The management of bilateral high hamstring tendinopathy with ASTYM^®treatment and eccentric exercise: a case report

Abstract

High hamstring tendinopathy (HHT) is an overuse injury that occurs most commonly in runners. The management of HHT is often challenging and the research supporting many interventions is limited. Eccentric exercise has been proven effective in the treatment of various tendinopathies but has not been thoroughly studied with HHT. Soft tissue mobilization, including ASTYM, is often utilized in the treatment of tendinopathies, though there is limited evidence supporting this approach. The purpose of this paper is to present the case of a patient referred to physical therapy with bilateral HHT. The patient was a 41-year-old recreational runner that had an insidious onset of right buttock pain 12 months prior to initiating therapy and left buttock pain 9 months prior. Her primary complaints included an inability to run, pain with prolonged or brisk walking, and pain with sitting on hard surfaces. The patient was treated in physical therapy two times per week for 16 visits with treatment focused on eccentric hamstring strengthening and ASTYM. By her eighth visit, the patient was able to walk 2.5 miles without pain and by her 12 visit, she was able to jog 1 mile before the onset of pain. After 16 visits, the patient reported that she was approximately 95% improved, was able to run 2.5 miles without pain, and had no pain with sitting on hard surfaces. This case suggests that eccentric exercise combined with ASTYM may be an effective treatment for HHT.

Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management

“…Patients may present with hamstring weakness and atrophy, often in relation to longstanding symptoms. Case se ries have reported hamstring weakness on manual testing 42 and reduced knee flexion and hip extension strength 59 in athletes with PHT. Handheld or fixed dy namometry may be used to assess ham string strength.…”

“…Limited case series and case presentations have been published that demonstrate improvements in pain and function with conservative manage ment, including hamstring strengthen ing. 26,34,42,59,95 Results from these studies cannot be generalized, however, due to small patient numbers, varying diagnos tic methods, and the use of adjunct inter ventions alongside exercise.…”

“…A full description of this approach is beyond the scope of this paper, but the reader is directed to a re cent review by Lempainen et al 47 Other Considerations Dry needling and soft tissue techniques have been utilized in the treatment of PHT, but supporting evidence is limited to case series. 42,59,95 In the authors' experience, massage and manual therapy addressing tone and restriction in the kinetic chain (eg, hamstring, tensor fascia latae) can be useful adjuncts in the management of PHT. However, such passive interven tions are unlikely to improve tissue load capacity, which is a key element of tendi nopathy rehabilitation.…”

Nerve Entrapment in the Hip Region: Current Concepts Review

“…These instruments used during assisted soft-tissue mobilization techniques attempt to induce biological changes to affect scar tissue and to stimulate the regeneration of soft tissues. 34 These techniques may also try to mechanically mobilize tissues that are restricting nerve gliding. In addition to manual therapy techniques, stretching and strengthening exercises, aerobic conditioning, and cognitive-behavioral education have been shown to be valuable in the treatment of those with nerve entrapments in the hip region.…”

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.…”