what is hamstring tendinopathy?
Causes and treatments to resolve pain from Hamstring Tendinopathy (Hamstring Tendonitis, Ischial Bursitis)
On the back of the sit-bone near your buttock, there are muscles and tendons that attach to the bone called the ischial tuberosity which is a boney protuberance on the pelvis. The muscles that attach to the sit-bone that can be injured are called the hamstring tendons and muscles. The most commonly injured tendons include the conjoint tendon made of the biceps femoris and semitendinosus, and than the semimembranous. Above the tendons between the gluteus maximus and the hamstring tendons there is a bursa that lubricates the tendons and can get inflamed which is the ischial bursa.
Although most people get diagnosed as bursitis, ischial bursitis, most of the time it is not the bursa being inflamed and it is the tendons being injured that can cause pain where you sit down.
A combination of over use and micro-damage from a host of causes can contribute to hamstring tendinopathy.
How do I know if I have hamstring tendinopathy (Hamstring tendonitis, ischial bursitis)?
Symptoms begin with pain focused on the sit-bone. Hamstring injuries occur most commonly in runners and water-skiing sports where the muscle is fully lengthened and has an eccentric contraction that is excessive and can cause an injury. A physician might press on the tendons which are tender and test the strength of the tendons which can have pain and weakness.
A diagnostic ultrasound or MRI can be used to properly evaluate the tendons to know if there is an injury. Ultrasound can be done in the clinic and can be useful to determine if the hamstring tendons or muscles are the cause.
What are treatment options for hamstring tendinopathy and partial thickness tears?
When hamstring tendinopathy initially happen, most of the time they are chronic injuries that happen over time. The first step in managing hamstring tendinopathy and partial tears is physical therapy to strengthen the hamstring muscles to help the tendon heal.
If physical therapy does not improve your pain or ability to perform activities, the next step is to consider injection. There are cortisone injections and orthobiologic injections. Cortisone can be injected in the ischial bursa which coats the tendons and decreases inflammation. This reduces pain and enables you to complete the strengthening exercises in physical therapy which is the sustainable treatment to preventing future hamstring tendon injuries.
Other injections to consider are orthobiologics. Orthobiologics include Platelet Rich Plasma (PRP). Please speak with your physician to see if you are a candidate with these procedures. They can help with reducing pain and increasing function. PRP has been shown in several studies to be effective in hamstring tendinopathy.
If injections do not provide relief, the next procedure to consider is tendon repair. This is where they stitch the tendon back together.