Dynamic Sitting Research Articles

Traditional versus dynamic sitting: Lumbar spine kinematics and pain during computer work and activity guided tasks

Dynamic sitting may mitigate low back pain during prolonged seated work. The current study compared pelvis and lumbar spine kinematics, pain, and work productivity, in traditional and dynamic sitting. Sixteen participants completed three 20-min blocks of computer work and activity guided tasks in a traditional office chair or backless and multiaxial rotating seat pan while kinematics were measured from accelerometers on the low back. Pain ratings were recorded on a visual analogue scale every 10 min. Similar pelvis and lumbar kinematics emerged when performing computer work in traditional and dynamic sitting. Pelvis and lumbar sagittal and frontal plane shifts and fidgets were largest for dynamic sitting in the activity guided tasks. Buttocks pain was higher in dynamic sitting, but low back pain and work productivity were unaffected. Dynamic sitting increased spine movement during activity guided tasks, without negatively impacting lumbar kinematics, low back pain, or productivity during seated computer work.

A novel motorized office chair causes low-amplitude spinal movements and activates trunk muscles: A cross-over trial.

Inactivity and long periods of sitting are common in our society, even though they pose a health risk. Dynamic sitting is recommended to reduce this risk. The purpose of this study was to investigate the effect of continuous passive motion (CPM) conducted by a novel motorized office chair on lumbar lordosis and trunk muscle activation, oxygen uptake and attentional control. Randomized, single-session, crossover with two periods/conditions. Twenty office workers (50% women) sat for one hour on the motorized chair, one half with CPM, the other not. The starting condition (CPM/no CPM) was switched in half of the sample. The participants were equipped with a spirometric cart, surface EMG, the Epionics SPINE system and performed a computer-based test for attentional control (AX-CPT). Outcomes were lumbar sagittal movements and posture, number of trunk muscle activations, attentional control and energy expenditure. The CPM of the chair causes frequent low-amplitude changes in lumbar lordosis angle (moved: 498 ± 133 vs. static: 45 ± 38) and a higher number of muscle activations. A periodic movement pattern of the lumbar spine according to the movement of the chair was observed in every participant, although, sitting behavior varied highly between individuals. Attentional control was not altered in the moved condition (p = .495; d = .16). Further, oxygen uptake did not increase higher than 1.5 MET. The effects of the motorized chair can be particularly useful for people with static sitting behavior. Further studies should investigate, whether CPM provides the assumed beneficial effects of dynamic sitting on the spine.

Dynamic sitting in infants: Limits of stability

BackgroundLimits of stability—defined by the maximum distances a person is willing to reach without falling or changing the base of support—are measures of dynamic balance. Research question: What are infants’ sitting stability limits in the forward and right directions? MethodsTwenty-one 6- to 10-month old infants participated in this cross-sectional study. To incentivize infants to reach beyond arm’s length, caregivers began by holding a toy close to their infants at shoulder height. Caregivers then moved the toy farther away as infants tried to reach for it until infants lost balance, placed their hands on the floor, or transitioned out of sitting. All sessions were conducted via Zoom™ and video-recorded for further analyses using DeepLabCut for 2D pose estimation and Datavyu to determine timings of the reach and to code infants’ postural behaviors. ResultsInfants’ trunk excursions in the anterior-posterior plane (for forward reaches) and medio-lateral plane (for rightward reaches) represented their stability limits. Most infants ended the reach by returning to their original sitting position; however, infants with higher Alberta Infant Motor Scale (AIMS) scores transitioned out of sitting and infants with lower AIMS scores sometimes fell (mostly during rightward reaching). Trunk excursions were correlated with months of sitting experience. Rightward trunk excursions were also correlated with AIMS scores and age. Overall, infants’ trunk excursions were larger in the forward than in the right direction, and such discrepancy was consistent across infants. Lastly, the more often infants adopted movement strategies with their legs (e.g., bending the knees), the greater the trunk excursion they attained. SignificanceSitting control entails learning to perceive the boundaries of stability limits and acquiring anticipatory postures to suit the needs of the task. Tests and interventions that target sitting stability limits could be beneficial for infants with or at risk of motor delays.

What Is the Relationship between Trunk Control Function and Arm Coordination in Adults with Severe-to-Moderate Quadriplegic Cerebral Palsy?

Adults with tetraparesis cerebral palsy (i.e., wheelchair users) tend to experience more accelerated ageing, resulting in physical deterioration that increases the impact of the disability, leading to a loss of mobility that interferes with people's daily activities and participation in the community. The aim of this work is to study the relationship between trunk control and the function of the less-affected arm in this population. For this purpose, 41 para-athletes were invited to participate in this study, performing five tests to assess upper limb coordination, two tests to assess manual dexterity [i.e., Box and Block Test (BBT) and Box and Ball Test (BBLT)] and three tests to assess intra-limb coordination in different planes. Trunk control was assessed in both static and dynamic sitting conditions. The results show moderate correlations between static postural control and manual dexterity tests in the BBT (r = -0.553; p = 0.002) and BBLT (r = -0.537; p = 0.004). Large correlations were also found between static postural control and intra-limb tasks in horizontal (r = 0.769; p = 0.001) and vertical movements (r = 0.739; p = 0.009). Better static trunk control is related to a better upper limb function in the sagittal plane. Considerations and implications are explained in the manuscript.

Comparison of Routine Physical Therapy with And Without Core-Stability Exercises on Dynamic Sitting Balance and Trunk Control in Sub-Acute Ischemic Stroke Patients

Stroke patients suffer from severe postural instability and likely to have a frequent number of drops and a higher limitation of post-fall activities. Stroke burden is increasing day by day which leads to significant musculoskeletal problems, physical and mechanical issue. Objectives: To compare the effects of routine physical therapy with and without core-stability exercises on trunk control and sitting balance in sub-acute ischemic-stroke patients. Methods: It was a Single blinding Randomized controlled trial. Total 58 patients participated in this study (29 in each group) with 20% drop out from Rabbani Hospital Thokar Lahore setting. In both groups control and experimental groups treatment given for the 45 mints per day in 8 week which includes conventional physical therapy with and without core stability exercises in as well. Exercises performed in sitting position on couch, chair and physio ball. BBS and TIS scale used for this study purpose. Data were collected through standardized questionnaire. Results: Total 15(62.5%) male and 9(37.5%) females in control group while 11(45.8%) males and 13(54.2%) females in experimental groups were included in study. BBS score in treatment groups before and after the treatment in control group is 11.29 while 20.25 in experimental group. TIS score in treatment groups before and after the treatment is 3.13 in control group while 4.88 in experimental group as well. Conclusions: It is concluded that core stability exercise training combined with conventional treatment helps sub-acute post-stroke patients improve their trunk control as well as their dynamic sitting and standing balance, gait, and capacity to do daily living tasks.

Chair Development on the Basis of Body Pressure Distribution—A Research Effort*

Abstract Surveys and studies show that more and more employees perform high- or low-skilled white-collar work predominantly in sitting postures. Therefore, comfortable sitting plays an important role in reducing the risk of musculoskeletal disorders and other harmful effects. Research efforts focus on reducing these risks by designing ergonomic chairs with multiple adjustment possibilities, allowing the chair to fit to the user's body shape or assuring a dynamic seating where the user's lower body is in continuous movement. This article summarizes the results of a research effort that evaluated the effect of several factors on sitting comfort based on body pressure distribution. The effects of foam elasticity, foam layer arrangement order, and seat support elasticity were investigated as well as the chair seat type (kneeling chair, saddle chair). Results were used to determine the optimal chair cushion including the layered foam system and seat support type. On the basis of our findings a new ergonomic chair was developed combining the advantages of static and dynamic sitting.

Development of a System for Measurement on Asymmetric Sitting Posture

Sitting posture measurement system using the unstable board with accelerometer was developed. And, postural balance was assessed to determine the effect of asymmetry on sitting posture between patients with pelvic asymmetry and healthy subjects. 10 subjects (pelvic asymmetry patients:5, healthy controls:5) were participated in this study. We performed experiment under static and dynamic sitting condition. Angular variation in the anterior-posterior and left-right direction was measured in both two conditions. Also, intra class correlation coefficient was used to evaluate the reliability of the system. The value of angle of pelvic asymmetry patients was more tilted significantly to the left side than right side during static and dynamic sitting. The reliability of the system was excellent. This paper suggested that a system for measurement on asymmetric sitting posture can be utilized to provide useful information about patients with pelvic asymmetry in rehabilitation medicine. Furthermore, results from this study can be used to develop the new clinical quantitative measurement system.

Low Back Pain Exacerbation Is Predictable Through Motif Identification in Center of Pressure Time Series Recorded During Dynamic Sitting.

Background: Low back pain (LBP) is a common health problem — sitting on a chair for a prolonged time is considered a significant risk factor. Furthermore, the level of LBP may vary at different times of the day. However, the role of the time-sequence property of sitting behavior in relation to LBP has not been considered. During the dynamic sitting, small changes, such as slight or big sways, have been identified. Therefore, it is possible to identify the motif consisting of such changes, which may be associated with the incidence, exacerbation, or improvement of LBP.Method: Office chairs installed with pressure sensors were provided to a total of 22 office workers (age = 43.4 ± 8.3 years) in Japan. Pressure sensors data were collected during working days and hours (from morning to evening). The participants were asked to answer subjective levels of pain including LBP. Center of pressure (COP) was calculated from the load level, the changes in COP were analyzed by applying the Toeplitz inverse covariance-based clustering (TICC) analysis, COP changes were categorized into several states. Based on the states, common motifs were identified as a recurring sitting behavior pattern combination of different states by motif-aware state assignment (MASA). Finally, the identified motif was tested as a feature to infer the changing levels of LBP within a day. Changes in the levels of LBP from morning to evening were categorized as exacerbated, did not change, or improved based on the survey questions. Here, we present a novel approach based on social spider algorithm (SSA) and probabilistic neural network (PNN) for the prediction of LBP. The specificity and sensitivity of the LBP inference were compared among ten different models, including SSA-PNN.Result: There exists a common motif, consisting of stable sitting and slight sway. When LBP level improved toward the evening, the frequency of motif appearance was higher than when LBP was exacerbated (p < 0.05) or the level did not change. The performance of the SSA-PNN optimization was better than that of the other algorithms. Accuracy, precision, recall, and F1-score were 59.20, 72.46, 40.94, and 63.24%, respectively.Conclusion: A lower frequency of a common motif of the COP dynamic changes characterized by stable sitting and slight sway was found to be associated with the exacerbation of LBP in the evening. LBP exacerbation is predictable by AI-based analysis of COP changes during the sitting behavior of the office workers.

Effectiveness of Combined Stretching and Strengthening Exercise Using Rehabilitation Exercise System with a Linear Actuator and MR Damper on Static and Dynamic Sitting Postural Balance: A Feasibility Study

Postural imbalance induced by prolonged sitting can be improved by exercise therapy. The aim of study was to evaluate the influence of combined stretching and strengthening exercise using rehabilitation exercise system with a linear actuator and MR damper on static and dynamic sitting postural balance. Twelve subjects who sit almost 10 h a day participated in this study. The rehabilitation exercise system with a linear actuator and MR damper was manufactured to provide stretching and strengthening exercise. All subjects were asked to perform an exercise program that was designed to enhance postural balance by stretching the tight muscle and strengthening the weakened muscle. Body pressure distributions were analyzed for mean force and mean pressure using a seat sensor system. Trunk muscle activities were measured by attaching surface electrodes to the thoracic erector spinae, lumbar erector spinae, and lumbar multifidus muscle. All data were divided into two regions (dominant and non-dominant side) under four conditions: no pelvic tilt, lateral pelvic tilt, anterior pelvic tilt, and posterior pelvic tilt. Body pressure distributions and trunk muscle activities were compared between before and after performing exercise under static and dynamic sitting conditions. Both in static and dynamic sitting conditions, there were significant differences in body pressure distributions and trunk muscle activities between the DS and NDS before performing the exercise (p &lt; 0.01). After performing exercise, the body pressure distributions increased on the dominant side while those decreased on the non-dominant side significantly (p &lt; 0.01). In addition, the activities of all trunk muscles on the non-predominant side increased significantly (p &lt; 0.01 and p &lt; 0.05). These results showed that postural balance was improved by decreasing the differences in body pressure distribution and trunk muscle activity between the dominant and non-dominant side after performing exercise. From the results of this study, we concluded that the rehabilitation exercise system with a linear actuator and MR damper is suitable for providing combined stretching and strengthening exercise, and it could be helpful to maintain correct posture by enhancing postural balance during sitting.

Trunk Posture Adaptations during Sitting on Dynamic Stool: A Validation Study

Back pain is a complex condition that results from multiple factors including sitting issues such as the chair type and spinal sitting posture. The physiological spinal curvature on the sagittal plane represents a typical feature of good body posture. Sitting postures matching the physiological shape of the spine on the sagittal plane during standing are deemed advantageous from a postural point of view. The aim of this study was to validate a novel dynamic stool by comparing trunk posture adaptations on the sagittal plane during dynamic sitting vs. conventional sitting (standard stool) in healthy people. In total, 100 healthy adults were included. Age, sex and body mass index were recorded. Thoracic kyphosis and lumbar lordosis were measured with the IncliMed® goniometer during standing posture, conventional sitting posture (standard stool) and dynamic sitting posture (novel dynamic stool). Sitting posture was maintained for 2 min before evaluation. Thoracic kyphosis and lumbar lordosis were significantly different between standing vs. sitting (dynamic and conventional) posture (p &lt; 0.001) and between dynamic vs. conventional sitting posture (p &lt; 0.001). Sitting on the novel dynamic stool tested in this study was shown to provide a greater match of thoracic kyphosis and lumbar lordosis with the physiological spinal curvature on the sagittal plane during standing than conventional sitting.

Dynamic body posture after unilateral mastectomy: a pilot study

Postural changes after unilateral mastectomy may appear in relation to the dominant hand, postoperative duration, and dynamic conditions. This study aimed to compare the postural changes by inclination angles and muscle activities in the static and dynamic sitting position between women with breast cancer who underwent mastectomy and women who did not have breast cancer. The observational study design was conducted. We evaluated 17 women who underwent modified radical mastectomy (MRM) more than 1 year prior to the study. They were categorized into the Rt. mastectomy group (n=7) and the Lt. mastectomy group (n=10). An aged-matched cohort of 8 healthy females was also included. The inclination angle in both static and dynamic sitting positions was measured using the balance board system (BBS), and the muscle activities of 8 muscles were measured in the dynamic sitting position. There was no significant difference in demographic characteristics between the patients, and all patients were right-handed. The inclination angle of the anterior-posterior axis when leaning forward was significantly increased to the anterior side in the Rt. mastectomy group than in the Lt. mastectomy group. Meanwhile, the inclination angle in the static sitting position and when tilted backward to both directions did not differ among the 3 groups. The inclination angle of the right-left axis was statistically increased to the left side during tilting anterior-left direction in the Rt. Mastectomy group. The muscle activities of the thoracic erector spinae were significantly lower when tilted backward in the Rt. mastectomy group than in the Lt. mastectomy group. Compared with left mastectomy, right unilateral mastectomy yielded more postural changes under dynamic sitting state in right-handed female patients with breast cancer. Thus, to maintain the trunk balance and prevent the postural changes after unilateral mastectomy, the postoperative exercise programs for the para-thoracic muscles will be helpful.

Do the Types of Seat Surface influence the pulmonary Functions during Prolonged Sitting?

Purpose: The purpose of this study was to identify the effects of the types of seat surface (static or dynamic seat surface) on the pulmo nary functions during prolonged sitting. Methods: Thirty-four participants (20 males and 14 females) were recruited, and distributed randomly into dynamic prolonged sitting (DPS, n=17) and static prolonged sitting (SPS, n=17) groups. The DPS group was seated on a chair with a dynamic air cushion, and the SPS group was seated on a chair without a dynamic air cushion. The pulmonary function was assessed before sitting, and after partici pants had been seated for one hour. The pulmonary function [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and Peak expiratory flow (PEF)] was measured using a spirometer. Results: Statistical analyses revealed significant differences in the time x group interactions of FVC, FEV1, PEF, and FEV1/FVC. The DPS group were significantly different in FVC, FEV1, PEF, and FEV1/FVC after prolonged sitting for one hour, compared to the SPS group (p<0.05). Conclusion: These findings suggest that dynamic sitting can prevent a decrease in the physiological function, such as pulmonary func tions, rather than static sitting during prolonged sitting.

Dynamic Sitting Exercise versus Spinal Extension Exercise on Pain, Lumbar Mobility and Quality of Life in Adults with Mechanical Low Back Pain

Background: Now-a-days it is seen that busy work schedule and unhealthy environment leads to discontinuityin exercising despite of awareness and knowledge of its effectiveness on problems like low back pain. Thereare many factors including improper posture, over loading, immobility, trunk muscles weakness leads tomechanical low back pain in adults. Exercises of various types have been used in managing low back pain.Hence there is a need to find out a single functional and effective exercise for such problems so that they canbe done anytime during work and without any equipment which is also economical.Methodology: Thirty adults aged between 20-30 years participated in this comparative experimental study.After underwent physical screening for selection criteria mechanical low back pain followed by simplerandomization participants were divided into group A and group B. Group A and group B received dynamicsitting and spinal extension exercise respectively for thrice a week for six weeks. Pre and post values wereassessed using outcome measures Visual Analog Scale for pain, MMST used for lumbar mobility and ShortForm-36 Health Survey Questionnaire for quality of life.Results: In comparison of post test scores of outcome measures evidenced that the reduction of pain score,improvement in lumbar mobility and quality of life scores. There were significantly improvement among theadults with mechanical low back pain treated with Dynamic sitting exercise (DSE) than treated with Spinalextension exercise (SEE).Conclusion: 6 weeks of dynamic sitting and spinal extension exercise can prevent in pain and improvementin lumbar mobility and quality of life in adults with mechanical low back pain

Relationship between Dynamic Trunk Balance and the Balance Evaluation Systems Test in Elderly Women.

ABSTRACTObjectiveFalls are major contributors to elderly subjects becoming bedridden. Consequently, it is important to evaluate and minimize the risk of falls in the elderly. Trunk stability is important for balance function and is related to fall prevention in elderly women. We developed a balance-measuring device that uses a dynamic sitting position to safely measure balance function. The Balance Evaluation Systems Test (BESTest) is useful method to assess balance function, a recently developed balance evaluation test that can detect minor balance problems not captured by previous tests. The purpose of the present study was to examine the relationship between dynamic trunk balance and findings of the BESTest in elderly women. MethodsThirty-one healthy women aged 60 years or more participated in this study. The evaluation items were the BESTest total score, scores for each of the six elements of the BESTest, dynamic sitting balance, static postural balance, and muscle strength. ResultsThe mean total BESTest score was 85.4 points. The mean total trajectory length of the center of gravity (COG) during the dynamic sitting balance test was 1447.5 mm. A negative correlation (r=–0.481, P= 0.006) was observed between the total COG trajectory length and the BESTest score. A negative correlation was also found between the total COG trajectory length and biomechanical constraints (r=–0.492, P=0.005) and anticipatory postural adjustments (r=–0.532, P=0.002). There were no correlations between the dynamic sitting balance total COG trajectory length and the stationary standing COG trajectory length or muscle strength. ConclusionsIn elderly women, the total COG trajectory length during dynamic sitting was negatively correlated with the BESTest total score.

Dynamic sitting: Measurement and associations with metabolic health

ABSTRACTDynamic sitting, such as fidgeting and desk work, might be associated with health, but remains difficult to identify out of accelerometry data. We examined, in a laboratory study, whether dynamic sitting can be identified out of triaxial activity counts. Among 18 participants (56% men, 27.3 ± 6.5 years), up to 236 counts per minute were recorded in the anteroposterior and mediolateral axes during dynamic sitting using a hip-worn accelerometer. Subsequently, we examined in 621 participants (38% men, 80.0 ± 4.7 years) from the AGES-Reykjavik Study whether dynamic sitting was associated with cardio-metabolic health. Compared to participants who recorded the fewest dynamic sitting minutes (Q1), those with more dynamic sitting minutes had a lower BMI (Q2 = −1.39 (95%CI = −2.33;–0.46); Q3 = −1.87 (−2.82;–0.92); Q4 = −3.38 (−4.32;–2.45)), a smaller waist circumference (Q2 = −2.95 (−5.44;–0.46); Q3 = −3.47 (−6.01;–0.93); Q4 = −8.21 (−10.72;–5.71)), and a lower odds for the metabolic syndrome (Q2 = 0.74 [0.45;1.20] Q3 = 0.58 [0.36;0.95]; Q4 = 0.36 [0.22;0.59]). Our findings suggest that dynamic sitting might be identified using accelerometry and that this behaviour was associated with health. This might be important given the large amounts of time people spend sitting. Future studies with a focus on validation, causation and physiological pathways are needed to further examine the possible relevance of dynamic sitting.

A Vibrotactile Feedback Device for Seated Balance Assessment and Training.

Postural perturbations, motion tracking, and sensory feedback are modern techniques used to challenge, assess, and train upright sitting, respectively. The goal of the developed protocol is to construct and operate a sitting platform that can be passively destabilized while an inertial measurement unit quantifies its motion and vibrating elements deliver tactile feedback to the user. Interchangeable seat attachments alter the stability level of the device to safely challenge sitting balance. A built-in microcontroller allows fine-tuning of the feedback parameters to augment sensory function. Posturographic measures, typical of balance assessment protocols, summarize the motion signals acquired during timed balance trials. No dynamic sitting protocol to date provides variable challenge, quantification, and sensory feedback free of laboratory constraints. Our results demonstrate that non-disabled users of the device exhibit significant changes in posturographic measures when balance difficulty is altered or vibrational feedback provided. The portable, versatile device has potential applications in rehabilitation (following skeletal, muscular, or neurological injury), training (for sports or spatial awareness), entertainment (via virtual or augmented reality), and research (of sitting-related disorders).

Biomechanical analysis of different dynamic sitting techniques: an exploratory study

Prolonged static sitting in wheelchairs increases the risk of pressure ulcers. This exploratory study proposed three dynamic sitting techniques in order to reduce the risk of developing pressure ulcer during wheelchair sitting, namely lumbar prominent dynamic sitting, femur upward dynamic sitting, and lumbar prominent with femur upward dynamic sitting. The purpose of this study was to analyze the biomechanical effects of these three techniques on interface pressure. 15 able-bodied people were recruited as subjects to compare the aforementioned sitting techniques in a random order. All parameters, including dynamic contact area, dynamic average pressure, and dynamic peak pressure on backrest and seat were measured and compared. In result, when compared with lumbar prominent dynamic sitting, femur upward dynamic sitting and lumbar prominent with femur upward dynamic sitting appeared to yield significantly lower dynamic average and peak pressure on the back part of seat, and significantly higher dynamic average and peak pressure on the front part of seat. This study can serve as a reference point for clinical physicians or wheelchair users to identify a suitable dynamic sitting technique.

Students and Faculty Perceptions of Standing and Dynamic Sitting in the University Classroom

Background: This study investigated the quantitative and qualitative perceptions of university students and faculty with alternative workstations (standing, sit-stand, and dynamic sitting) in the classroom. Although alternative workstations have health benefits by reducing prolonged periods of sitting, questions still remain on their acceptability. Methods: University students (N=1005) and faculty (N=218) completed a mixed-method online survey assessing their perceptions of alternative workstations in the classroom. Results: A large portion of students believed standing, sit-stand, and to a lesser extent dynamic sitting options should be available for students in the university classroom. A majority of the students also stated that they would use these options if they were available in the university classroom. Conclusions: Thus, we recommend providing standing, sit-stand, and to a lesser extent dynamic sitting options in university classrooms to allow students to receive health benefits as they learn.

Standing and Dynamic Sitting: Effects on University Classroom Performance – A Pilot Study

Background: There are health risks associated with prolonged periods of sitting. A concern with interventions to reduce sitting is performance may suffer. Purpose: This pilot study investigated the effect of alternative posture on classroom performance. Methods: University students (N=20) listened to three 50-minute lectures followed by three quizzes pertaining to the lectures, performed cognitive tasks, and rated their discomfort, ease, enjoyment, focus, and future use after each condition. For the main results, one-way repeated measures ANOVA were used to examine for differences across classic sitting, dynamic sitting, and standing conditions. Results: Classroom performance, cognitive performance, enjoyment, and focus do not suffer by changing students’ anatomical position from classic sitting. However, standing posture may cause more discomfort and difficulty for some students. Conclusion: At this early stage of inquiry there is no evidence to recommend against providing dynamic sitting and standing options in university classrooms to allow students to receive health benefits as they learn.

P 137 - The effectiveness of dynamic sitting in sedentary workers with low back pain

Proximal hamstring injuries cause buttock pain and may result in significant weakness and sciatic neuralgia. Avulsion ruptures involving 2 or more tendons with >2-cm retraction may benefit from early open surgical repair. More chronic equivalents may benefit from Achilles allograft reconstruction. Chronic proximal hamstring syndrome causing posterior thigh and sit pain may occur from less severe, often repetitive injury to the proximal hamstring origin with secondary sciatic neuralgia from local adhesions or scar entrapment. Recalcitrant cases may benefit from surgical intervention, but the most effective procedure (tenotomy, resection of degenerative tissue with tenotomy vs repair, sciatic neurolysis) has not been established. The role of endoscopic surgery of the proximal hamstring is evolving, but currently may best be indicated for ischial bursectomy, debridement of degenerative tendon tissue, and/or sciatic neurolysis. Although endoscopic proximal hamstring repair is feasible for treating tears with mild retraction, the role of endoscopic (or open) surgery in repair of acute complete tears with <2-cm retraction or less severe injuries (partial tears or complete tears without retraction) is controversial because most of these injuries may respond to nonoperative management. In this setting, perhaps surgical treatment (open or endoscopic) should be reserved for patients who have failed nonsurgical management.