Hamstring Tendonitis
What is it and how is it treated?
What is hamstring tendonitis?
Hamstring tendonitis, also called hamstring tendon injury, is a common injury to the large hamstring tendon that attaches the hamstring muscle to the lower part of the pelvic bone. We see this overuse injury in endurance runners, triathletes, and team sports such as hockey, rugby, and football.
Also, tendonitis occurs at the attachment of the hamstring to the inside of the knee. These conditions are also known as pes anserine bursitis or semimembranosus tendonitis. Generally, athletes present with pain at the back of the knee, often toward the inside.
Hamstring tendon pain
People with proximal hamstring tendinopathy typically report a gradual onset of pain in the lower buttock. In some cases, the pain moves down to the upper part of the hamstring muscle. Pain is worse after walking and running and better with rest. In severe cases, pain occurs when sitting or driving. Sometimes, people experience numbness and pins and needles in the back of the thigh caused by irritation of the large nerve close to the tendon. In rare cases, the hamstring tendon’s entrapment of the proximal sciatic nerve causes symptoms down the leg, similar to piriformis syndrome or deep gluteal syndrome.
Generally, it is essential to confirm that the hamstring tendon is the cause of pain. We examine people to rule out other causes of buttock pain, such as a pinched nerve from the lower back or ischiofemoral impingement. Imaging such as ultrasound or MRI is useful to confirm hamstring tendonitis, mainly if the diagnosis is unclear. Moreover, some MRI changes in the hamstring tendon are related to pain.
What causes hamstring tendonitis?
An overload of the tendons causes hamstring tendonitis. Generally, overload is caused by a change in running or sport. Occasionally, tendonitis is caused by an acute injury such as ‘doing the splits’ during sport.
Proximal hamstring tendinopathy treatment
Exercises
In general, exercise effectively treats proximal hamstring tendinopathy. This blog outlines the exercise treatment options for hamstring tendonitis well. Exercise works by gradually strengthening the muscles around the tendon, such as the large hamstring and gluteal muscles. By strengthening the muscles, we apply less force to the tendon, allowing the tendon to heal. Exercise programs are more successful if supervised by a therapist. Overall, patients must understand that exercise produces small but gradual improvements in pain over many months.
Although most hamstring tendonitis responds to exercise, some cases require additional treatment. Shockwave therapy is where pressurised air delivers sound waves directly to the tendon. The sound waves start inflammation, which stimulates the body’s healing capacity. Shockwave treatments are weekly for up to a total of 5 sessions. Alternatively, tendon injections can help with pain and improve exercise in some cases. There are different types of injections, with no clear favourites for hamstring tendonitis. The injection selected depends on the patient’s choice when considering potential benefits and risks. You can read research summarising injections for tendonitis here. After any injection, it is essential to rest your hamstring tendon for at least a week, followed by a careful return to running or sport.
Finally, we should only consider surgery with a partial ‘interface’ tear of the tendon attachment to the bone and only when other measures have failed. Hamstring tendon surgery recovery is prolonged and not consistently successful.
Do you have hamstring origin tendonitis? Dr Masci is performing a study on hamstring origin tendonitis.
More data are needed on this condition. We need more data to determine which factors may be essential to predicting outcomes and which treatments are effective. This study aims to follow patients with hamstring-origin tendinopathy for 12 months.
As part of the study, you will be followed closely, and specific outcome scores will be used to ensure that you’re getting better.
If you have high hamstring tendonitis, live in the UK, and want to participate in the study, please contact Dr Masci.
Final word from Sportdoctorlondon about hamstring tendonitis
Hamstring tendonitis is common in endurance runners and players in team sports. Typical features include pain during or after walking or running. Treatment consists of exercises to strengthen the muscles on the buttock and hamstring. Finally, other treatments, such as shockwave therapy or injections, can improve surgery outcomes.
