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Hamstrung No More: Tackling That Persistent Pain in the Butt!



Understanding Proximal Hamstring Tendinopathy (PHT) and Its Impact (Part 1)


What is Proximal Hamstring Tendinopathy?

Proximal Hamstring Tendinopathy (PHT) is a condition that affects the hamstring tendons at their attachment to the ischial tuberosity (your 'sit-bones), located in the lower buttock area. This condition is commonly seen in middle and long-distance runners, as well as athletes participating in sports involving jumping, landing, and rapid hip flexion such as hockey, football, and ballet. Additionally, PHT can impact non-athletic individuals, particularly older adults who spend prolonged periods sitting.


Symptoms and Pain Patterns

PHT typically presents as a deep, aching pain in the lower buttock and posterior thigh. In some cases, the sciatic nerve may become involved, leading to symptoms resembling sciatica, such as sharp, burning pain extending down the leg or numbness in the nerve’s distribution. This condition, known as PHT-related sciatic nerve entrapment, results from adhesions between the sciatic nerve and surrounding fibrotic tissue.


Activities That Exacerbate PHT

Individuals with PHT may experience increased pain during:


  • Prolonged sitting, especially on hard surfaces

  • Running at higher speeds or with longer stride lengths

  • Climbing stairs or walking uphill

  • Squatting, lunging, and deadlifting

  • Forward bending, such as golfers retrieving a ball


Causes and Risk Factors

PHT often develops gradually due to excessive strain on the hamstring tendons. It may also result from a sudden stretch or injury. Common causes include:


  • Sudden increases in training intensity, volume, or speed

  • Repetitive hip flexion under load, such as during running or Romanian deadlifts

  • Prolonged sitting, leading to tendon compression

  • Weakness in gluteal muscles, leading to increased hamstring load

  • Poor biomechanics, such as short hip flexors or muscle imbalances


Diagnosis and Management


Diagnostic tests: Physiotherapists at Up N Adam Performance Training & Physiotherapy use a variety of objective tests to help them determine the diagnosis, identify risk factors and formulate a management plan. This condition is very treatable and the chances of achieving normal, pain-free activity again are good. The rehab journey just requires time and sound guidance by your treating physiotherapist.


Treatment approaches: Managing PHT involves a combination of load modification and structured rehabilitation. Avoiding prolonged sitting, initially reducing high-impact, aggravating activities, and engaging in a progressive activation / strengthening program can improve tendon health and function. Remember, tendons love load, but only if it is appropriate for their current state of 'fitness'.


By understanding the nature of PHT, implementing appropriate modifications, sorting out less than optimal movement / recruitment patterns and getting appropriately strong, individuals can effectively manage symptoms and return to enjoying their desired activities.


This is APA Sports Physiotherapist, Darren Glendenning, signing off for now!


You can book an appointment with Darren or Newcastle Knights Physiotherapists Katie or Hayd'n at www.upnadamptphysio.com

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