proximal hamstring tendinopathy (PHT) Flashcards

week 4 lab

1
Q

What are some symptoms of proximal hamstring tendinopathy

A
  • deep localized buttock pain
  • pain during or after running, lunging, squatting, sitting and change of direction activities
  • pain lasting over 24hrs
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2
Q

what are some sypmptoms of proximal hamstring tendinopathy that are similar to other pathologies

A
  • sciatic n. irritation
  • ischiofemoral impingemetn
  • deep glute tear
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3
Q

what is the etiology of proximal hamstring tendinopathy

A

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

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4
Q

if a weak glute max is assessed during gait analysis for proximal hamstring tendinopathy what is the result on the hamstrings?

A

proximal hamstring overload

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5
Q

if a weak glute med is assessed during gait analysis for proximal hamstring tendinopathy what is the result on the hamstrings?

A

increase in hip adduction and contralateral pelvic drop in dee psquat or lunging (increased enthesis compression present in less flexible ppl)

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6
Q

what are some diagnostic/objective tests that can be performed for proximal hamstring tendinopathy

A
  • 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

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7
Q

isometric hamstring loading: stage 1 isometric hamstring loading
Purpose:
ex recs:
dosage & progression:
Pain monitoring:

A

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

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8
Q

stage 2: isotonic hamstring loading w/minimal hip flexion
Purpose:
ex recs:
dosage & progression:
Pain monitoring:

A

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

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9
Q

stage 3: isotonic exercises in positions of increased hip flexion
Purpose:
ex recs:
dosage & progression:
Pain monitoring:

A

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

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10
Q

stage 4: energy storage loading
Purpose:
ex recs:
dosage & progression:
Pain monitoring:

A

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

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