INJECTION THERAPY FOR PROXIMAL HAMSTRING TENDINOPATHY

What is Proximal Hamstring Tendinopathy?

The ischial tuberosity is connected to the hamstring muscles by a tendon (the bones you sit on, deep to your buttock muscles). The proximal hamstring tendon is the name given to this tendon. The internal structure of this tendon can be compromised if it is subjected to repeated pressures and strains. The afflicted tendon becomes weaker and painful once it has been compromised. A proximal hamstring tendonopathy is what this is called.

What are the symptoms of Proximal Hamstring Tendinopathy?

The following are signs and symptoms of proximal hamstring tendinopathy:

  • A sharp or deep throbbing pain in the buttocks over the sitting bone that is worse by extended sitting, standing after sitting, walking, and exercise.
    After exercise, latent discomfort deep in the buttocks that can last the next day Pain that progressively grows after beginning a new activity, frequently without trauma
  • When stretching your hamstring muscles, you may experience pain.

What are some additional conditions that are similar to Proximal hamstring tendinopathy?

  1. Femoroacetabular impingement
  2. Greater trochanteric pain syndrome
  3. Iliopsoas tendinopathy
  4. Osteitis pubis
  5. Hip osteoarthritis

Proximal hamstring osteoarthritis vs greater trochanteric pain syndrome:

Both proximal hamstring tendinopathy and greater trochanteric pain syndrome are mostly tendon disorders that are frequently linked to weak hip muscles. The site of pain is the most important diagnostic criteria. In contrast to the discomfort of greater trochanteric pain syndrome, which is felt on the outer portion of the hip, proximal hamstring tendinopathy is felt deep in the buttock.

What is Proximal hamstring tendinopathy?

The proximal hamstring tendon endinopathy is a prevalent cause of buttock pain that can cause a lot of discomfort and incapacity. Tendon pathology is common in both occupational medicine and sports medicine, and it is frequently linked to unusual activity and overuse. Tendinopathy is thought to be the cause of up to half of all injuries (Rees at al, 2009).

Patients of all ages, from young long-distance runners and sprinters to the more sedentary elderly, suffer from proximal hamstring tendinopathy. It’s also known as hamstring origin tendonopathy or high hamstring tendonopathy. The injury happens where the hamstring muscles join to the ischial tuberosity (your sitting bone).

It usually starts at the buttock crease and refers down the leg, causing pain at the top of the thigh (see illustration above). Sitting, extended walking, driving, and running are all known to worsen it. Patients frequently have had this problem for months, if not years, before coming to visit us. It’s well-known for being a difficult and frustrating injury to recover from.

The Anatomy of hamstring

The hamstrings are a trio of muscles positioned near the rear of the thigh. The biceps femoris, semimembranosus, and semitendinosus muscles are the names of these muscles. A short, strong, and powerful tendon connects all of these muscles to the ischial tuberosity (sitting bone) (see image below). The proximal hamstring tendon is what it’s called.

The hamstrings are a large, powerful muscle group that controls hip extension and knee flexion. During sports, especially running and sprinting, they are constantly under pressure and are subject to pain and injury.

Why does proximal hamstring tendinopathy occur?

The specific origin is uncertain, however it appears to be linked to recurrent tendon tension and overload. During movements like sprinting and jumping, the proximal hamstring tendon stores energy. Injury can occur when the tendon is subjected to extreme, high energy demands for an extended length of time. Tendon overload is thought to cause structural changes within the tendon, resulting in weakening and pain. Excessive, high energy demand sometimes occurs as a result of a rapid increase in training and/or insufficient recuperation time between bouts of intense activity. For example, if it is a new exercise or you have not done it in a long time, you should run every day or play football every Saturday and Sunday. The tendon may become irritated and inflamed as a result of this action. Tendinitis is the medical term for this condition. When tendinitis occurs frequently, the healing process is slowed, and the tendon thickens and swells. Tendinopathy refers to a thickened, swollen tendon. This process can take months, although the actual discomfort typically occurs suddenly, such as during a run. A tendon tear can occur as a result of a specific injury to the tendon. This can happen during a sprint, when reaching for a football, or when extending the hamstring above its limit, such as when doing the splits. Tears will usually heal with time, but it is not uncommon to suffer chronic tendon discomfort as a result of a rip.

How is a proximal tendinopathy daignosed?

How can you know if you have proximal hamstring tendinopathy? It is critical to have a precise diagnosis in order to adopt the most effective treatment plan for your disease. A clinical examination and diagnostic imaging are required for a formal diagnosis of proximal hamstring tendinopathy. Joint injection’s experts are all experienced physiotherapists and musculoskeletal sonographers, so we can diagnose your injury with clinical testing while also doing a diagnostic ultrasound scan at the same time. A scan will confirm a diagnosis as well as assess the following:

  • What are the tendons that are involved?
  • Is there a tendon tear present?
  • Is there any ischial bursitis present?
  • What is the extent of tendonitis?

We will also perform a comprehensive assessment of your lower limb during your initial consultation to detect any other potential contributing causes. Your muscle strength, flexibility, and range of motion will all be evaluated. You may be asked to repeat the movement that causes your pain during your evaluation. This could be anything as simple as squatting or running on a treadmill. Once a diagnosis has been established, a treatment plan tailored to the person will be devised.

What else could it be?

Other disorders can be mistaken with proximal hamstring tendinopathy. These are some of them:

  • The lower back is the source of the referral.
  • Sciatic nerve irritation (‘sciatica’) is a condition in which the sciatic nerve is irritated.
  • Pain in the sacroiliac joint
  • Stress fracture of the posterior pubic or ischial ramus
  • Impingement of the ischium on the femur
  • Apophysitis or avulsion in teens

We’ll be able to tell the difference between these ailments during your appointment. It’s possible that you’re dealing with more than one issue that’s causing you discomfort. It’s not uncommon to experience proximal hamstring tendinopathy and sciatic nerve discomfort, for example.

What is the best way to treat proximal hamstring tendinopathy?

Conservative management practises are positively received by the majority of individuals. To strengthen the tendon and muscle, physiotherapists commonly combine manual soft tissue treatments with a gradual loading/rehabilitation programme.

It’s crucial to keep in mind that many tendon issues take a long time to heal, often months. If you’ve had a tendon problem for more than six months, expect it to take three months to totally heal. Rehabilitation is time-consuming and takes both patience and perseverance.

The good news is that you rarely need to take a break from any of your sports or activities. For most tendinopathies, including proximal hamstring discomfort, rest has not been proved to be a viable therapy strategy.

Following your evaluation, you will be given specific counsel and therapy. However, here are a few simple pointers that may assist you in your recovery:

  • Activities that cause pain should be avoided or modified. Running, cycling, squatting, and deadlifting are all uncomfortable exercises. For example, if a 10-mile run causes you pain, reduce your run to two 5-mile runs each week with 2-3 days between them.
  • Avoid putting yourself in positions that are unpleasant to your body. Limit long periods of sitting, especially on a hard surface, as this might irritate the tendon. Crossing your legs might further add to the tendon’s stress.
  • Use a standing desk or taller seats with a soft surface. To avoid direct contact between the proximal hamstring tendon and the seat surface, some persons choose to sit on a blow-up doughnut cushion.
  • Stretching your hamstring can increase the pain, according to our experience. The tendon is compressed as a result of this. If your physician hasn’t told you otherwise, don’t stretch. If you practise Yoga, you will most likely need to adapt your poses to avoid aggravating the tendon.
  • Begin by doing some easy hamstring strengthening exercises. A bridging exercise is a good example (see image below). Start with both legs and work your way down to single leg bridges. In a perfect world, you’d lift your hips up and down slowly 12 times. Every other day, do three sets.

What do you do if these strategies dont work?

In some cases, conservative treatment is insufficient to relieve proximal hamstring tendinopathy. There are a few other therapy alternatives accessible to you in this scenario. Following your examination and ultrasound scan, your doctor will discuss these options with you and advise you on which is best for you.

There are two alternatives at this point:

  • Shockwave therapy
  • injection with ultrasound guidance

Both of these options are used in conjunction with treatment. This means they should be used in conjunction with rehabilitation and activity modification rather than as a stand-alone treatment.

Extracorpeal Shockwave Therapy:

Shockwave therapy is a regularly utilised evidence-based treatment technique for tendon discomfort. The goal of this treatment is to give a tiny amount of controlled micro-trauma to the afflicted tendon. Your natural healing process is triggered by this micro trauma. Furthermore, shockwave desensitises local nerve terminals, resulting in pain relief. This may offer you with a window of opportunity to continue your recovery programme.

At 6 weeks and 12 months, shockwave is found to be superior than physiotherapy and medicine (NSAIDs). This demonstrates a long-term beneficial effect on proximal hamstring tendonopathy discomfort (Cacchio et al, 2011).

According to studies, 3 to 5 shockwave sessions are required to alleviate discomfort and increase tendon quality. Our clinicians are all completely qualified to administer shockwave therapy and have a lot of experience doing so for proximal hamstring discomfort.

Conservative treatment for proximal hamstring tendinopathy fails to relieve symptoms in a small minority of instances. If your symptoms persist, we’ll talk to you about the possibility of steroid injections. Steroids have a powerful anti-inflammatory effect.

Steroid injections are used to treat a variety of tendon problems and can help you get back on track with your rehabilitation programme by reducing inflammation and pain. They increase your sitting tolerance in the vast majority of cases.

Steroid injections are not curative, but they do provide a window of opportunity for muscle and tendon strengthening in a pain-free environment, allowing you to return to your preferred activity.

Ultrasound guidance is required for injections for proximal hamstring tendinopathy. Joint Injections, we use real-time ultrasound to guide the method for all of our injections. To decrease any pain connected with the surgery, we normally combine local anaesthesia with the steroid. We anticipate that the injection will provide you with immediate pain alleviation. The majority of individuals experience a reduction in pain 3-4 days after receiving the injection. We always advise you to begin your rehabilitation exercises as soon as the discomfort subsides.

Ultrasound guided injection (USGI)

Conservative treatment for proximal hamstring tendinopathy fails to relieve symptoms in a small minority of instances. If your symptoms persist, we’ll talk to you about the possibility of steroid injections. Steroids have a powerful anti-inflammatory effect.

Steroid injections are used to treat a variety of tendon problems and can help you get back on track with your rehabilitation programme by reducing inflammation and pain. They increase your sitting tolerance in the vast majority of cases.

Steroid injections are not curative, but they do provide a window of opportunity for muscle and tendon strengthening in a pain-free environment, allowing you to return to your preferred activity.

Ultrasound guidance is required for injections for proximal hamstring tendinopathy. At Joint Injections, we use real-time ultrasound to guide the method for all of our injections. To decrease any pain connected with the surgery, we normally combine local anaesthesia with the steroid. We anticipate that the injection will provide you with immediate pain alleviation. The majority of individuals experience a reduction in pain 3-4 days after receiving the injection. We always advise you to begin your rehabilitation exercises as soon as the discomfort subsides.

How many injections can you have?

We are frequently asked how many shots are safe. It is quite rare to require more than one injection for proximal hamstring tendinopathy.

If you have proximal hamstring tendinopathy, you should try a steroid injection.

1. Due to pain, you are unable to participate in a rehabilitation programme.

2. The discomfort is affecting your quality of life, and you have not improved with conservative treatment, such as physiotherapy.

3. You have a limited ability to sit (less than 20 minutes) and have not improved with conservative treatment, such as physiotherapy

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all Hip and Pelvis disorders, including Proximal Hamstring Tendinopathy. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.