What is Hamstring Tendinosis & How is it Treated?

To understand Hamstring Tendinosis, we will first understand what comprises a hamstring muscle and what are the functions of the Hamstring Muscles. Hamstring Muscles are made up of three muscles which are the biceps femoris, the semimembranosus, and semitendinosus muscles.

The function of the Hamstring Muscles are to facilitate bending of the knee like when getting in and out of a car, kicking a football, running, and sprinting activities.

Now coming to Hamstring Tendinosis, this is a degenerative condition which occurs gradually over time and involves the tissue of the Hamstring Muscles without the presence of any inflammation. The muscles of the hamstrings have tendinous insertions on the ischial tuberosity and the back part of the lover portion of the knee. Due to repetitive wear and tear these tendons start to degenerate causing pain resulting in Hamstring Tendinosis. Athletes are more prone to suffering from Hamstring Tendinosis as they put their hamstrings under a lot of stress when they play and hence the tendons become weak and result in development of Hamstring Tendinosis.

As stated, Hamstring Tendinosis is normally caused by repetitive stress to the hamstring tendons. This repetitive stress can be put on the tendons by movement disorders, inappropriate body mechanics, sporting activities which involve a lot of running and sprinting like football, hockey, and baseball. Long and high jumpers are also at risk for developing Hamstring Tendinosis.

The main presenting feature of Hamstring Tendinosis is pain experienced in the thigh area or behind the knee. This pain may radiate to the back part of the thigh or back of the knee. This pain associated with hamstring tendinosis tends to worsen with aggravating factors like continued pressure on the hamstring muscles which is done by continuing activities which attribute to these symptoms. In severe cases of Hamstring Tendinosis, the individual will find it difficult to bear weight on the affected leg. The individual will feel immediate pain after the injury.

Diagnosing a pathological condition of the Hamstring Muscles is quite easy due to the localized pain behind the thigh that the individual will experience. Immediately after the injury, the individual is taken to a physician who will take a detailed history and conduct a detailed physical examination exploring the area in question. There will be tenderness in the hamstring area and the patient will find it difficult to move the affected leg without recreating pain. The physician will then order radiological studies to determine the exact nature of the injury in the form of an MRI scan to look at the internal structures and then formulate a treatment plan accordingly which usually involves rest and aggressive physical therapy. Only in cases of a tendon rupture is a surgery required.

The treatment plan for Hamstring Tendonosis varies from individual to individual and depends on the overall health and age of the patient. The general method of treating Hamstring Tendinosis is by taking plenty of rest, avoid any activities that may aggravate the condition, and taking NSAIDs and pain medications to calm down the pain.

Once the pain has calmed down, the patient will then be referred to physical therapy for aggressive management of Hamstring Tendinosis. The goal of the physical therapy for hamstring tendinosis will be to regain strength, stability, and motion of the affected leg.

The physical therapy will begin after a few days when the pain has calmed down and the patient is able to move the leg without much discomfort. The therapy will begin with stretching exercises which will be done for a couple of weeks followed by a detailed strengthening exercise regimen for hamstring tendinosis. When the patient is able to move the leg without any discomfort then the patient will be started with range of motion exercises to increase mobility and get rid of any stiffness that may be there due to immobilization of the affected leg.

After about four weeks of range of motion exercises, the patient suffering from hamstring tendinosis will then be recommended partial weight bearing on the affected extremity for a few days before full weightbearing on the extremity.

Once the patient accomplishes these goals then the patient may be cleared for gradual return to activity as tolerated without reproduction of symptoms. Sometimes, soft tissue mobs and ultrasound techniques are also used by physical therapist for treatment of Hamstring Tendinosis.

Majority of the patients with Hamstring Tendinosis who really work hard in physical therapy and are determined to get back to their activities at the soonest possible time can do so within a time span of 10-12 weeks. Recovery period can take longer in patients who are older and cannot be aggressive in physical therapy or in people who have a chronic case of Hamstring Tendinosis.