What is chronic high hamstring tendinopathy and how is it treated?
The hamstring muscles are the three large muscles in the back of the thigh, the biceps femoris, the semitendinosus and the semimembranosus. Strains or tears in these muscles are common, especially for athletes. In fact, while especially prevalent in football, hamstring injuries account for almost 30 percent of all lower extremity injuries across all sports, professional all the way down to youngsters.
Acute injuries are the result of a single movement or action that typically produces sudden pain at the back of the thigh along with associated weakness. There may also be a range of symptoms, such as tingling, numbness and problems with sitting all the way to sustained pain when there is a significant tear or complete rupture. These injuries commonly take place during exercise, or they may happen during a fall or other accident.
Treatment for Acute Hamstring Injuries
Age, lack of muscle flexibility, muscle fatigue and insufficient warm up prior to activity can all contribute to hamstring injury. Because there is a relatively high rate of re-injury, it is important to correctly diagnose and treat an acute hamstring injury as soon as possible. The RICE method is suggested:
- Rest – keeping legs as still as possible and avoiding or restricting physical activity
- Ice – apply cold packs to hamstrings for 15 to 20 minutes every two to three hours during the day
- Compression – compress or ace bandage around the thigh to limit any swelling or movement that could cause further damage
- Elevation – keep leg raised and supported to help reduce swelling
High hamstring pain, or pain that occurs near the origin of the hamstring muscles, can sometimes lead to chronic issues such as chronic high hamstring tendinopathy, which is a repetitive use injury, brought on by activities such as running and biking. It results from failing to let hamstring injuries completely heal and can be aggravated by excessive sitting. This condition often results in degeneration of the hamstring tendon and may potentially cause long-term disability. During an acute hamstring injury, the pain is immediate, but with chronic high hamstring tendinopathy the pain usually comes on gradually.
Treatment for Chronic High Hamstring Tendinopathy
The best treatment for high hamstring tendinopathy is to seek professional help when the symptoms first present themselves and get an accurate diagnosis and immediate treatment. There are non-invasive methods that are effective in the majority of cases. These include rest, ice and heat, as well as stretching and strengthening under the guidance and direction of a physical therapist. For the 20 percent or so for whom this is not sufficient, there are treatments designated as “minimally invasive”. These are:
- Steroid Injections – ultrasound-guided injections of anesthetic and corticosteroid solutions
- Ultrasound-Guided Needle Tenotomy – introducing a needle into the tendon and manipulating it to create bleeding and tissue damage, bringing blood and platelets to the area to speed healing
- Platelet-Rich Plasma (PRP) Injections – ultrasound-guided concentrated solution of platelet-rich plasma (PRP) injected into the damaged area
Although reserved as a last option, patients who have not been able to find relief from the less invasive treatment methods may consider surgery. This can involve anything from the removal of diseased or damaged tissue to cutting the tendon and reattaching it to the bone.
At Long Island Spine Rehabilitation Medicine, our physicians are committed to more than just treating your symptoms. We focus on finding the underlying cause and providing evidence-based solutions tailored to your specific condition and needs. If you have questions about a hamstring injury or lower back or leg pain, we invite you to schedule a consultation by simply calling (516) 268-0070 or using our convenient online form by clicking here.