PROXIMAL HAMSTRING TENDINOPATHY
There proximal hamstring tendinopathy This corresponds to an injury to the tendons that connect the muscles located at the back of the thigh to the pelvis, near the buttock. It can cause pain at the base of the buttock, sometimes felt in the upper back of the thigh.
The discomfort often develops gradually, particularly as the stress on the tendon increases. Treatment initially aims to identify the movements or positions that perpetuate the pain, then to adapt activities and gradually strengthen the thigh muscles.
UNDERSTANDING PROXIMAL HAMSTRING TENDINOPATHY
RECOGNIZING THE SYMPTOMS
There proximal hamstring tendinopathy It most often causes pain at the base of the buttock, near the bone on which one sits. It can be triggered by running, movements that stretch the back of the thigh, or prolonged sitting.
- Pain under the buttock: The area where the tendons attach to the pelvis can be sensitive, especially to pressure.
- Discomfort while sitting: Sitting for long periods, especially on a hard surface, can increase pressure on the painful area.
- Pain during running: Speeding up, running uphill, or rapidly increasing training time can trigger symptoms.
- Pain during certain movements: Stretching the back of the thigh, bending forward, or performing a deep hip flexion can accentuate the discomfort.
The pain is often gradual, but sudden pain after exertion may suggest a different injury, such as a tendon tear or avulsion. Examination can distinguish these situations from other causes of pain in the buttock or back of the thigh.
WHY DOES PROXIMAL HAMSTRING TENDINOPATHY OCCUR?
Tendinopathy can occur when tendons are subjected to stresses exceeding their adaptive capacity. A rapid increase in activity or the repetition of movements that put the tendon under tension or compression can contribute to the onset of symptoms.
RAPID INCREASE IN ACTIVITY
A sudden increase in running volume, more intense sessions, or more hills can put greater stress on the tendons. The change in workload may be more significant than the activity itself.
MOVEMENTS THAT STRETCH THE BACK OF THE THIGH
Hip flexion with the knee straight can put tension on the tendon. Repeated movements, or those performed with a heavy load, can perpetuate the pain.
PROLONGED PRESSURE ON THE AREA
Sitting puts pressure on the tendon insertion point near the ischial tuberosity. Prolonged sitting or sitting on a hard surface can make the area more sensitive in some people.
PROGRESSIVE EVOLUTION OF THE TENDON
Tendons can become more sensitive over time, sometimes without a single triggering event. Tendon damage can also occur alongside other causes of pain in the buttock or back of the thigh.
MAKE THE RIGHT DIAGNOSIS
The diagnosis is initially based on symptoms and clinical examination. Imaging may be recommended if symptoms persist, if the diagnosis remains uncertain, or if a tear is suspected.
01 – THE CLINICAL EXAMINATION
The location of the pain, tenderness near the tendon insertion, and hip and knee movements are assessed. Certain tests, such as resisted knee flexion or hamstring stretching, can help reproduce the pain.
02 – X-RAYS
X-rays can help examine the pelvic bones and look for other possible causes of symptoms. They do not directly show the condition of the tendons.
03 – ULTRASOUND OR MRI
An ultrasound or MRI may be requested to examine the tendons, determine the presence of tendinopathy or a tear, and assess surrounding structures. The choice of examination depends on the clinical situation.
An abnormality visible on imaging should always be interpreted in conjunction with symptoms and clinical examination.
RELIEVE proximal hamstring tendinopathy WITHOUT SURGERY
The management of proximal hamstring tendinopathy Treatment most often begins with non-surgical measures. These aim to reduce the stresses that trigger the pain and to gradually rebuild the tendon's ability to withstand activity.
Temporarily adapt activities
Reduce for a while any movements that clearly trigger pain, such as sprints, hill work, or deep hip flexion, without necessarily stopping all activity. Then gradually resume, according to tolerance.
Limit positions that compress the tendon
Prolonged sitting, especially on a hard surface, can increase pressure near the hamstring attachments. Taking breaks, changing positions, and avoiding stretches that aggravate the pain can help.
Gradually strengthen the hamstrings
Physiotherapy can offer an individualized progression of exercises for the hamstrings and pelvic muscles. The load increases gradually, while monitoring the pain response and the return to activities.
Review of complementary treatments
Pain medication may sometimes be considered in consultation with a healthcare professional, depending on each individual's medical situation. An injection may also be discussed if symptoms persist, but its benefit remains uncertain: it is not a first-line treatment.
The treatment is based primarily on adapting the effort and a gradual resumption of strengthening. Surgery is generally not necessary for this tendinopathy.
IS SURGERY NECESSARY?
Surgery is generally not necessary for proximal hamstring tendinopathy. Management primarily focuses on activity modifications and physiotherapy. Intervention may only be considered in rare cases, following a specialist evaluation.
Preference non-surgical treatment
Adapting activities and physiotherapy with progressive strengthening are the first steps. An injection may sometimes be considered depending on the symptoms and the condition of the tendon.
REASSESS THE PERSISTENT PAIN
If the pain remains very bothersome despite appropriate management, the diagnosis, imaging and treatments already followed can be reassessed with the specialist.
DISCUSSING INTERVENTION IN RARE CASES
Intervention may be considered in certain selected situations, particularly if an associated tendon injury is identified. It is not a standard treatment for this tendinopathy and does not guarantee tendon healing.
KEEP MOVING WITH PROXIMAL HAMSTRING TENDINOPATHY
Proximal hamstring tendinopathy does not mean that all activity must be stopped. It is often possible to remain active by temporarily reducing the movements or positions that strongly trigger pain.
Walking, cycling, or strengthening exercises can be adapted to the thigh's tolerance. Movements are resumed gradually, taking into account pain during exertion and in the hours that follow.
After an intervention, if necessary, the resumption of activities follows a program adapted to the procedure performed and to the recovery of each patient.
Progress depends on tendon tolerance and movement quality, not on a uniform schedule for everyone.
A CARE APPROACH TAILORED TO EACH PATIENT
Pain under the buttock can have several causes. A consultation allows the doctor to determine the relationship between the location of the pain, the activities that trigger it, the clinical examination, and, if necessary, the results of imaging.
Treatment may involve adapting activities and physiotherapy with progressive hamstring strengthening. The program evolves according to the pain level, exercise tolerance, and the patient's goals.
If symptoms persist or if a tendon injury is suspected, further tests and other treatment options can be discussed. Surgery is reserved for selected cases, after assessment of the tendon's condition and the impact of pain on daily life.
«"Gradually regain a more comfortable thigh by adapting the stresses and strengthening the tendons according to their tolerance."»
FREQUENTLY ASKED QUESTIONS
DO YOU WANT TO BETTER UNDERSTAND YOUR PAIN?
A clinical examination combined with appropriate imaging helps to determine the origin of symptoms and identify the most suitable treatments.
