High Hamstring Tendinopathy in Runners: Meeting the Challenges of Diagnosis, Treatment, and Rehabilitation

Abstract

High hamstring tendinopathy is an uncommon overuse injury seen in running athletes. Patients typically report deep buttock or thigh pain. A detailed physical examination and, occasionally, imaging studies are necessary to confirm the diagnosis. Rehabilitation involves soft-tissue mobilization, frequent stretching, and progressive eccentric hamstring strengthening and core stabilization exercises. In recalcitrant cases, an ultrasound-guided corticosteroid injection into the tendon sheath can be helpful, and, occasionally, surgery may be necessary to release the scar tissue around the proximal hamstring muscles and the sciatic nerve.

The management of bilateral high hamstring tendinopathy with ASTYM®treatment and eccentric exercise: a case report

“…1,14 Eccentric hamstring weakness has been associated with an increased risk for injury and eccentric training has been shown to reduce the chance of re-injury. 1,[15][16][17] There is less research available on the effects of eccentric hamstring training for reducing pain and allowing athletes to return to sport. A case study reported that an 8-month eccentric-based rehabilitation program was effective at allowing a football player with chronic-recurrent hamstring strains to return to sport.…”

“…1 Limited information is available on the diagnosis and treatment of HHTs but histologic studies have shown dense fibrosis at the hamstring attachment to the ischial tuberosity. 1,2 Running is thought to place the hamstrings at risk for injury because of the large amount of time that the muscle group spends under maximal stretch and because of repetitive eccentric loading into this position. 1,3 Eccentric strength training has shown promise as an effective treatment for many types of tendinopathies.…”

“…1,2 Running is thought to place the hamstrings at risk for injury because of the large amount of time that the muscle group spends under maximal stretch and because of repetitive eccentric loading into this position. 1,3 Eccentric strength training has shown promise as an effective treatment for many types of tendinopathies. 1,[3][4][5][6][7][8] Various mechanisms have been proposed to describe the effects of eccentric exercise on tendon healing.…”

“…1,3 Eccentric strength training has shown promise as an effective treatment for many types of tendinopathies. 1,[3][4][5][6][7][8] Various mechanisms have been proposed to describe the effects of eccentric exercise on tendon healing. It has been suggested that eccentric exercises work by promoting collagen fiber cross-linkage within the tendon to allow remodeling to occur.…”

Posterior, Lateral, and Anterior Hip Pain Due to Musculoskeletal Origin: A Narrative Literature Review of History, Physical Examination, and Diagnostic Imaging

“…30 Proximal hamstring tendinopathy is sometimes referred to as hamstring syndrome and can produce symptoms mimicking sciatica in addition to focal posterior hip pain. 31,32 The clinical features of proximal hamstring tendinopathy include previous injury, pain during activity, and pain with prolonged sitting. [32][33][34] The clinical examination may reveal tenderness or pain elicited with palpation, muscular defect over the ischial tuberosity against resisted knee flexion or hip extension, and pain with passive stretching of the muscle.…”