High Hamstring Tendinopathy Conservative Treatment

Treatment For High Hamstring Tendinopathy

Treatment for high hamstring tendinopathy is typically managed by a physiotherapist.  Where the approach is to firstly minimize stress to the area to allow healing, and then attempt to reintriduce loading to the tissue in a safe way whilst addressing any muscle imbalances, lack of flexibility as well as biomecahnics associated with chosen sport/s. Other treatment modalities employed by physiotherapists can include the use of soft tissue techniques, dry needling, shockwave therapy… If physiotherapy and all it encompasses fails to resolve the issue and restore normal function following approximately 3-6 months of treatment then more minimally invasive and invasive options may be considered. These less conservative approaches to proximal hamstring complaints are briefly mentioned below.

Proximal Hamstring Tendinopathy And Shockwave Therapy

Shockwave therapy is a non-invasive treatment approach useful with a wide range of soft tissue complaints, and is use to good effect in managing other areas of the body such as treating plantar fascia pain and Achilles tendon issues. Shockwave therapy has a number of effects on the body one of which is promoting healing through improving local blood flow and cellular activity. Personally I have experienced some great results with shockwave therapy in the treatment of high hamstring tendinopathies and feel it works best when combining the treatment with other appropriate rehabilitation guidance strategies. In my Sydney physio practice I typically use shockwave therapy when treating high hamstring tendinopathy if symptoms have been present for greater than 3 months. I am less inclined to use it as a treatment modality in acute stage of injury, however the relevance of any therapy can always be assessed on a case by case basis.

Cortisone And PRP Injection Use In Hamstring Tendinopathies

As mentioned any conservative treatment program such as physiotherapy rehabilitation for proximal hamstring tendinopathy can be expected to take in the vicinity of 3-6 months to achieve good results. For patients that fail to improve and return to play within this time period considering alternative treatment options can be the next step.
Corticosteroid injections more commonly referred to as cortisone injections are once such alternative therapy, cortisone injections are frequently used in the management of high hamstring tendinopathy pain. A cortisone injection is often not delivered directly into the tendon itself as this may impact the healing of the tendon and increase risk of future tendon damage. However the use of ultrasound imaging to assist in guiding the injection into surrounding tissue, such as the ischial bursa can provide good symptomatic relief for some chronic hamstring pain patients. The ischial bursa is a small, fluid-filled structure that acts as a buffer between the overlying gluteal muscles and hamstring tendons at the sit bone (ischial tuberosity). If this bursa is “swollen” or “inflamed” a powerful anti-inflammatory like delivered in a cortisone injection can work to settle this irritation. If the bursa is the may cause of someone’s high hamstring symptoms then a cortisone will frequently prove to be an effective option. In many situations the ischial bursa may be source of discomfort but similar to trochanteric bursitis the bursa has become irritated for a reason and if this reason is not uncovered there is a good chance that the cortisone injection relief may be short lived. This is why coupling of injection therapy like corticosteroid injections, or PRP injections with active physiotherapy rehabilitation to address loading issues and return to function tends to achieve best results.

An injection of platelet-rich plasma (PRP) is a treatment approach where a concentrated platelet separation of the individuals blood is injected into the damaged area. Platelets are the body’s “healing cells” and when injected release a multitude of “growth factors” that have regenerative and healing properties. As a result it is believed that PRP, by releasing of growth factors locally into a damaged tendon, will induce tissue healing and regeneration, this approach to tendon pathology is favoured by some sports medicine specialists.

Surgery For High Hamstring Tendinopathy

In rare situations surgery is sometimes employed as a management approach for high hamstring tendinopathy, typically this is not the norm at least in the patients I have managed over the years. In my experience most patients are successfully managed with physiotherapy, or minimally invasive approaches such as PRP injections, or cortisone injections as mentioned above. When the last resort is triggered and the surgery option is being considered, this may involve anything from debridement (removal of diseased or damaged tissue/tendon), to complete tenotomy (a release of the tendon through cutting of the tendon and reattachment to the bone).  The surgical world from both an understanding and technique point of view is changing rapidly, and it is not the place of a physiotherapist to comment on what appropriate surgery would be for a persistent high hamstring strain. However what I will say is that if it reaches this point where conservative methods have failed to yield satisfactory results, then we are lucky that Sydney has a number of fantastic surgeons and I am happy to point people in that direction as indicated.

Disclaimer: Sydney Physio Clinic provides this information as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance on High Hamstring Tendinopathy Conservative Treatment should consult his or her physiotherapist or otherwise appropriately skilled practitioner.