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Hamstring Tendonitis: Know the Symptoms, Treatment & Recovery Time (Infographic)

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You feel it while walking, definitely when you bend forward and the idea of running fails to transform into spirit…all because of that pain in the rear. Hamstring injuries are notorious among runners. Meet with a group of athletes and runners and you shall understand how much this band of muscles is discussed and how any damage to them can affect their career and life. One of such dreaded hamstring injuries is high hamstring tendonitis.

The WHO medical classification list states that based on the area that is affected on the hamstring, tendonitis can be experienced in different parts. Thus, one can have distal hamstring tendonitis, lower hamstring tendonitis, proximal hamstring tendonitis, high hamstring tendonitis or lateral hamstring tendonitis. Runners inflicted with high hamstring tendonitis complain of deep buttock pain, difficulty when sitting, and deep posterior upper thigh pain and upper hamstring pain. This is due to the inflammation of the hamstring tendon.

 Want to know more about high hamstring injuries? Keep reading to get the details for high hamstring tendonitis.

What is Hamstring Tendonitis

Hamstring Tendonitis
High Hamstring Tendonitis Site (source)

In medical jargon, it is known as proximal hamstring tendinopathy. But we shall stick to the colloquial term - hamstring tendonitis, in our discussion.

The hamstring complex is a group of three muscles (Semitendinosus, Semimembranosus, and Biceps femoris) that helps in flexing of the knee and assists in hip extension. These muscles originate at the hip and just below the pelvis and end in thick tendons at the back of the knee. High hamstring tendonitis means inflammation of hamstring tendons at the back of the thigh. This condition occurs when the hamstring tendon is damaged or inflamed due to excessive strain on the tendon. This is a common running injury in runners, football players, and athletes in jumping sports.

Unlike an acute strain, the pain in upper hamstring develops gradually and it is aggravated by activities like running, riding, driving, and worsened by prolonged sitting.

Causes of High Hamstring Tendonitis

By now you may have a fair idea that repeating the above activities for a longer period of time may trigger high hamstring tendonitis condition. This is because such activities strain the tendon and irritate it.

The proximal hamstring tendons connect the three hamstring muscles to ischial tuberosity (the sit bone), located in the buttocks. They are likely to suffer an injury while performing actions like running, rowing and prolonged sitting repeatedly. Straining the hamstring muscles, frequently changing the speed while running, ignoring warm-up workouts, and underdeveloped core strength leads to high hamstring tendonitis.

Symptoms of High Hamstring Tendonitis

Symptoms of Hamstring tendonitis
High Hamstring Tendonitis Obtruscts Running (source)

The frustrating high hamstring tendonitis is characterized by tightness and gradual pain at the back of the knee and under the buttocks, which increase over time. Hamstring tendon pain can turn chronic when it doesn’t undergo a complete recovery. This condition begins with either failure of proper healing from a previous tendon tear or from chronic tendinitis, a non-inflammatory, degeneration of the tendon that changes its structure or composition due to repetitive trauma.

You will also notice swelling or bruising of the hamstring muscle under the lower buttock on either side of the knee. If any intense activity is followed by stiffness and tenderness of the posterior knee while resting then perhaps the hamstring tendon is injured. In most severe cases, this pain and swelling can be felt in the thigh and calf muscles as well. Such individuals will experience acute pain in the morning and often the knee joint feel weak which makes them unable to resume activity. If you have lower hamstring pain, it could also be due to hamstring stiffness.

Read all about How to Treat a Pulled Hamstring

Hamstring Tendonitis: Recovery Time

Well, generally after a hamstring injury, the most common question will be, “Will hamstring tendonitis ever go away?” or "What is the recovery time for hamstring tendonitis?"

The recovery time for the hamstring injuries varies and depends on the type of injury, along with the fitness level of the runners. The important thing though is when you begin the treatment. The sooner you begin, the better the recovery. 

Be it exercises, physiotherapy or the RICE protocol, it does take time. Though it may seem to continue for a long time, it does heal for most of the people, especially for runners. However, some runners also go for major surgical procedures. In this case, the recovery period can be anywhere between three to six months.

The risk of re-injury is a major concern for the ones who suffer from hamstring injuries. In such cases, runners need to be extra careful and take all necessary steps to prevent any kind of recurrence. Recovery doesn’t happen over the night. So, give sufficient time to your body to heal and do exercises of moderate intensity to achieve flexibility and strength.

Speed Healing of Hamstring Tendonitis:

There are some case studies that suggest speed healing, especially for high hamstring tendinopathy. Be it soft tissue massage or manipulation with ART and Graston techniques, especially in the case of high hamstring tendinopathy treatment, it is suggested that direct compression should be totally avoided. Gentle stretching of the hamstrings is suggested and encouraged.

Try deep tissue massage techniques for optimum healing. It has been observed that deep tissue massage is effective in repairing scarred tissues. Perform the tissue massage therapy with a foam roller or cylinder directly to the muscle-tendon juncture of the upper biceps femoris. Be gentle and massage the affected area only after the acute stage has passed.

How to Determine High Hamstring Tendonitis

Deep pain and stiffness in the buttocks can mean many other physical conditions. For such cynical individuals, we have three hamstring stretches to determine high hamstring tendonitis condition. Try out!

First Stretch

Hamstring Tendonitis Stretches
Keeping the Affected on a Table, Try to Stretch Forward (source)

This is a simple standing hamstring stretch. Rest your foot on a knee- to waist-high support and stretch your hamstrings by trying to reach your toes and pushing the heel outwards.

Second Stretch

Hamstring Stretch
Use a Stretch Band for Better Stretch (source)

Lie down on your back, with the hip and knee flexed. Using a rope or a stretch band, slowly straighten your knee and stretch the hamstring.

Third Stretch

hamstring stretch
Using a Stretch Band Rapidly Straighten the Leg (source)

Similar to the second, the third stretch is about doing the same thing but rapidly. In this test, you are supposed to straighten the leg promptly. In case you experience any pain in the buttock or the hamstring during any of these three stretches then that’s a situation of high hamstring tendinopathy. Although these exercises may confirm the presence of high hamstring tendonitis, it is also advisable to take a second opinion from a physician for proper prognosis.

Treatment of High Hamstring Tendonitis

Any physical injury requires ample amount of rest.

That said, you can follow the tried and test RICE method.

  • R - Rest
  • I -  Ice
  • C - Compression
  • E - Elevation

Resting will reduce pain and give the hamstrings a chance to recover. Resting is essential and is one of the best technique to treat high hamstring pain. Take some time off from running and indulge in cross-training activities.  Avoid strenuous activities, take rest and give time to your injured tendon to recover.

Apply ice on the injured hamstring region to minimize the swelling. Wrap it with an elastic bandage, such as Ace wrap, be careful not to wrap it too tightly as that can instigate more swelling. Put a pillow under the affected leg while sleeping for elevation. The elevation level should be above the heart level. Ice packs should be applied every 2 to 4 hours for a minimum of at least 10 minutes. You can also use heat and massage the area followed by stretching.

The RICE technique will definitely reduce the inflammation and lower the associated pain. You can also take Non-steroidal anti-inflammatory medications, such as ibuprofen (e.g. Motrin, Advil), or naproxen (e.g. Aleve, Naprosyn) or Extracorporeal shock-wave therapy (ESWT).

Once the pain and swelling have diminished to a considerable level, get engaged in a stretching and strengthening regime to gain strong hamstring muscles.

Stretching improves flexibility and improves the range of motion. However, you should realize that it will take time and it does not happen overnight. Strengthening regime will include exercises for preventing high and lower hamstring pain too! If, however, as a runner you fail to improve within the stipulated time period, you should consider alternative treatment options.

Alternative treatment includes options such as ultrasound-guided needle tenotomy, ultrasound-guided corticosteroid injections, percutaneous (ultrasound-guided through the skin), PRP - platelet-rich plasma injections which are also ultrasound-guided, or ultrasonic tenotomy.

Exercises for Preventing Hamstring Tendonitis

Stretching and strengthening the injured muscle is very critical for complete healing. Here are a few hamstrings stretches and strengthening exercises for better running injury recovery. Check out!

Stretching Exercises for High Hamstring Tendonitis

Muscle tightness can also contribute to high hamstring tendonitis. Hence, stretching is a must to ease the tension in the tendon.

1. Standing Forward Bend with Raised Leg

Raised Leg Stretches - Hamstring
Keeping the Foot on a Chair, Bend Forward, and Stretch (source)

Stand with a straight spine and place the heel of the affected leg on a chair. Keep the other leg straight but avoid locking the knee. Slowly bend forward from the hips, keep the raised leg and your back straight. Try reaching for the toes of the raised leg.

Stop as you feel a stretch along the back of the knee and thigh of the raised leg. Hold the position for 30 seconds before returning to the initial stance.

2. Standing Forward Bend with Crossed Legs

Crossed Leg Stretches - Hamstring Tendon
Fold Your Ankles and Bend Forward to Reach the Ground (source)

Stand straight and cross your feet at ankles. Keeping both the feet flat on the ground, slowly bend forward from the hips. You can take the support of the wall for stability. Bend as far as possible until a tug is sensed on the back of the knee. Reach for the ground if possible and hold the stance for 10 seconds before releasing.

3. Stretch for the Back of the Knee

 Bending Stretches - Hamstring tendon
Keeping Your Feet As Shown in the Picture, Bend Forward (source)

Stand to face the stair, place the affected leg on the step such that the heel should touch the ground and the ball of the foot is raised, resting on the edge of the step. Your toes should be pointing upwards. Keeping the other foot straight and flat on the ground, slowly bend forward from your hips. Be sure to keep both the legs straight as you bend and stop when you sense a stretch on the raised leg. Hold the position for 20 seconds before returning the initial position.

4. Seated Stretch with Rotation

Seated Rotation Hamstring Stretches
Seated Stretch with Rotation is Good for the Knees Too (source)

Seat up straight on the ground with the affected leg stretched out. Cross the other leg over and bend it to tuck under the affected thigh. Now slowly rotate your body from the hips to the outer side of the affected leg. Rotate as far as possible. Stop as you feel a stretch. Hold it for 30 seconds before relaxing and switching sides.

5. Standing Hamstring Stretch

Standing hamstring stretch
This is a Classic Hamstring Stretch (source)

Take the standing position, keep both the legs hip-width apart. Place one foot slightly behind the other. Keeping the front leg straight, bend the other knee and as you do that, lean forward from the hips. Be sure not to hunch over as you bring the torso toward the knees. Rest your hands on the outstretched leg for support. For a better stretch, keep the toes of the straight leg pointing upwards. Hold it for 30 seconds before switching sides.

Strengthening Exercises for High Hamstring Tendonitis

Start with the strengthening workouts once the hamstring tendon becomes less sore to direct pressure.

1. Hamstring Bridge (Hamstring muscles)

Hamstring Bridge
Lift Your Lower Body Up and Push the Heels Towards the Hips (source)

Lie down straight on a mat. Tighten your abs and lift your hips off the floor. Pull the heels of your legs towards the hip to tighten the hamstring muscles. Be sure not to lift too high or arch your lower back. Hold the posture for 30 holds before trying 15 reps. Continue the exercise until the hamstrings are completely fatigued. You will feel a burning sensation in the muscles. Perform three to four sets of it.

2. Squat (quads, glutes, hamstring)

Squats for Hamstrings
Keeping Your a Distance Apart, Slowly Squat Down (source)

Stand straight with both feet hip-width apart. Now slowly squat down while pushing the hips slightly back. Concentrate your weight on the heels. Hold the posture a little above 90 degrees for 20-30 seconds. Next, maintaining the posture move up and down for 10 repetitions. Perform three to four sets of it.

So, as you see with a little caution and exercise you can treat and prevent the distressful high hamstring tendonitis. All runners are vulnerable to hamstring injuries and other running injuries. When we push our body during training and workouts, it tends to suffer tear and abuse but it also recovers while taking its own sweet time. 

hamstring injuries prevention
Know all about the risks and preventive measures (Source)

As runners and athletes, you should listen to your body. Let an injury heal completely to avoid future related damages. Do not forget to warm up before running and stretching too! Perform regular strengthening exercises to keep muscles stronger so that they can absorb the impact forces. Avoid sudden increase in the intensity of your training programs and wear proper, well-fitting shoes - they are a runner’s shield.

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