Shockwave Therapy for the Treatment of Chronic Proximal Hamstring Tendinopathy in Professional Athletes

Cacchio, Angelo; Rompe, Jan D.; Furia, John P.; Susi, Piero; Santilli, Valter; Paulis, Fosco De

doi:10.1177/0363546510379324

Cited by 116 publications

(164 citation statements)

References 37 publications

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“…Treatment options initially consist of non-operative modalities for management of symptoms including activity modification, non-steroidal anti-inflammatory medication, and shockwave therapy, and local injection with either corticosteroid or platelet rich plasma. Despite these various options the management of symptomatic proximal hamstring tendinopathy presents a clinical challenge to the orthopaedist and often results in a prolonged and frustrating treatment course for the patient [5,6]. Lempainen and colleagues published their results on surgical management for recalcitrant cases and reported an 89% good to excellent result allowing return to sport at the pre-injury level.…”

Section: Introductionmentioning

confidence: 99%

Operative Management of Partial-Thickness Tears of the Proximal Hamstring Muscles in Athletes

Bowman¹,

Cohen

Bradley³

2013

Am J Sports Med

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Background: Partial tears of the hamstring muscle origin represent a challenging clinical problem to the patient and orthopaedic surgeon. Although nonoperative treatment is frequently met with limited success, there is a paucity of data on the efficacy of surgical management for partial proximal hamstring tears in the active and athletic population. Purpose: To evaluate the results of an anatomic repair for partial tears of the hamstring muscle origin in athletes. Study Design: Case series; Level of evidence, 4. Methods: The records of 17 patients with partial tears of the proximal hamstring origin were reviewed after institutional review board approval was obtained. All patients were treated with open debridement and primary tendon repair after failure of at least 6 months of nonoperative therapy. Clinical and operative records, radiographs, and magnetic resonance images were reviewed for all patients. A patient-reported outcomes survey was completed by 14 patients that included the Lower Extremity Functional Score (LEFS), Marx activity rating scale, custom LEFS and Marx scales, and subjective patient satisfaction scores. Early and late postoperative complications were recorded. Results: There were 3 male and 14 female patients; their average age was 43 years (range, 19-64 years) and average follow-up was 32 months (range, 12-51 months). There were 2 collegiate athletes (field hockey, track), 14 amateur athletes (distance running, waterskiing, tennis), and a professional bodybuilder. Postoperative LEFS was 73.3 ± 9.9 (range, 50-80) and custom LEFS was 66.7 ± 17.0 (range, 37-80) of a maximum 80 points. The most commonly reported difficulty was with prolonged sitting and explosive direction change while running. The average Marx score was 6.5 ± 5.3 (range, 0-16) of a maximum 16, correlating with a greater return to recreational running activities in this patient cohort than regular participation in pivoting or cutting sports. Marx custom scores were 20 of a maximum 20 in all patients, demonstrating no disability in the operative extremity with activities of daily living. No patient underwent a subsequent surgery. One patient was not satisfied with the result and reported persistent symptoms during competitive distance running. All patients were able to return to their preoperative level of activity after surgery. Conclusion: Anatomic surgical treatment of partial proximal hamstring avulsions can lead to satisfactory functional outcomes, a high rate of return to athletic activity, and low complication rate. This procedure should be reserved for patients who have failed an extended course of nonoperative treatment, and the proximity of the sciatic nerve mandates a careful assessment of the risk-benefit ratio before surgery is undertaken.

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Section: Introductionmentioning

confidence: 99%

Operative Management of Partial-Thickness Tears of the Proximal Hamstring Muscles in Athletes

Bowman¹,

Cohen

Bradley³

2013

Am J Sports Med

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“…This is a common clinical sign and is usually associated with tendon morphological changes, 16,17 which may actually be the cause of the primary complaint; however the presence of Gluteus Maximus hypotrophy and decreased muscle cushion may increase pain, because the hamstring tendon would be more exposed to pressure imposed by the sitting position.…”

Section: ■ Resultsmentioning

confidence: 99%

“…16,17 This could be correlated with hamstrings and Gluteus Maximus imbalances, which lead to progressive proximal hamstring tendon overload, injury, and pain. 5,7,8,[18][19][20] Patients in this study also presented this complaint.…”

Section: ■ Resultsmentioning

confidence: 99%

Gluteus Maximus inhibition in proximal hamstring tendinopathy

Jesus¹,

Bryk²,

Moreira³

et al. 2015

Medical Express

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OBJECTIVE:The purpose of this study was to demonstrate the inhibition of the ipsilateral Gluteus Maximus in the presence of proximal hamstring tendinopathy and to collect information about its cause. DESIGN: We studied three subjects with clinical evidence of proximal hamstring tendinopathy previously submitted to conservative treatment with poor results and exhibiting severe hypotrophy and diminished strength in the ipsilateral Gluteus Maximus in comparison with contralateral Gluteus Maximus. INTERVENTIONS:Patients were submitted to evaluation of the Gluteus Maximus inhibition through handheld dynamometer strength measurements before and during neuromuscular electrical stimulation. RESULTS:The three subjects exhibited increased strength in the affected Gluteus Maximus (mean 43%; range 27%-62%) when neuromuscular electrical stimulation was added in the evaluations. CONCLUSION: This study demonstrates that individuals with proximal hamstring tendinopathy present ipsilateral Gluteus Maximus inhibition with hypotrophy and diminished strength. Neuromuscular electrical stimulation partially restores muscular strength. Further studies are required to evaluate the effects of this type of treatment.

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“…[7][8][9] Pain is often localized to the ischium; but because of its location close to the sciatic nerve, patients may also present with radicular pain. 10,11 Clinical diagnosis may be difficult if the patient is complaining of gluteal and posterior thigh pain; therefore, lumbar pathology and piriformis syndrome should be considered and ruled out in the chiropractic examination. 11,12 If hamstring tendinopathy is suspected, a focused lower extremity examination may include gait analysis, proprioceptive testing, and evaluation of hamstring flexibility and eccentric strength.…”

Section: Discussionmentioning

confidence: 99%

“…On magnetic resonance imaging, the hamstring tendon will appear thickened and there will be signal variation within the tendon. [10][11][12] Fluid accumulation in the tendon will appear as a highintensity signal on T2-weighted images (Fig 2). Advanced imaging can also help to identify compression of the sciatic nerve or inflammation of the ischial bursa that may also present with pain when sitting on hard surfaces.…”

Section: Discussionmentioning

confidence: 99%

High hamstring tendinopathy in 3 female long distance runners

White¹

2011

Journal of Chiropractic Medicine

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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.

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Shockwave Therapy for the Treatment of Chronic Proximal Hamstring Tendinopathy in Professional Athletes

Abstract: Shockwave therapy is a safe and effective treatment for patients with chronic proximal hamstring tendinopathy.

Cited by 116 publications

References 37 publications

Operative Management of Partial-Thickness Tears of the Proximal Hamstring Muscles in Athletes

Operative Management of Partial-Thickness Tears of the Proximal Hamstring Muscles in Athletes

Gluteus Maximus inhibition in proximal hamstring tendinopathy

High hamstring tendinopathy in 3 female long distance runners

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