Rehabilitation and Prevention of Proximal Hamstring Tendinopathy

Abstract

Proximal hamstring tendinopathy (PHT) comprises a small but significant portion of hamstring injuries in athletes, especially runners. PHT is a chronic condition that is clinically diagnosed but can be supported with imaging. The main presenting complaint is pain in the lower gluteal or ischial region that may or may not radiate along the hamstrings in the posterior thigh. There is little scientific evidence on which to base the rehabilitation management of PHT. Treatment is almost always conservative, with a focus on activity modification, addressing contributing biomechanical deficiencies, effective tendon loading including eccentric training, and ultrasound-guided interventional procedures which may facilitate rehabilitation. Surgery is limited to recalcitrant cases or those involving concomitant high-grade musculotendinous pathology. The keys to PHT management include early and accurate diagnosis, optimal rehabilitation to allow for a safe return to preinjury activity level, and preventative strategies to reduce risk of reinjury.

Proximal Hamstring Injuries: Review of Operative and Nonoperative Management

“…As the painful postinjury period resolves, specific rehabilitation protocols that have been broadly developed for hamstring injuries 21,77,78 and specifically adapted for proximal hamstring injuries and tendinopathy have been described with a typical symptom based progression from isometric and concentric strengthening exercises to eccentric loading exercises and then explosive plyometric movements prior to return to sport. 79,80 Nonoperative Management Outcomes…”

“…81 Patients with true proximal hamstring tendinopathy often respond well to nonoperative treatment protocols focused on eccentric strengthening. 79 While the addition of shockwave therapy to a nonoperative treatment protocol has shown promising results in high-level athletes, 68 the role of other modalities or injectable agents, including platelet-rich plasma or corticosteroids, remains unclear with further high-level evidence required before routinely implementing their use in conjunction with established protocols. [82][83][84][85][86] Ultimately, when considering nonoperative management, it is important to clearly identify the goals of the patient while taking into consideration the spectrum of pathology that can occur at the proximal hamstring.…”

Alteraciones en la presión plantar posterior a un protocolo de fatiga neuromuscular en máquina isoinercial

“…El orden de reclutamiento de unidades motoras a través del sistema nervioso central es mayor en las contracciones máximas excéntricas vs concéntricas douglas et al (2017), debido a que tiene patrones motores únicos, mayor grado de dificultad como un mecanismo de reducción de riesgo de lesiones Walker et al (2016), o en el tratamiento de tendinopatías en los procesos de rehabilitación deportiva, también se ha evidenciado que dichas acciones excéntricas ayudan a prevenir múltiples riesgos en las distenciones de los isquiotibiales debido a factores como déficit de fuerza, perdida del rango de movilidad articular, alteraciones en la postura (Beatty et al, 2017) .Por otro lado, en un meta análisis Jalal et al (2016) reporto la activación muscular isoinercial y elástica con el fin de comparar los dos modos de entrenamiento de fuerza, donde concluyeron que las adaptaciones musculares son relativamente similares si se emplea las mismas cargas de resistencia, también Lima et al (2018) demostró un comportamiento similar en adultos mayor.…”

Exercise therapy in the treatment of tendinopathies of the lower limbs: a protocol of a systematic review

“…The second tendinopathy with a higher prevalence in the lower limbs, especially in runners (approximately 23% [12]), is Achilles tendinopathy, which is also related to the overload of local micro-trauma [15]. Proximal tendinopathy of the hamstring muscles still has an unknown prevalence, but the literature emphasizes that it is prevalent in sprinters [2, 16]. Similar to the others, proximal tendinopathy of the hamstring muscles is due to an imposed overload during training or recreational activity [16, 17].…”

“…Proximal tendinopathy of the hamstring muscles still has an unknown prevalence, but the literature emphasizes that it is prevalent in sprinters [2, 16]. Similar to the others, proximal tendinopathy of the hamstring muscles is due to an imposed overload during training or recreational activity [16, 17]. Finally, gluteal tendinopathy affects about 45% of the population in developing countries and is unrelated to a specific work or sporting activity [18, 19].…”