Proximal Hamstring Tendinopathy (pain at the base of your buttocks)
Hamstring pain has often been described as the 'pain in the bum'. People often describe pain right on their sitting bone and can feel it when sitting on hard surfaces, bending, walking and taking their shoes off.
It is often mistaken for sciatic pain or even the elusive 'piriformis syndrome' as it can travel down the leg slightly. The hamstring tendon attaches to your sit bone, which is at the bottom of your pelvis. The hamstring acts to bend the knee behind you as well as extend the hip back.
The hamstring can often become problematic if you are a runner and have had a previous hamstring strain or tear in the belly and not fully strengthened after. Or perhaps as you have increased your pace or intensity or volume of running or sport.
If you experience any numbness and pins and needles or associated back pain then there may be a problem with your back.
To test your hamstring, you can isolate it with the stretch below
If you feel pain with this stretch and/or when you resist the movement it is likely you have a hamstring tendinopathy.
TREATMENT OF HAMSTRING TENDINOPATHY
At JYphysiotherapy we are experts at diagnosing hamstring tendon problems as they are often missed or treated as back or sciatic problems. The two main aspects to manage hamstring tendons are reducing the COMPRESSION of the tendon as well as building up the hamstring strength both for the muscle and tendon.What is compression of a tendon?
A tendon can be visualised like an elastic tube when it is stretched it can squash down and if you were to sit on it or physically squash it, that would also make it squashed.
The same process seems to be problematic for tendons. So, if you imagine a hamstring tendon being stretched when you bend forwards or as in the above picture, this make be keeping the tendon in a painful state. So, the first few weeks you will try and avoid too many activities that cause compression. See below for some ideas.
These are a few positions that can put compressive forces through the tendon. So if you try and avoid these whilst your starting to build up strength then the combination should take effect.
Other things that may help is not sitting for too long especially on hard surfaces. Also Doing too much Pilates or yoga as there is a lot of back bends may not be helpful to start.
Alongside the compression gradually loading the hamstring is the answer. It is important to do it in positions that do not stretch the hamstring to begin with.
Photo 1 bent knee for hamstring. You can add resistance to this exercise by using theraband or by using the cable at the gym. Repeat 15)3
NB Successful programmes need to be monitored so it is always suggested that you get an expert to check that you are at the right phase at the right time. If things are getting worse DO NOT persevere, seek help.
Photo 2. Nordic curls. This is a hamstring exercise where you lean forwards using your hamstrings.
Photo 3 and 4. These are bridge variations. The main component is that your legs are not too bent to reduce the compressive forces.
As with all tendons make sure your pain levels do not go above a 3/10 and there is no lingering pain after the exercise or the following day.
- Back Pain and Sciatic pain
- Ante and post natal Back pain
- Hip pain
- Tendon pain
- The Young Sports person
- Sports Injury
- Knee pain
- Neck pain
- Shoulder pain
Surbiton Hockey Club
At JYPhysiotherapy we have been working with Surbiton Hockey Club for the last year and compiled a list of helpful tips and videos to help you with injury prevention.
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