pain

Pain at the back of the thigh, particularly at the top end at the location of the sitting bone. Pain is felt during or after activities that involve hamstring use, such as running, jumping, or when sitting for long periods. Patients often notice significant discomfort when driving for long periods.

Tenderness

Increased sensitivity to touch at the sitting bone which can also result in the need to sit awkwardly, in order to offload weight from the tender spot, shifting weight to the other sitting bone.

Stiffness

Difficulty and pain on flexing the knee or extending the hip.

Weakness

Decreased strength in the hamstring muscles with pain on attempts to activate the muscles.

Loss of range of motion

Reduced ability to bend the knee or extend the hip.

How is hamstring tendinopathy diagnosed?

Diagnosis of hamstring tendinopathy typically involves a physical examination, medical history review, and sometimes imaging tests.

  • Physical examination:

    The doctor will carefully examine the thigh, checking for pain with resisted knee bend and hip extension. They will also assess for localised tenderness at the sitting bone, range of motion limitations, and weakness in the hamstring muscles.  The individual may find it difficult and painful to perform a hamstring bridge.
  • Medical history:

    The doctor will inquire about the patient's symptoms, activities, any previous hamstring injuries, and family history of tendon problems.
  • Imaging tests:

    Ultrasound or MRI scans may be ordered to visualize the tendons and rule out other causes of thigh pain, such as muscle strains or tears. Under ultrasound assessment the doctor will be looking at the tendon attachment to the sitting bone, looking for tears and inflammation surrounding the tendons.

How is hamstring tendinopathy treated?

 

Treatment for hamstring tendinopathy focuses on reducing inflammation (paratendinitis), alleviating pain, and restoring function to the hamstring muscles and tendons. Non-surgical treatments are usually effective and may include:

  • Rest:

    Avoiding activities that aggravate the pain.
  • Ice application:

    Applying ice packs to the affected area for 10-15 minutes at a time, several times a day, can help reduce inflammation and pain.
  • Over-the-counter pain relievers:

    Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help alleviate mild to moderate pain and inflammation.
  • Physiotherapy:

    Physiotherapy can provide exercises and stretches to improve range of motion, progressively load and strengthen the hamstring muscles/tendons, and promote normal hamstring movement patterns.
  • Gradual return to activities:

    Once the pain has started to settle then a gradual return to activity process can be initiated, starting with low-impact exercises and gradually increasing the intensity and duration of activities over time.
  • Corticosteroid injections:

    Corticosteroid injections can be used to reduce inflammation and pain surrounding the hamstring tendon.

At The Joint Injection Clinic, these injections are performed after a thorough consent process, whereby the risk and benefits of the procedure are discussed in detail with your doctor.  The experienced medical doctor will then place you in a front lying position.  The skin is cleaned using a cleaning solution to ensure that the procedure is performed under sterile conditions.  Local anaesthetic is injected from the skin to the tendon under ultrasound guidance.  After giving the local anaesthetic a few minutes to take effect, the tendon injection is performed with a small dose of steroid and local.

The injection itself is normally completed within 30-60 seconds, after which a plaster is applied and post-injection advice is given.  The patient is advised to look out for any signs of infection, specifically to check whether the local area becomes red, hot, tender, swollen or if they develop a fever.  If this occurs then the patient is asked to contact the clinic immediately at which time a formal reassessment will occur and if needed oral antibiotics can be prescribed.  The patient is also warned that following any injection they may notice a short-term worsening or flare in their symptoms after the local anaesthetic has worn off (4-5 hours).  This may last for 3-5 days and the patient is advised to consider icing of the area using an ice pack for 10-15 minutes every hour as required.