HAMSTRING TENDINOPATHY

TEAM INDIA | BASU | 2018

Tendinopathy – the importance of staging and role
of compression
 TENDON PROBLEMS

• Are common in runners and can become chronic

• In recent years our understanding of the pathology of tendinopathy has

grown – we now know that it isn’t really an inflammatory process and that
load plays a large role.

• We also know that it’s important to determine the ‘stage’ of the

tendinopathy and this will have a huge influence on how you manage it.
 3 STAGES

1. Reactive

2. Dysrepair

3. Degenerative
1. REACTIVE
• Tendon undergoes a rapid increase in load, for runners its an increase in mileage,
reduced rest days, change in training like speed work or hill work.

• It was thought inflammation but its not the case.

• Tendon does swell up coz of movement of water into the tendon matrix and not
inflammatory products.

• Reactive tendon means structurally it remains intact and there is minimal change in
collagen integrity.

• In a nutshell - reversible
2. TENDON DYSREPAIR
• The stage that follows reactive tendinopathy

• If you continue to hammer the tendon the structure begins to change with
greater matrix breakdown.

• There may be an increase in vascularity

• Is usually the stage that would follow reactive tendinopathy if the tendon
continues to be excessively loaded. It is similar to the reactive stage but the
tendon structure begins to change with greater matrix breakdown.
3. DEGENERATIVE TENDINOPATHY

• Is more common in the older athlete. It represents a response of the

tendon to chronic overloading
• There are multiple tendon structure changes making it less efficient
at dealing with load
• Collagen becomes disorganized and advanced matrix breakdown takes
place alongside further increases in vascularity
• The tendon can appear thickened and nodular and there is risk of
tendon rupture with advanced degeneration
 MANAGEMENT OF TENDINOPATHY
• The treatment varies considerably between the stages

• Many runners will have heard of “eccentric” exercise for tendon

problems and may be trying ‘heel drops’ for Achilles tendinopathy or
other eccentric exercises

• This will probably make things worse in a reactive tendinopathy but

might help in the degenerative stage – this is why staging is so
important! If you don’t identify the correct stage you could well be
making your problem worse!
MANAGING TENDINOPATHY IN EARLY/REACTIVE STAGE
• Arguably the most important treatment in this stage is load management

• This means reducing both tensile and compressive load on the tendon

• Tendons connect muscle to bone and as a result are placed under a great deal of tension
during activities that involve the muscle contracting or resisting a stretching force

• This is what we mean by tensile load. Each time your foot contacts the ground during
running your body has to deal with an impact force equal to roughly 2.5 times your body
weight

• Fortunately tendons are thought to be able to withstand up to approximately 8 times our

body weight. Runners can reduce tensile load simply by decreasing how far or fast we run,
or taking a rest from running if indicated
• For example with proximal hamstring tendinopathy the tendon is
thought to be compressed against the ischial tuberosity (bone in
your bottom) when the hip is flexed, such as during sitting

• Reducing time spent sat is a simple way to reduce this

compressive load

• Of particular importance is reducing movements that combine

both compressive and tensile loads

• Staying with the example of hamstring tendinopathy, running

uphill and stretching the hamstring muscle can both place tension
on the hamstring while it’s tendon is compressed against the
ischial tuberosity

• As such both are likely to aggravate the condition, especially in

the reactive stage.
• Managing load is the key

• That means reducing the load

• Runners probably rest from running or modifying the

workload.

• Pain may settle in 5 to 10 days but the tendon is still sensitive

to high loads and it all depends upon 24 hours later. dose
response relationship.

• So with tendinopathy it all depends upon the reaction. They

may seem fine while running but the next morning they may
react with pain

• Anti inflammatory works during reactive stage

 ISOMETRIC EXERCISE WORKS

• Isometric exercise can reduce pain and maintain muscle strength in

the reactive stage

• Provided it’s not done in a position where the tendon is compressed

STAGE – 1: PROXIMAL HAMSTRING REHAB
• Isometric straight leg pull down

• Bridge hold

• Unilateral bridge hold

• Unilateral bridge hold on heel

• Long leg bridge hold - bilateral

• Long leg bridge hold - unilateral

• Straight leg bridge

• Unilateral straight leg bridge

STAGE – 2

• Glute Ham Falls

• Hammy Roll-outs

• Prone Curls with band

STAGE - 3

• Step up
• Reverse lunge
• Walking lunge
• SL DL
• Hip thrust march
• RDL
STAGE – 4: PERFORMANCE
• Clean with Lunge or Step
• RDL
• Glut Ham Raise
• Hammy Toss
• Single leg back extension with rotstion and perturbations