HAMSTRING TENDINOPATHY – A PAIN IN THE BUTT
Got a lingering pain in the butt that won’t go away? It may not actually be your butt, but your hamstrings to blame..
Hamstring Tendinopathy is a commonly misdiagnosed condition, and one that can become quite severe and debilitating when not managed appropriately.
This condition will often present as literally a pain in the butt. The main symptom will be low buttock pain, particularly around the area of your sitting bones. This is common in anyone from young, fit runners or athletes, to middle aged sedentary office workers who do a lot of sitting. People complain of buttock pain, which is often misdiagnosed by doctors or clinicians as a back or hip compliant, and thus being poorly managed.
A tendinopathy is when a tendon (band of tissue connecting muscle to bone) reacts painfully to an increase in load. Tendons will usually react 1-2 days after the activity that causes overload, or can degenerate over time in an older/sedentary population. Hamstring tendinopathy is felt at the tendon that connects your hamstring muscles to your pelvis at your sitting bones (ischial tuberosity). If tendinopathies are not managed effectively (by decreasing the load through the tendon and through specific rehabilitation exercises), the structure of the tendon can break down, and the problem can become chronic.
Compression is a major contributing factor for hamstring tendinopathy. People who do a lot of hill running, who do a lot of sitting, or who generally have tight hamstrings are more susceptible to hamstring tendinopathy, as these factors all place the tendon under extra compression. This needs to be addressed, with strategies put in place to de-load the affected tendon (sitting on a donut cushion can be a great strategy if sitting pain is an issue). Once the compression has been dealt with, an exercise program should be commenced to help settle down the pain, strengthen the area and gradually increase the tendons ability to take load. Tendons do not respond favorably to a rapid increase in load, so the rehabilitation program and any return to sport needs to progressed gradually, with careful monitoring of pain levels the day after activity.
The prognosis for this sort of tendinopathy largely depends on the length and severity of your symptoms. However once correctly diagnosed, and if you are compliant with decompression strategies and rehabilitation exercises, you should aim to experience a significant reduction in your pain within 4-6 weeks. Rehabilitation should then be continued for several months to improve the causative factors and prevent recurrence.
Chris Bryceson
B. Health Sciences (Physio), APAM
CB Physiotherapy