The hamstrings are the muscles found at the back of our thighs. They work together with the quadriceps (in front of our thighs) to move us from one point to the other. While the quadriceps straighten the knee joint and flexes the hip, the hamstrings bend the knee and take the entire leg to the back.
Hamstring injuries tend to be common among athletes especially those involved in running or jumping activities. It could be a muscle strain or a tear but we will be discussing another structure that can be affected: the hamstring tendons.
Hamstring tendonitis is an inflammation of the hamstring tendon which can be due to overuse of the muscle as the tendon receives most of the tension while the hamstrings are being used. The tendons act as communication lines between the muscles and bones that need to be moved.
What Do You Need To Know About The Hamstring Tendons?
The hamstrings are made up of three muscles. These muscles are responsible for bending the knee joint and extending the hip. The three muscles are:
- Biceps Femoris
Hamstring tendonitis is classified into two:
1. High Hamstring Tendonitis
This involves the inflammation of the tendon found at the buttocks.
2. Low Hamstring Tendonitis
This involves the inflammation of the tendon at the back and side of the knee joint.
What Causes It?
1. Inadequate Warm-up
A warm-up prepares your muscle for any activity. It assists the circulatory system to pump oxygen-rich blood to the muscles you are warming up and reduces the risk of any form of injury that may come up during any sporting activity. The inadequate warm-up can lead to stress on the muscle which indirectly causes an injury to the acting tendon.
2. Tight Hamstrings
Imagine stretching a tight hamstring. It will definitely tear. Having tight hamstrings affects the muscle’s ability to function effectively.
When you overuse a car, for example, it will break down. The same mechanism is the same for overusing a muscle especially if it does a lot of work than normal. Athletes that run may overuse the tendon at the back of the knee because of the repetitive knee bending and hip extension.
4. Muscle Imbalance
Imagine the muscles in front of your thighs are stronger than the muscles at the back of the thigh. The muscles in front of the thigh, known as squads, straighten the knee while the hamstrings bend them. when the quads straighten the knee joint, the weak hamstrings find it difficult to bend the knee and move the leg to the back which can lead to inflammation at the tendon.
5. A Sudden Change Of Speed
A surprised muscle can cause tension within the muscle and cause an injury at the tendon. A sudden increase in speed like running from sitting may place a lot of strain in the muscle and affect the tendons.
Hamstring Tendonitis Symptoms
- Sharp pain is usually felt at either the back of the knee joint or buttocks or the side of the knee joint.
- Swelling at where the tendons attach (buttock, back and lateral side of the knee)
- Joint Stiffness that is usually felt at rest
- Muscle Weakness of the hamstrings
- Diagnostic tests like X-ray and MRI are usually recommended by a doctor or physiotherapist to rule out other conditions that may have similar symptoms.
- Orthopedic tests are carried out by physiotherapists to further ensure that the tendon and not ligaments are affected.
How Is It Treated?
Anti-inflammatory medications are prescribed or recommended to relieve pain and reduce swelling at the tendon. Some of these medications include ibuprofen, naproxen, and diclofenac. Sometimes, doctors may suggest steroid injections to help relieve pain.
Physiotherapists assess the cause of the injury and rule out other conditions that may mimic the condition based on their signs and symptoms.
As the injury heals, the physiotherapist will prescribe exercises depending on the state of the injury. They will also use pain relieving modalities such as:
- Ice Therapy
- Heat Therapy
- Electrical Muscle Stimulation
Massage comes in handy to reduce swelling and relieve pain using pain-relieving creams with diclofenac and ketoprofen as active ingredients.
The RICE protocol is usually recommended for the first 72 hours of the injury. However, seeing a physiotherapist will determine when it should be stopped.
The injured leg needs to be well rested to aid the healing process. Since overuse is one of the causes of hamstring tendonitis, reducing the work on the hamstrings will help aid healing. The use of ambulating devices like walking frame or crutches are usually recommended at the initial stage of injury.
Tendonitis is an inflammation of the tendon. Ice has been shown to reduce swelling, relieve pain and prevent muscle spasm. Ice should be applied on the injured site every 3-4 hours for 15 minutes. Ice packs can be bought over the counter at pharmacies or can be made in your homes. Never apply ordinary ice on your skin as it can burn your skin. Place the ice in a damp towel and put on your skin instead.
Elastic bandages are used to reduce swelling at the injured site. However, do not make the bandage too tight as it can also increase swelling.
Elevate the affected place on pillows. This will help reduce swelling at the injured site.
The stage of injury determines the type of exercises to be done. At the initial stage, rest is usually recommended but as the injury begins to heal, the goal is to get back to how the muscles were before the injury happened. A physiotherapist will guide through the different form of exercises. Stretching and strengthening exercises are always recommended.
Some exercises that are usually recommended are:
Static Hamstring Contraction
This exercise involves the contraction of the hamstring without causing any movement at the knee joint.
- Sit on a chair with the affected leg bent to about 45 degrees
- Press your heel on the floor and feel your hamstrings contract
- Hold for 10-15 seconds and release.
Hip Abduction Exercises
Surrounding muscles need to be strengthened as well to support the hamstrings when movement and strengthening exercises start at the knee. One of these muscles are the hip abductors.
- If the right leg is affected, lie on the left side with your right leg on your left leg
- Raise your right leg towards the ceiling
- Slowly return your leg to the original position
- Repeat 5 times
Single Leg Raise
This involves a static contraction of all the leg muscles to raise the leg up at the hip.
- Lie on your back with your legs straight
- Lift the affected leg towards the ceiling without bending your knee and ankle
- Return to original position slowly
- Repeat 5 times or according to physiotherapist’s prescription
Sit To Stand
When standing from sitting, all your muscles in your legs are engaged to help you move from the chair to standing. This helps to balance out muscle strength.
- Sit on a chair with your knees slightly apart and your back straight and your feet firmly on the ground
- Move forward slowly in your chair
- Stand up slowly
- Repeat according to exercise prescription
Squats are another exercise that strengthens all the muscles at once.
- Stand with your feet slightly apart
- Sit back like you want to sit in a chair
- Slowly bend your knees and squat
- Return to original position
- Repeat as prescribed
As the hamstring tendon heals, there is a tendency for the muscles or tendon to shorten in length which may make the hamstrings tighter. There are different ways of stretching the hamstring muscles. Your physiotherapist will determine which is convenient for you.
- Sit on the floor or on your bed with your legs straight in front of you
- Bend your ankle towards you
- Hold for 10 – 20 seconds
- Sit up on the floor with your legs straightened out in front of you
- Bend the unaffected leg
- Slowly bend at the waist and reach towards your toes
- If your knees begin to bend as you reach for your toes, stop and maintain that position for 30 seconds
- Return to original position
- Sit on a chair
- Move forward in your chair
- Bend the unaffected leg at 90 degrees
- Bend the affected leg at 45 degrees
- Bend at the waist and reach for your toes on the affected leg
- Hold for 20 – 30 seconds
- Release and return to the original position
This exercise is a strengthening exercise for the hip extensors
- Lie on your back with your knees bent
- Place your arms by your side
- Raise your buttocks off the floor
- Hold for 2 seconds
- Return to original position and repeat 10 times
This exercise is targeted at only the hamstrings, unlike the other ones that involve all the muscles in the legs.
- Lie on your chest with your knees straight
- Bend the affected knee with your heel towards your buttock
- Return to original position
- To make it more interesting, you can place weights on your ankle and repeat the exercise
A tendon release surgery or a tendon repair surgery is usually recommended as a last resort or depending on the severity of the injury.
Depending on the severity of the injury and overall fitness level, it takes roughly 2 – 10 weeks to return to activity. However, there is the risk of reinjuring the tendon.
Also, the early the intervention, the faster the recovery.
How Can I Prevent It?
- Stretch More
- Remember to warm up before any activity
- Exercise for muscle balance
- Rest your muscles after every workout
- Reduce your sitting time
- Wear the appropriate footwear