Proximal Hamstring Tendinopathy Rehab (4 Stages)

Summary

In this video, Dr. Mark Sertica, a physical therapist, discusses the assessment and management of proximal hamstring tendinopathy, a condition that commonly affects athletes and active individuals. He explains the anatomy of the hamstrings, the balance between tendon load and capacity, and the gradual onset of symptoms. The video outlines a step-by-step rehabilitation approach, from isometric exercises to sport-specific movements, emphasizing the importance of monitoring symptoms, adjusting activity levels, and gradually building capacity. Dr. Sertica stresses that rehabilitation takes time and consistency, with expected recovery spanning three to six months.

Takeaways

• 😀 Proximal hamstring tendinopathy (PHT) is a condition involving deep, localized pain near the ischial tuberosity, often aggravated by activities like running, lunging, and sitting.
• 😀 The hamstring muscles (semimembranosus, semitendinosus, biceps femoris long head) originate from the ischial tuberosity and are involved in hip extension, knee flexion, and posterior pelvic tilt.
• 😀 PHT is a non-traumatic condition with a gradual onset, and the focus of treatment is on balancing load (stress) and capacity (tolerance) rather than inflammation or degeneration.
• 😀 Pain during rehab for tendinopathies is normal, but it should remain tolerable (ideally <3/10 pain) and not interfere with daily activities like work, sleep, or study.
• 😀 Monitoring symptoms post-exercise is crucial. If pain increases the next day, it may indicate overloading, requiring adjustments in activity or exercise intensity.
• 😀 The rehab process for PHT includes four stages, starting with low-intensity isometric exercises and gradually progressing to more dynamic and sport-specific movements as pain tolerance improves.
• 😀 Stage 1 of rehab focuses on isometric hamstring loading exercises (e.g., bridge holds, leg curls) at low hip flexion angles, performed 3-5 sets of 15-45 seconds per day.
• 😀 Stage 2 introduces isotonic loading exercises (e.g., single-leg bridges, hamstring sliders) with minimal hip flexion, progressing from no weight to added resistance, 3-4 sets of 8-15 reps every other day.
• 😀 Stage 3 progresses to exercises that involve more hip flexion (70-90 degrees), such as hip thrusts and deadlifts, with 3-4 sets of 6-12 reps every other day, incorporating heavier weights and faster movement over time.
• 😀 Stage 4 is for athletes returning to sport, focusing on high-intensity movements (e.g., sprints, bounding) to build tolerance to high loads and sport-specific drills, performed every third day.
• 😀 It is important to identify and modify aggravating factors (e.g., sitting, cycling) to reduce tendon load. Small changes in daily activities can make a big difference in long-term recovery.

Q & A

What is proximal hamstring tendinopathy and who is most likely to experience it?

Proximal hamstring tendinopathy is a condition that affects the tendons of the hamstring muscles near the ischial tuberosity (sit bone). It is common among athletes like runners, sprinters, hurdlers, and football players, but can also affect less active individuals, including yoga practitioners.

What are the primary functions of the hamstrings?

The hamstrings are involved in hip extension, knee flexion, and posterior pelvic tilting. They help in movements such as running, lunging, squatting, and other sagittal plane motions.

Why is the biceps femoris short head not included in the discussion of proximal hamstring tendinopathy?

The biceps femoris short head is not relevant to the diagnosis of proximal hamstring tendinopathy as it has a different origin and innervation compared to the other hamstring muscles.

How does load and capacity relate to proximal hamstring tendinopathy?

Proximal hamstring tendinopathy is believed to occur when the load placed on the tendon (from activities like running or sitting) exceeds the tendon’s capacity to tolerate those stresses. This imbalance can result in tendinopathy.

What are the three key criteria for monitoring symptoms in tendinopathy rehab?

The three key criteria for monitoring symptoms are: 1) ensuring pain is tolerable during exercise (around 3/10 or less), 2) checking if symptoms worsen after exercise and affect daily activities, and 3) evaluating the condition 24 hours later to assess any flare-ups.

What exercises are recommended for managing proximal hamstring tendinopathy?

The recommended exercises include: 1) Isometric exercises like bridge holds and leg curls, 2) Isotonic exercises like single-leg bridges and eccentric hamstring curls, and 3) Higher-level dynamic exercises such as hip thrusts and deadlifts.

Why are hamstring stretches discouraged during early-stage rehabilitation?

Hamstring stretches are discouraged because they place high tensile and compressive loads on the hamstring tendons, which can exacerbate symptoms early in the rehabilitation process.

What are the stages of rehabilitation for proximal hamstring tendinopathy?

Rehabilitation is divided into four stages: Stage 1 focuses on isometric hamstring loading, Stage 2 on isotonic exercises with minimal hip flexion, Stage 3 on isotonic exercises with increased hip flexion, and Stage 4 on energy storage loading, particularly for athletes returning to sport.

How can individuals modify their activities to help manage tendinopathy symptoms?

Individuals can modify their activities by adjusting factors like exercise intensity, duration, and type. For example, reducing running distance, substituting cycling for swimming, or incorporating regular breaks during prolonged sitting can help manage symptoms.

How long is the expected duration for recovering from proximal hamstring tendinopathy?

Recovery from proximal hamstring tendinopathy typically takes 3 to 6 months. It requires consistent rehabilitation, including managing load, monitoring symptoms, and gradually progressing exercises.