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Understanding Proximal Hamstring Tendinopathy (PHT) and Its Impact (Part 2)
(Part 1: https://www.upnadamptphysio.com/post/hamstrung-no-more-tackling-that-persistent-pain-in-the-butt )
Understanding the Functional Role of the Hamstrings
The hamstrings are essential for hip extension, knee flexion, and overall lower limb stability. They play a critical role in running, decelerating the leg & bending the knee during swing phase, stabilizing the knee during stance and assisting the gluteals with walk / run / push-type propulsion. However, repetitive compressive &/or tensile stress or sudden overload can lead to proximal hamstring tendinopathy (PHT), causing pain and dysfunction.
Key Risk Factors for Developing PHT
Several factors contribute to the development of PHT, including:
Mechanical Stress: Excessive tensile and compressive forces at the hamstring origin, particularly in activities involving hip flexion and knee extension.
Training Errors: Rapid increases in training volume, speed work, or hill running without adequate recovery.
Muscle Imbalances: Weak gluteal muscles may increase hamstring load, while tight hip flexors can contribute to altered movement patterns.
Sustained Compression: Prolonged sitting, particularly on hard surfaces, increases tendon compression against the ischium, worsening symptoms.
Preventing PHT: Modifying Risk Factors
To reduce the risk of PHT, consider the following strategies:
Gradual Progression: Avoid sudden spikes in training intensity; increase volume and speed gradually.
Recruitment / Strength Training: Incorporate hamstring and gluteal activation & strengthening exercises to enhance muscle support.
Proper Biomechanics: Optimize running mechanics by maintaining a controlled stride length and avoiding excessive forward trunk lean.
Avoiding Prolonged Sitting: Use a decompression cushion or standing workstation to minimize ischial compression.
Rehabilitation Strategies for PHT
Recovery from PHT requires a structured approach, including:
1. Load Management
Reducing aggravating activities while maintaining functional movement is essential. Modifications may include:
Adjusting Sitting Habits: Avoid deep or low chairs and prolonged forward lean postures.
Running Modifications: Reduce stride length, avoid hills, and limit high-speed sprints.
Activity Adjustments: Temporarily limit deep lunges, step-ups, and exercises that impose high compressive loads on the hamstring tendons.
2. Progressive Strengthening
Rehabilitation focuses on building strength without overloading the tendons. Key exercises include:
Isometric Hamstring Loading: Helps alleviate pain while promoting tendon adaptation.
Slow, Heavy Resistance Training: Nordic hamstring curls and eccentric exercises improve tendon resilience.
Functional Strengthening: Targeting hip abductors, glutes, and core muscles to optimize movement efficiency.
3. Tendon Adaptation and Recovery
Tendons adapt best to slow, progressive loading. A structured program, formulated by the Physios and Performance Trainers at Up N Adam Performance Training & Physiotherapy, incorporating controlled eccentric and concentric loading improves tendon structure and neuromuscular control, enhancing recovery and reducing re-injury risk.
By addressing biomechanical imbalances, modifying aggravating activities, and following a gradual strengthening program, individuals with PHT can regain function and return to their sport or daily activities with confidence.
This is APA Sports Physiotherapist, Darren Glendenning, signing off for now!
You can book an appointment with Darren or Newcastle Knights Physiotherapists Katie or Hayd'n at www.upnadamptphysio.com
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