Managing High Hamstring Strains

Treating Proximal Hamstring Tendinopathy

Similar to the patella tendon and the achilles tendon, the tendon at the origin of the hamstrings is thick and fibrous, with poor blood supply. These traits contribute to making recovering from high hamstring strains an often arduous process. With hamstring tendinopathy the issue is generally considered to be one more associated with a degenerative process than an inflammatory one. A symptomatic degenerative tendon is the more common presentation with high hamstring strains and tendons in this condition are referred to as being in a state of tendinosis.  Suggesting in descriptive terms that parts of the tendon have become frayed, thinned and more disordered. This tendinosis is again similar to the majority of Achilles tendinopathies I see in my practice, where the tendon rather than inflammation being the main source of symptoms, is more associated with an underlying degenerative complaint.  Making a diagnosis of a high hamstring strain and gauging severity and developing an understanding regarding what state the tendon is in, be it inflammatory, degenerative, reactive on degenerative, a tendon tear… can be achieved through a thorough history of the condition and its behaviour, coupled with a physical examination and/or this use of any medical investigations like an MRI.  Following this treatment can begin, directed at restoring the tendons capacity to take load again.

Loading For High Hamstring Strains

Achilles and patella tendon complaints for many years now have been treated quite effectively with  the prescription of eccentric strength exercises. Similar loading strategies make up a core part of high hamstring strain rehabilitation. Frequently loading begins with more sustained holds (referred to as isometric contractions) and progressing as tolerated towards more concentric and then eccentric (lengthening loading) exercises. A strong and stable core including hip musculature such as the deep gluteal muscles can help stabilize the pelvis, potentially taking strain off the hamstrings. And in the management of high hamstring complaints it is not uncommon to be prescribed exercises addressing trunk and hip stability to be included in any high hamstring rehabilitation program.
While some risk factors such as age cannot be altered, others proposed risk factors such as muscle imbalances and tissue flexibility, can be addressed through physiotherapy treatment. Patients should work with their physio to strengthen weak muscles, increase mobility in tight areas as well as optimize postural alignment, form and activity biomechanics where applicable.

Maintaining Fitness Whilst Rehabilitating High Hamstrings Strains

It is important whilst undergoing rehabilitation for high hamstring strains that fitness is maintained to help a smooth transition with return to play. Maintaining mental well being with long term layoffs resulting from injury, often a challenge in chronic tendinopathies which can be a real headache for athletes frustrated with the interruption to performance and/or training. Personally, I don’t have an issue with people cross training during their rehab and in fact I typically encourage it, however any cross training clearly should not stress the injury area throughout training, or felt post training (either once cooled down, or the following day). Your physiotherapist can help guide you on what would be considered appropriate cross training in your individual situation following assessment of the severity of the injury and specific demands of the sports and activities you wish to return to.

Tips For Avoiding Day To Day Aggravation With High Hamstring Strains

• High Hamstring strains are frequently uncomfortable, even painful when sitting, or with pressure applied to the ischial tuberosity (sit bones). Generally I recommend with high hamstring strains that individuals aim to limit their sitting and certainly attempt to avoid sitting on hard surfaces to minimize aggravating the condition.
• Some individuals will find bending their hip “up”, taking their knee up towards their tummy can cause pain, as the tendon is placed under stretch in this motion. Finding ways to reduce this motion day to day, when dressing and washing can help avoid unnecessary irritation to the tendon. Consider using loose slip on, or open shoes rather than shoes with laces, as tying laces, or pulling on tight shoes can cause a fair amount of discomfort with proximal hamstring pain.

Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on Managing High Hamstring Strains should consult his or her physiotherapist or otherwise appropriately skilled practitioner.