proximal hamstring tendinopathy (PHT) Flashcards
week 4 lab
What are some symptoms of proximal hamstring tendinopathy
- deep localized buttock pain
- pain during or after running, lunging, squatting, sitting and change of direction activities
- pain lasting over 24hrs
what are some sypmptoms of proximal hamstring tendinopathy that are similar to other pathologies
- sciatic n. irritation
- ischiofemoral impingemetn
- deep glute tear
what is the etiology of proximal hamstring tendinopathy
load related extrinsic:
- training errors
- increasing vol or intensity quickly
- excessive use of static stretches
load related intrinsic:
- genetic polymorphisms (collagen type V encoding)
- EDS hypermobility
- age, BMI, metabolic issues, hormonal changes
- medication (ex. fluoroquinolone antibiotics)
- premenopausal women (loss of estrogen lvls - distruvting collagen homeostatsis)
not just seen in athletes, seen in ppl who sit a lot on hard surfaces
if a weak glute max is assessed during gait analysis for proximal hamstring tendinopathy what is the result on the hamstrings?
proximal hamstring overload
if a weak glute med is assessed during gait analysis for proximal hamstring tendinopathy what is the result on the hamstrings?
increase in hip adduction and contralateral pelvic drop in dee psquat or lunging (increased enthesis compression present in less flexible ppl)
what are some diagnostic/objective tests that can be performed for proximal hamstring tendinopathy
- pain provocative loading test
- three passive stretch tests (bend knee stretch, modified bent knee stretch, puranen-orava tests)
test may be negative in less severe cases
isometric hamstring loading: stage 1 isometric hamstring loading
Purpose:
ex recs:
dosage & progression:
Pain monitoring:
Purpose: reduce pain and begin tendon loading w/o excessive stress
ex recs: exercises in neutral hip position, iso leg curl, iso straight leg pull downs, long legged bridge holds
dosage & progression: performed multiple times per day based on symptom severity, moderate resistance (70%), 45 sec for 5 sets
Pain monitoring: some pain is acceptable,symptoms resolve in 24 hrs
stage 2: isotonic hamstring loading w/minimal hip flexion
Purpose:
ex recs:
dosage & progression:
Pain monitoring:
Purpose: restore hamstring strength, bulk and capacity in a functional ROM
ex recs: load hip flexion minimized to protect tendon, SL bridge, prone hip extension, Nordic HS curls, bridging progressions, supine leg curls
HSR showed greater collagen turnover than submaximal eccentric loading
dosage & progression: beging w/ 15 rep max progress to 8 rep max, 3-4 sets every other day, 3 sec concentric & eccentric
Pain monitoring: mild pain okay, symptoms resolve 24 hrs
stage 3: isotonic exercises in positions of increased hip flexion
Purpose:
ex recs:
dosage & progression:
Pain monitoring:
Purpose: continue HS muscle strength, hypertrophy, functional position training while progressing hip flexion
ex recs: slow & controlled technique, step ups, walking lunges, hip thursts, romanian deadlifts and SL dead lifts
dosage & progression: same as stage 2
Pain monitoring: at end of the phase, loading of HS origin through sport specific ranges should produce minimal pain
stage 4: energy storage loading
Purpose:
ex recs:
dosage & progression:
Pain monitoring:
Purpose: high speed, explosive movements needed in sports
ex recs: adequate execution of movements, limited hip flexion, A skips, sprinter leg curls, fast sled push/pull, bounding, KB swings
dosage & progression: form 3 day (high/low/mediium) cycle 2x a week w/ rest between cycles, 3-4 exercises of 3x15-20reps
Pain monitoring: most provactive stage, return to psort when pain is 0-3 and settles after 24 hrs