Proximal Hamstring Tendinopathy Research Articles

Clinical Progression and Load Management For Proximal Hamstring Tendinopathy In A Long-Distance Runner: A Case Report.

The characteristics of Proximal Hamstring Tendinopathy (PHT) include deep, localized pain in the region of the ischial tuberosity. Chronic lesions are often found in long-distance runners. Compression of the tendon and shear force at its insertion at the ischial tuberosity during hip flexion/adduction is a key etiologic factor. The aim of this case report is to analyze the effectiveness of an exercise protocol with progression of tendon loading in PHT in an amateur runner, by assessing pain and functional capacity. The subject was a 30-year-old male runner. After participating in a 10km race, he experienced an insidious onset of deep buttock pain in the right ischial tuberosity. His pain was aggravated by running on sloped roads and prolonged sitting on hard surfaces, particularly while driving. The visual analog scale (VAS) for pain, the Puranen-Orave test (PO), the Bent-Knee stretch test (BK stretch), the supine plank test, the Victorian Institute of Sport Assessment-proximal hamstring tendons (VISA-H) questionnaire, and the sciatic nerve mobility (via the Slump test) were assessed. The intervention involved a 12-week progressive loading exercise program divided into four phases. The initial pain was reduced at 6 weeks of intervention and further decreased at 12 weeks (VAS from 7, to 5 and to 1). Function increased at 6 weeks and at 12 weeks (VISA-H from 23, to 53, to 80). Sciatic nerve mobility was normal. The progression of training in a subject with PHT tendon injury based on isometric exercise, concentric/eccentric, energy storage, progressively increasing hip flexion was beneficial, increasing function and decreasing pain. Studies with a larger sample size and a more precise methodological design would be necessary to support this type of intervention in clinical practice. 5.

Current and future advances in practice: tendinopathies of the hip.

Tendinopathy describes persistent tendon pain and loss of function related to mechanical loading. Two common hip tendinopathies seen in practice are gluteal tendinopathy and proximal hamstring tendinopathy. Both conditions can be frustrating for patients and clinicians due to the delay in diagnosis, significant disability caused and lack of response to common treatments. Tendinopathy is a clinical diagnosis and can most often be made using findings from the patient interview and pain provocation tests, without the need for imaging. Specific education and progressive exercise offer a low-risk and effective option for gluteal tendinopathy and result in greater rates of treatment success than corticosteroid injection, both in the short term (8 weeks) and at 1 year. Proximal hamstring tendinopathy is a common, but less researched, and under-recognized cause of persistent ischial pain. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies.

Use of extracorporeal shockwave therapies for athletes and physically active individuals: a systematic review

ObjectiveTo determine the efficacy of extracorporeal shockwave therapy (ESWT) and investigate outcomes following the use of ESWT for athletes and physically active individuals.DesignSystematic review.Data sourcesWe followed the Preferred Reporting Items...

Ischiofemoral Impingement Syndrome Masked by Proximal Hamstring Tendinopathy as a Cause of Gluteal Pain in a Marathon Runner.

Ischiofemoral Impingement Syndrome Masked by Proximal Hamstring Tendinopathy as a Cause of Gluteal Pain in a Marathon Runner.

Poster 223: Patient Reported Outcomes Following Treatment with Leukocyte Rich Platelet Rich Plasma Injections for Proximal Hamstring Tendinopathy

Poster 223: Patient Reported Outcomes Following Treatment with Leukocyte Rich Platelet Rich Plasma Injections for Proximal Hamstring Tendinopathy

Comparison of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation

Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating the effectiveness of the current conservative management of proximal hamstring tendinopathy (PHT) and outcomes are lacking. The purpose of this review is to provide insights into the efficacy of conservative therapeutic interventions in the management of PHT. In January 2022, databases including PubMed, Web of Science, CINAHL, and Embase were searched for studies assessing the effectiveness of conservative intervention compared with that of a placebo or combination of treatments on functional outcomes and pain. Studies that performed conservative management (exercise therapy and/or physical therapy modalities) in adults 18-65 years were included. Studies that performed surgical interventions or whose subjects had complete hamstring rupture/avulsion greater than a 2 cm displacement were excluded. A total of 13 studies were included: five studies compared exercise interventions, while eight studies investigated a multimodal approach of either shockwave therapy and exercise or a hybrid model incorporating exercise, shockwave therapy, and other modalities, such as ultrasound, trigger point needling, or instrument-assisted soft tissue mobilization. This review supports the notion that the conservative management of PHT may best be optimized through a multimodal approach incorporating a combination of tendon-specific loading at an increased length, lumbopelvic stabilization exercises, and extracorporeal shockwave therapy. With regard to hamstring-specific exercise selection, PHT may be optimally managed by including a progressive loading program at combined angles of the hip flexion at 110 degrees and the knee flexion between 45 and 90 degrees.

A pilot randomised trial comparing individualised physiotherapy versus shockwave therapy for proximal hamstring tendinopathy: a protocol

PurposeProximal hamstring tendinopathy (PHT) presents as localised lower buttock pain with tasks such as squatting and sitting. It is a condition that occurs at all ages and levels of sporting participation and can cause disability with sport, work, and activities of daily living.This paper details a pilot trial protocol for investigating the effectiveness of individualised physiotherapy compared to extracorporeal shockwave therapy (ESWT) on pain and strength in people with PHT.MethodsThe study is an assessor-blinded, pilot randomised controlled trial (RCT). One hundred participants with PHT will be recruited from the local community and sporting clubs. Participants will be randomised to receive six sessions of either individualised physiotherapy or ESWT, with both groups also receiving standardised education and advice.Primary outcomes will be global rating of change on a 7-point Likert scale, and the Victorian Institute of Sport—Hamstring (VISA-H) scale, measured at 0, 4, 12, 26 and 52 weeks. Secondary outcomes will include sitting tolerance, the modified Physical Activity Level Scale, eccentric hamstring strength, modified Tampa scale for kinesiophobia, the Örebro Musculoskeletal Pain Screening Questionnaire Short Form (ÖMPSQ-SF), Numerical Pain Rating Scale (NPRS) for average and worst pain, participant adherence, the Pain Catastrophizing scale, satisfaction scores, and quality of life. Data will be analysed on an intention to treat basis, with between-group effects estimated using linear mixed models for continuous data and Mann Whitney U tests for ordinal data.ConclusionsThis pilot RCT will compare individualised physiotherapy versus ESWT for PHT. The trial will determine feasibility and estimated treatment effects to inform a definitive trial in the future.Trial registrationThe trial has been prospectively registered with the Australia & New Zealand Clinical Trials Registry (ACTRN12621000846820), registered 1 July 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373085

Comprehensive Open Management of Buttock/Ischiofemoral Symptoms: The COMBIS Procedure for Posterior Hip Pain

Background: Posterior hip and buttock pain can arise from several overlapping but distinct etiologies. Ischiofemoral impingement, sciatic neuropathy, and proximal hamstring tendinopathy, occurring alone or in combination, have been implicated as precipitants. However, diagnosis and management of underlying pathology can be challenging, as few diagnostic modalities reliably differentiate between these etiologies and surgeon decision-making may be complicated by uncertainty over which pathology to address. Indications: Posterior hip and buttock pain which occurs in a sciatic nerve distribution and is refractory to conservative measures (eg, physical therapy, analgesics, and activity modification) raises suspicion for 1 or several of the above pathologies. A combined procedure to address all 3—ischiofemoral decompression, sciatic neurolysis, and proximal hamstring repair—is described here. Technique Description: The patient is placed prone on a radiolucent table. An incision is made, and dissection is taken down through the superficial layers of the buttock, gluteal fascia, and fascia overlying the proximal hamstring tendons. The sciatic nerve is identified, mobilized, and lysed using blunt dissection. The fascia overlying the ischium is incised and the tendinous insertion decorticated with rongeur. Two anchors are placed, and sutures are passed through the proximal hamstring tendon in mattress fashion. An incision is made in line with the external rotators and dissection is taken down to the lesser trochanter. The lesser trochanter is identified, and osteotomy performed, with mobilization and removal of the resected fragment. The interval in the external rotators is closed with interrupted suture. Results: This is an uncommon procedure with little data on patient outcomes. Nonetheless, it is effective for relief of symptoms related to the pathologies enumerated above. Keys to success include careful diagnosis and comfort with surgical technique. Conclusion: The COMBIS procedure simultaneously addresses 3 common etiologies of posterior hip and buttock pain. Although it is important to conduct a thorough diagnostic evaluation to rule out imitators, patients with symptoms due to ischiofemoral impingement, sciatic neuropathy, proximal hamstring tendinopathy, or combination thereof may experience good relief of symptoms with appropriate application of this technique. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Hamstring Injuries: Critical Analysis Review of Current Nonoperative Treatments

Hamstring injuries are common among active and athletic individuals, especially those involved in high-speed running, distance running, or sports requiring sudden directional changes. Acute hamstring strains often occur as an eccentric strain during running or a stretch-type injury caused by simultaneous hip flexion and knee extension. Proximal hamstring tendinopathy is an overuse injury of the hamstring tendon as a result of chronic cicatrization of the musculotendinous unit. Repeated stress to the hamstring tendon leads to increased cellularity of tendon fibers, disruption of collagen, and subsequent microinjury of the tissue that attaches the tendon to bone. Management of hamstring injuries generally begins with nonoperative modalities consisting of eccentric rehabilitative exercise programs. Although various other treatment modalities are available, the comparative efficacy of these supportive measures is not well differentiated at this time. In this article, we review the current literature with regard to the nonoperative treatment of hamstring injuries, specifically focusing on acute hamstring muscle strains and proximal hamstring tendinopathy in order to provide supplementary insight on the effectiveness of current modalities.

Translation, Linguistic Validation, and Readability of the Spanish Version of the VISA-H Scale in Elite Athletes.

Data regarding the diagnosis of Proximal Hamstring Tendinopathy (PHT) is limited. There is a need for a standardized, valid, and reliable instrument for evaluating PHT among Spanish population. The purpose of this study was to linguistically validate and cross-culturally adapt the Spanish version of the VISA-H for Spanish population and to assess its readability, initial feasibility, appropriateness and acceptability. Cross-cultural adaptation was done according to established guidelines. Process included 5 steps: independent translations, synthesis of the translations, back-translations, expert committee, and pre-test. The linguistic validation of the questionnaire followed a standard methodology that included comprehension test interviews to assess the relevance, understanding and acceptability of the VISA-H. Comprehension was analyzed with cognitive interviews of 18 Spanish Professional basketball and soccer players (n = 8 male, n = 10 female end-users, healthy individuals at risk), using think-aloud and probing techniques. All subjects (18/18) reported that the items were clear and did not cause upset. Additionally, every respondent had no difficulty in completing the form and found it fairly easy. No difficulties with the instructions were reported. Readability score resulted in adequate levels of understanding (Fernandez-Huerta score of 67.5), showing high level of acceptability. The results of the linguistic and semantic validation conducted with health risky population enable the identification that the Sp-VISA-H was well accepted and easily understood by the participants. Further testing on PHT patients is needed to corroborate these preliminary data.

Effectiveness of High Power Laser Therapy on Pain and Isokinetic Peak Torque in Athletes with Proximal Hamstring Tendinopathy: A Randomized Trial.

Athletes such as long-distance runners, sprinters, hockey, and/or football players may have proximal hamstring tendinopathy (PHT). Laser therapy has been shown to be effective in tendinopathies. High power laser therapy (HPLT) is used for the treatment of several musculoskeletal conditions; however, its efficacy on PHT has not been investigated. This study is aimed at examining the effects of HPLT on pain and isokinetic peak torque (IPT) in athletes with PHT. The two-arm comparative pretest-posttest experimental design was used with random allocation of 36 athletes aged 18-35 years into two groups (experimental and conventional group). The experimental group included the application of HPLT for 3 weeks. The conventional group included treatment with a conventional physiotherapy program including ultrasound therapy, moist heat pack, and home exercises for a total of 3 weeks. Pain and IPT of the hamstring muscle were measured before and after the application of the intervention. Pain score decreased, and IPT increased significantly (p < 0.05) after application of HPLT, by 61.26% and 13.18%, respectively. In the conventional group, a significant difference (p < 0.05) was observed in pain scores only, which decreased by 41.14%. No significant difference (p > 0.05) was observed in IPT in the conventional group. When HPLT was compared with conventional physiotherapy, a significant difference was found in pain scores only. HPLT for 3 weeks was found to be effective in improving pain in athletes with PHT. However, no significant difference was found between HPLT and conventional physiotherapy (US, moist heat, and home exercises) in improving the IPT of the hamstring muscle.

Core outcome set development for proximal hamstring tendinopathy (COS-PHT): a study protocol

Background Proximal hamstring tendinopathy is a common cause of buttock pain in running based sports. A recent systematic review found outcome measures used in research studies on this condition were inconsistent, which impedes synthesis of evidence. To understand the impact tendinopathy has on patients an international collaboration (International Scientific Tendinopathy Symposium Consensus Group) agreed on nine core health domains that should be measured in research on tendinopathy. The aim of this study is to develop an outcome set for proximal hamstring tendinopathy that covers all nine tendinopathy core health domains. This protocol describes the steps taken to develop this core outcome set. Methods This mixed method study will follow two key phases. Phase one: a systematic review will produce a comprehensive list of outcome measures that have been used in studies evaluating proximal hamstring tendinopathy. Outcome measures extracted will be matched to the tendinopathy core health domains by a steering committee of clinicians and researchers. Phase two: following a Delphi process, outcome measures will be considered by experienced clinicians, researchers, and patients. Within this study, outcome measures will be screened and selected using the Outcome Measures in Rheumatology filters of truth, feasibility, and discrimination, with a threshold of 70% agreement set for consensus. Discussion This project aims to provide and disseminate a core outcome set that can be recommended for use in future studies related to proximal hamstring tendinopathy. This will have the potential to improve research quality, allow pooling of studies in meta-analysis and assist in directing future research. Trial registration Protocol registered with the Core Outcome Measures in Effectiveness Trials in May 2021 (http://www.comet-initiative.org). Key points There is no agreed set of outcomes that are consistently used when researching proximal hamstring tendinopathy This protocol outlines the methods to derive a set of outcome measures to use when researching proximal hamstring tendinopathy Researchers, clinicians and patients will participate in a process of selecting outcome measures against the nine core health domains for tendinopathy Where core health domains do not have an outcome measure recommendations for future research will be provided Consistent use of outcome measures will allow pooling of data in meta-analysis and minimise research waste

The Brazilian version of the Victorian Institute of Sport Assessment - Hamstring (VISA-H) Questionnaire: Translation, cross-cultural adaptation and measurement properties

Study of diagnostic accuracy/assessment scale. Proximal hamstring tendinopathy (PHT) usually causes disability, deep pain in the proximal insertion of the tendon, and limitations in daily life and sports practice. Scales that assess PHT pain and disability may assist practitioners in their clinical decision-making processes. To perform a translation, cross-cultural adaptation and to evaluate the measurement properties of the Victorian Institute of Sport Assessment - Hamstring (VISA-H) questionnaire for the Brazilian population. The VISA-H was adapted to Brazilian Portuguese (VISA-H-Br) and applied in 2 occasions with 5-8-day intervals. The following measurement properties were evaluated: internal consistency, test-retest reliability, standard error of the measurement (SEM), smallest detectable change (SDC), structural validity, and construct validity. Ninety (n=90) participants (40 PHT and 50 asymptomatic participants) were evaluated using the Lower Extremity Functional Scale (LEFS) and VISA-H. PHT was diagnosed via clinical examination. The questionnaire was successfully translated, cross-culturally adapted, and renamed VISA-H-Br. The VISA-H-Br questionnaire demonstrated high internal consistency (Cronbach α=0.96), excellent test-retest reliability (ICC=0.90, CI 95% 0.83-0.93), and strong construct validity (rho=0.692, p<0.01 compared to LEFS). The SEM was 2.15 points, and the SDC was 5.96 points. No ceiling or floor effects were detected. The Brazilian version of the VISA-H was consistent, reliable, and valid. Therefore, it may be used in clinical practice and research to assess the pain and disability of patients with PHT.

Radial versus Combined Shockwave Therapy in the Management of Proximal Hamstring Tendinopathy: Similar Functional Outcomes in Running Cohort

Radial versus Combined Shockwave Therapy in the Management of Proximal Hamstring Tendinopathy: Similar Functional Outcomes in Running Cohort

Cross-cultural adaptation of the Victorian institute of sports assessment - Hamstrings (VISA-H) questionnaire for Spanish speaking athletes with proximal hamstring tendinopathy

ObjectiveTo cross-culturally adapt and validate the Victorian Institute of Sports Assessment – Hamstrings (VISA-H) scale into Spanish. DesignClinical measurement study (psychometric analysis). SettingSports clubs and physiotherapy clinics. ParticipantsThe Spanish version of the VISA-H (VISA-H-Sp) scale was administered to 101 subjects: 50 healthy runners and 51 patients with a clinical diagnosis of PHT. Main measuresThe Victorian Institute of Sports Assessment – Hamstrings. ResultsCronbach's alpha for the VISA-H-Sp was >0.8. The ICC 2,1 was 0.993 (95%CI 0.991–0.995). In the exploratory factor analysis, a one-factor solution explained 72.1% of the total variance. Athletes with PHT scored significantly lower in the VISA-H-Sp than healthy subjects (P < 0.001). The VISA-H-Sp score results in the PHT group showed significant correlations with SF-36 physical components (Spearman r’>0.6; P < 0.001), and low or non-significant association with psychological dimensions. The standard error of measurement was 1.45 whereas the minimal detectable change was 4.02 points. The responsiveness indicators included an effect size of 2.75, and a standardised response mean of 3.1 at discharge. ConclusionThe VISA-H-Sp shows adequate psychometric properties for assessing the severity of symptoms in Spanish-speaking athletes who suffer from PHT.

Proximal hamstring tendinopathy; expert physiotherapists’ perspectives on diagnosis, management and prevention

ObjectivesTo explore and summarise expert physiotherapists’ perceptions on their assessment, management and prevention of proximal hamstring tendinopathy (PHT). MethodsWe conducted semi-structured interviews with expert physiotherapists until data saturation was met (n = 13). Interviews were transcribed verbatim and data were analysed systematically and organised into categories and sub-categories according to study aims. ResultsExperts report using a clinical reasoning-based approach, incorporating information from the patient interview and results of clinical load-based provocation tests, in the physical examination to diagnose PHT. Experts manage the condition through education and progressive loading targeting the hamstring unit and kinetic chain, avoiding provocative activities in positions of compression in early-mid stage rehab and a gradated and controlled return to sport. Passive therapies including injection therapies and surgery were believed to have limited utility. Prevention of recurrence primarily involved continuation of hamstring and kinetic chain strengthening programs and management of physical workload. ConclusionExperts rely on a combination of information from the patient interview and a battery of pain provocation tests to diagnose PHT. Education and graded exercise of the hamstring group and synergists, minimising early exposure to hip flexion, were the foundation of management of the condition.

THE MANAGEMENT OF PROXIMAL HAMSTRING TENDINOPATHY IN A COMPETITIVE POWERLIFTER WITH HEAVY SLOW RESISTANCE TRAINING - A CASE REPORT.

Proximal hamstring tendinopathy is a chronic, overuse condition that commonly develops in athletes. Eccentric exercise has been widely accepted in the clinic as the treatment of choice for the management of tendinopathies. However, this form of treatment has seldom been compared to other forms of load-based management for hamstring tendinopathies. Heavy slow resistance training, which consists of both concentric and eccentric phases, increases the loading time experienced by the tendon compared to eccentric only exercises. Heavy slow resistance training has achieved positive clinical results in the management of Achilles and patellar tendinopathy. The purpose of this case report is to describe the outcomes of a powerlifter with proximal hamstring tendinopathy who responded favorably to a heavy slow resistance biased rehabilitation program after traditional, conservative management failed to alleviate symptoms. A 31-year-old male competitive powerlifter was seen in physical therapy for the management of proximal hamstring tendinopathy. The subject had experienced long duration pain localized at the ischial tuberosity combined with hip weakness that limited his ability to lift weigtht and sit for longer than 30 minutes. Treatment included a 12-week heavy slow resistance program with the focus of increasing load intensity. Numeric pain-rating scale was assessed at baseline, after a 12-week heavy slow resistance protocol, and 12 months post protocol. Within four weeks of starting the heavy slow resistance program, the subject noted a meaningful decrease in pain. The subject experienced clinically important improvements in numeric pain-rating scale immediately after the protocol and these improvements remained 12 months after completing the protocol. The subject was able to return to competitive powerlifting after the 12-week program. A meaningful change in pain occurred within four weeks of starting the program and continued improvement throughout the remainder of the 12 weeks with outcomes maintained 12 months after completing the program suggests that increasing the loading strategy with a heavy slow resistance program was helpful for this subject. 4.

Female Athlete Hip Injuries: A Narrative Review.

In this narrative review, we highlight sex-specific anatomic and biomechanical features of the hip region in female athletes, as well as the potential impact of these characteristics on observed disparities in both intra-articular and extra-articular injury patterns between female and male athletes. It is our goal to broaden the scope of knowledge related to hip pathology in active female athletes among sports medicine providers with the hope of better optimizing sport participation and performance in female athletes. A literature review was conducted using PubMed database and Google Scholar search engine. Search terms included sport, female, athlete, sex differences, injury, hip, and all diagnoses discussed in this review. Cross-reference of these articles identified additional resources. Sex-specific differences in both static design and dynamic function contribute to disparities in hip injury patterns between female and male athletes. Intra-articular injuries, including labral and ligamentum teres pathology, as well as extra-articular injuries, including iliopsoas tendon dysfunction, gluteal and proximal hamstring tendinopathy, ischiofemoral impingement, bone stress injuries, and certain nerve entrapment syndromes, seem to affect female athletes more commonly than male counterparts. Given unique anatomic and functional considerations, the growing population of female athletes worldwide warrants specialized care and consideration. Potential predisposition to specific hip injuries should be taken into consideration during diagnostic evaluation of hip pain in the female athlete.

Platelet-rich plasma for treatment of chronic proximal hamstring tendinopathy.

Aim: To determine whether platelet-rich plasma (PRP) can successfully treat symptoms associated with proximal hamstring tendinopathy. Materials & methods: Charts were retrospectively reviewed of patients with a diagnosis of chronic proximal hamstring tendinopathy who underwent an ultrasound-guided leukocyte-rich PRP injection to assess reported outcomes at baseline and final follow-up post-intervention. Results: In 22 patients with a mean age of 48.7years and mean symptom duration of 26.5months, mean Numeric Pain Rating Scale and Victorian Institute of Sport Assessment Scale for Proximal Hamstring Tendinopathy subscores demonstrated statistically significant improvements (p < 0.05) at a mean of 7.91months follow-up. Sixty-eight percent of patients demonstrated ≥50% reduction of pain. Conclusion: Pain and functional outcomes improved following injection of PRP.

Orthobiologics for the Hip Region: A Narrative Review.

Management of hip region disorders is challenging. Orthobiologic treatments including platelet rich plasma (PRP), mesenchymal stem cells, and amniotic injectables have gained popularity as promising treatments despite a lack of robust evidence for their effectiveness. We review rationale and current evidence for orthobiologics for three common hip region conditions: hip osteoarthritis, gluteal tendinopathy, and proximal hamstring tendinopathy. Overall, the current state of evidence is extremely limited for orthobiologic treatments and is predominantly relevant to PRP injections. There is currently a lack of data to support the use of mesenchymal stem cells or amniotic injectables in these conditions of the hip.