Hamstring Tendinopathy

What is Hamstring Tendinopathy?

A tendinopathy occurs when a tendon fails to heal after an overuse injury. This causes pain and swelling of the tendon and often results in a limp, lack of function and stiffness.

The hamstring tendons run from a bony prominence in the buttock area down the thigh and attach to the tibia (shin bone) just below the knee.

Hamstring tendinopathy is often seen in runners and in others whose sport involves repetitive running, jumping or kicking, such as football.  Football also predisposes people to this condition as it involves frequent acceleration and deceleration, another risk factor for this condition.

The condition often develops gradually but we see cases where sudden-onset symptoms are be provoked by an episode where the tendon is suddenly overloaded, such as a forceful kick in football or sudden acceleration or deceleration whilst running.

Pain is felt in the buttock and sometimes down the back of the thigh.  Symptoms can be made worse by sitting.  If the tendons are affected further down the leg, pain may be felt at the back of or on the inner side of the knee.

Factors that predispose to the condition include:

  • sudden increase in activity (such as a sudden increase in running distance) or excessive training (hence this being an “overuse” injury)
  • inadequate warming up and stretching prior to activity
  • muscle weakness
  • lower spine, hip or knee stiffness

How is Hamstring Tendinopathy diagnosed?

The condition can sometimes be confused with others, such as spinal problems.   Diagnosis of hamstring tendinopathy condition is made following a thorough assessment by an Orthopaedic Surgeon, Sports specialist or Physiotherapist.  Sometimes an MRI or Ultrasound scan is recommended to confirm the diagnosis or to exclude other conditions.

How is Hamstring Tendinopathy treated?

Treatment involves firstly identifying and correcting any causative factors.  Physiotherapy can be very helpful.  Treatment involves activity modification,  anti-inflammatory medication, exercises to improve strength, flexibility and core stability, stretches, massage, local ultrasound therapy, education on appropriate warming up and stretching pre-exercise and a graduated return to activity.

Unfortunately, the condition can often fail to respond to these measures, and many patients go on to suffer longer-term and are unable to participate in their usual recreational activities.

What if these don’t work?

In longstanding (chronic) cases that have not responded to other measures, we recommend shock wave therapy as it is a non-invasive, needle-free outpatient procedure that is well tolerated and successful in relieving pain in 80-85% of cases.  If shock-wave therapy doesn’t work then a PRP (platelet-rich plasma) can be performed under ultrasound guidance.

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