High hamstring tendinopathy in 3 female long distance runners

Abstract

Objective: The purpose of this case report is to describe and discuss the clinical presentation, diagnosis, and management of 3 female long distance runners with high hamstring tendinopathy. Clinical Features: Three female runners presented to a chiropractic office with proximal hamstring pain that was aggravated by running. Increasing mileage, hills, and/or interval training preceded the onset of symptoms in each case. The subjects all displayed weakness of the hip abductors, pelvic joint dysfunction, hamstring tightness, and ischial tuberosity tenderness. Other clinical findings included overpronation, proprioceptive weakness, and lumbar dysfunction. Intervention and Outcome: All 3 patients were treated with Graston Instrument Assisted Soft Tissue Mobilization, lumbopelvic manipulation, and electrical muscle stimulation with ultrasound. Active exercise focused on hamstring stretching and strengthening, gluteal strengthening, and proprioceptive training. The 3 runners seen in this clinic had resolution of hamstring pain in an average of 13 treatments and were able to continue competing without restriction. Conclusion: Runners with high hamstring tendinopathy may respond favorably to conservative chiropractic treatment and active rehabilitation with minimal time off of training.

Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management

“…Extrinsic factors include training errors, such as increasing volume or intensity too quickly, particularly the sudden introduction of sprinting, lunging, hurdles, or hills. Several case series 42,95 have been identified that report these training errors to precede PHT. These activities require the hamstring to contract or lengthen while in hip flexion and may result in provocative tensile and compressive load at the tendon insertion.…”

“…Handheld or fixed dy namometry may be used to assess ham string strength. 43,90,95,96 In the absence of these instruments, the authors suggest testing strength in a legcurl machine to preferentially isolate the hamstring mus cles, as a loaded hamstring curl achieves high levels of biceps femoris and semi tendinosus activity with minimal gluteus maximus (GMax) recruitment. 4 Other kineticchain deficits have the potential to increase hamstring origin stress concentration.…”

Expert opinion: diagnosis and treatment of proximal hamstring tendinopathy

“…On clinical examination, there is often palpable tenderness and pain over the ischial tuberosity against resisted knee flexion. Furthermore, active stretching of the hamstrings recreates the pain at the site of the ischial © C I C E d i z i o n i I n t e r n a z i o n a l i plasma (PRP) injection 19,[23][24][25]38,39 . When compared to a combined NSAID, physiotherapy and a hamstring specific exercise program, SWT had significantly better results with a mean follow-up of 10.7 months 19 .…”

Conservative Treatment of Subacute Proximal Hamstring Tendinopathy Using Eccentric Exercises Performed With a Treadmill: A Case Report

“…3,4 Several nonsurgical options have been described for the treatment of PHT, including shockwave therapy, 7 eccentric exercises with trunk/pelvis musculature strengthening, 10,11 corticosteroid injection, 33 massage/soft tissue mobilization, 10,17 platelet-rich plasma injection, 31 and a combined chiropractic approach. 32 A recent description of 2 runners with PHT reported positive results with conservative treatment consisting of eccentric strengthening, lumbopelvic stabilization exercises, and trigger point dry needling of the hamstring and adductor magnus muscles. 11 …”