proximal hamstring tendinopathy (PHT)

Question 1

What are some symptoms of proximal hamstring tendinopathy

Answer 1

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

Question 2

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

Answer 2

• sciatic n. irritation
• ischiofemoral impingemetn
• deep glute tear

Question 3

what is the etiology of proximal hamstring tendinopathy

Answer 3

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

Question 4

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

Answer 4

proximal hamstring overload

Question 5

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

Answer 5

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

Question 6

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

Answer 6

• 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

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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