Do you suffer pain in the lower buttock/sit bone region? You may be experiencing proximal hamstring tendinopathy.
Definitions:
- Proximal means near the centre of the body (therefore, top of the back of your thigh).
- Tendon is like a cord of strong, dense connective tissue that attaches muscles to bones.
- Tendons help to absorb high levels of forces.
Where’s the tendon pain?
Deep, localised pain in the region of the ischial tuberosity/sitting bone. You can also have pain or tightness at the back of the thigh. If there is nerve entrapment, you may have nervy symptoms like pins and needles, numbness, or sharp pain referred down the leg.
When does it hurt?
- Pain sometimes with sitting especially on hard surfaces
- Walking up stairs
- Walking/running up hill
- Forward lean activities
- Unable to stretch the tightness/pain out
The Impact:
- The pain can be very bothersome in sitting impacting work & social
- It may have the effect of reduced day to day activity levels
- It may have the effect of reducing sporting performance
Most commonly seen in:
- Runners especially long distance
- Dancers
- Yoga
- Hockey
- Older males
- Post menopausal women
How does it happen?
In hip flexion the hamstring tendon wraps around the ischium bone/sitting bone like a pulley. When the tendon is inflamed when overloaded, compression from the tendon on the bone(that is usually tolerated) becomes irritating. This is more apparent in positions of a deep forward lean, especially with a straight leg (when the hamstring is its tightest). Irritation can occur when your muscle is relaxed going into that position like a deep hamstring stretch or when you are actively using that muscle, like on an arabesque type movement.
Here are some examples of common sources of compression positions:
If you resonate with this condition, the good news is that physiotherapy is the gold standard for first line management. A physiotherapist will help you understand your condition, modify the positions/movements that are irritating to alleviate pain, assist you nourishing your hamstring tendon with appropriate exercises and the appropriate amount of loading to overcome the condition. Exercises like bridges from the floor and prone hamstring curls are wonderful for a proximal hamstring tendon.
Some General Tendon Rules (very different to muscle!):
- Don’t poke the tendon
- Don’t stretch the tendon
- Get the loading right & gradually increase strength- not too much & not too little and you’ll have a happier tendon
– Lucy
References:
- Beer, B. (2022) How to rehabilitate proximal hamstring tendinopathy, POGO Physio Gold Coast. Available at: https://www.pogophysio.com.au/blog/how-to-rehabilitate-proximal-hamstring-tendinopathy/ (Accessed: 12 October 2024).
- Grimaldi, A. (2024) Proximal hamstring tendinopathy, Dr Alison Grimaldi. Available at: https://dralisongrimaldi.com/store/ebook/understanding-tendinopathies-of-the-hip-pelvis/proximal-hamstring-tendinopathy/ (Accessed: 12 October 2024).
- Proximal hamstring tendinopathy (no date) Physiopedia. Available at: https://www.physio-pedia.com/Proximal_Hamstring_Tendinopathy (Accessed: 11 October 2024).
- Lempainen, L. (2015) ‘Expert opinion: Diagnosis and treatment of proximal hamstring tendinopathy’, Muscles, Ligaments and Tendons Journal [Preprint]. doi:10.11138/mltj/2015.5.1.023.
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