Hamstring tendinopathy is a common cause of posterior thigh pain, affecting both athletes and non-athletes alike. It refers to a condition affecting the hamstring tendon, which can manifest in two distinct areas: proximal (near the glutes) and distal (in the sides of the knee). Understanding the nature, symptoms, assessment, and treatment options for proximal and distal hamstring tendinopathy is crucial for effective management and rehabilitation.
As a condition itself, Hamstring tendinopathy may involve degeneration, microtears, and/or inflammation of the hamstring tendon. Proximal hamstring tendinopathy occurs near the attachment of the tendon to the ischial tuberosity of the pelvis (under the buttock area), while distal hamstring tendinopathy affects the insertion of the tendons at the back of the knee. It is uncommon to sustain both concurrently, but I’m sure you can see how different sports or activities can predispose you to a proximal OR a distal hamstring tendinopathy.
When talking about signs and symptoms, both proximal and distal hamstring tendinopathy present with pain and stiffness in the posterior thigh region. However, there are distinct differences in their manifestation. Proximal tendinopathy typically produces deep buttock pain that worsens with sitting, stretching (bending at the hip), or running uphill. On the other hand, distal tendinopathy often causes pain at the back of the knee, especially during activities involving high-speed running or kicking. As you can picture, accurate assessment is paramount in diagnosing and managing hamstring tendinopathy. A comprehensive evaluation includes a thorough history-taking, physical examination, and potentially imaging studies such as ultrasound or MRI. Differentiating between proximal and distal tendinopathy is essential for tailoring appropriate treatment strategies. Plus, several conditions may mimic the symptoms of hamstring tendinopathy, necessitating careful consideration during assessment. Differential diagnoses for proximal tendinopathy include ischial bursitis, piriformis syndrome, or lumbar spine pathology. For distal tendinopathy, other possible causes of posterior knee pain include popliteal artery entrapment syndrome, meniscal injuries, or Baker's cyst.
Physiotherapy plays a central role in the management of both proximal and distal hamstring tendinopathy, although treatment approaches may vary based on the location and severity of the condition.
- Activity modification is essential for managing both proximal and distal hamstring tendinopathy. For proximal tendinopathy, patients should avoid uphill running and prolonged sitting, opting for flat surfaces and minimising deep hip flexion activities. For distal tendinopathy, high-speed running and deep knee flexion exercises should be avoided, with low-impact exercises and eccentric loading emphasised.
- Strengthening exercises are vital for treating, and ultimately resolving, both proximal and distal hamstring tendinopathy. For proximal tendinopathy, focus on eccentric exercises like Nordic curls, while also strengthening the gluteal muscles and core for stability. For distal tendinopathy, eccentric strengthening targeting the hamstring tendon's distal portion, along with strengthening exercises for surrounding knee muscles. Gradually increase exercise intensity under professional guidance by one of our OHL Physiotherapists to ensure effective rehabilitation and minimise symptom aggravation and optimal recovery.
If you suspect you have hamstring tendinopathy, whether proximal or distal, characterised by posterior thigh pain and stiffness, it's crucial to seek accurate assessment and treatment. Don't hesitate to book an appointment with our expert physiotherapists at Optimal Health Lab for personalised care and a tailored treatment plan to support your recovery journey. Bookings available via 9431 5955, or you can book any time day or night via the Client Portal on the website.
