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Proximal Hamstring Tendinopathy

The Hamstrings are the group of muscles at the back of the thigh. At each end of the muscles, they attach to the bone via a tendon and the end closest to your bottom is the proximal end.

A tendinopathy is essentially a problem with a tendon which is usually caused by an unaccustomed amount or type of activity. Things that can make you more likely to get a tendinopathy include: increases in loading especially compressive loading, age, genetics, hormones, and some medications.

There are different stages of tendinopathy which will determine how long it takes to improve. The reactive stage is the first stage and can be managed well with anti-inflammatories, rest, and gradual increase in loading above and beyond your requirements. The disrepair stage is when the tendon tries to heal itself but does a poor job, resulting in changes within the tendon which reduce the strength and potentially make it more painful. The degenerative stage is where some cells within the tendon begin to die, the structure of the tendon becomes less orderly and less tolerant to load.

Sometimes people can have tendinopathies show up on imaging even though it isn't the problem. This is because your body can adapt to having a tendinopathy. The main aim of treatment is to optimise the amount and type of activity you do with the tendon to get it to adapt to the demands you place on it. Rehab initially focuses on reducing pain and improving strength of the tendon, it then progresses into activities that you would like to do, developing strength and speed as required for what you need to do. Often, we start with holding exercises to reduce the pain and begin the strengthening process. The next stage is to progress into slow repetitions through range with increasing loads. Finally, adding speed to increase stiffness and elastic properties if it's required.

The current research indicates that steroid injections offer some relief but do not help the tendon adapt for the long term. Optimal loading programs for tendons have good long term outcomes, especially if rehab is continued after your pain subsides and you can perform the tasks required.

Courtney has kindly demonstrated some of the exercises often included in proximal hamstring tendinopathy rehabilitation.

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