Upper hamstring tendon pain is a common condition experienced in runners and weight lifters. The pain is usually felt at the bottom on the glute area where the hamstrings attach to the pelvis. This blog post will discuss what causes upper hamstring tendon pain (commonly referred to as proximal hamstring tendinopathy) and how to treat it. Be sure to also check out our #DocTalk episode on hamstring pain here.
Upper hamstring tendon pain, sometimes called proximal hamstring tendinopathy, is considered to be an overload syndrome. This means that the load placed upon the tendon has exceed its ability to absorb the load. Two common ways of overloading the hamstring is by increasing the magnitude of load on the tendon too quickly (ie. adding too much weight) or increasing the frequency of load on the tendon too quickly (ie. running multiple times per week).
Running, sprinting, squatting, and lunges are frequently the movements associated with increasing load on the hamstrings, however, even prolonged sitting can lead to upper hamstring pain. This is because all of these movements involve flexing the hips which compresses the hamstrings against a bone in the pelvis (the ischial tuberosity).
The first step towards treating hamstring tendon pain is to manage the load that is being placed on it. Typically we would try to minimize the amount of time doing the aggravating activity (which may include limiting the amount of sitting!) so that the pain calms down. Once we have a plan for calming down the tendon pain, we can start a rehab program for the tendon to strengthen it.
The rehab program for hamstring tendon pain generally occurs in four stages: (1) loading without knee or hip movement (isometric contraction), (2) loading with knee movement (isotonic contraction), (3) loading with hip and knee movement, and (4) return to sport.
In the first stage, we will start placing load on the hamstring without any movement. Performing this type of exercise has been shown to have a pain reducing effect on tendons. Generally, we recommend 45 second holds for 5 repetitions at a heavy load (approximately 70% of your max). Examples of exercises for this stage include an isometric leg curl or a straight leg pull down.
During the second stage, we start introducing some movement but only at the knee joint. Exercises for this stage could include a prone leg curl, supine leg curl, or a Nordic hamstring curl. When doing these exercises, try to perform them slow and controlled.
Once we can tolerate loading of the hamstring with movement at the knee, we can progress to including hip movements. Hip thrusts, lunges, and deadlifts are all exercises that can be done in this stage.
In the final stage, we will start doing exercises that are specific to the sport or activity we want to do. For runners and sprinters, we may have them perform a sprinter’s leg curl. Or for a volleyball or basketball player, we may have them do more plyometric work like skipping and jumping. The goal of choosing an exercise for this stage is that we want them to be as similar to whatever is going to be done during the activity or sport.
Adjunct treatments should be aimed at decreasing pain and making the rehab program more tolerable. Soft tissue therapy, either performed by hand or by tool (Graston), can be used to de-sensitize the tissues. Kinesiology taping can also be used on the hamstring, which stimulates the receptors of the skin to block pain. While exercise is the only therapy that has been shown to increase the capacity of the tendon, these therapies can aid in the recovery process.
Upper hamstring tendon pain can be a pain in the butt. Following a rehab program that progressively increases the load on the hamstring while also using soft tissue therapy and kinesiology taping can help get you back to activity. As always, don't be afraid to seek out a professional to diagnose and help guide you on your road to recovery!