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A Pain in the Butt


Mrs X had been experiencing a ‘pain in the butt’ for over a year, which was greatly affecting her ability to run. It had started as a discomfort at the beginning of her jogs, which went away as she warmed up. Unfortunately, this only got worse, and now the pain persisted throughout the duration of her run. She had sort out advice from other health professionals, but was only given general strengthening advice, and told to stop running – something no runner wants to hear!

Proximal hamstring tendinopathy (a pain in the butt) is a commonly encountered problem in sports that involve long distance running, jumping, or repeated bending at the waist (hip flexion). Among its many functions, the hamstring complex is responsible for propelling your body forward with every step. The hamstring complex is actually composed of three separate muscles that share the same origin at the bottom of the pelvis (sitting bone) but all attach to different areas after crossing behind the knee joint.

Proximal hamstring tendinopathy is a common problem among recreational runners. This injury causes localised pain in the back of the thigh near the gluteal fold; it is often mistaken for low back pain, gluteal muscle or piriformis pain.

Common features of this injury include:

  • Pain when sitting – pressing or sitting down on the ischial tuberosity (sit bone) may be uncomfortable or even painful.
  • Pain with repetitive activity – biking, hiking, running and other repetitive activities can exacerbate the posterior pain. There is often a pattern to the pain, for example, the pain may appear at the same time into a workout.
  • Pain with acceleration or sprinting – the pain is typically worse just prior to heal stroke, when the hamstring is firing to slow the body down. In some cases, severe pain may prevent athletes from sprinting.
  • Pain when bending at the hip – for example when tying shoes or bending at the wait to pick something up off the ground.

The primary cause of proximal hamstring tendinopathy is mechanical overload of the tendon, such as a sudden change or increase in training duration, intensity, or terrain.

Firstly we need to understand the problem from the patient’s perspective.  How often does Mrs X run? What type of running does she do? Why is it important to her? What are her goals? What other types of activity does she do each week at home and at work?
Next, we do a thorough assessment. We start to build up a picture of her strengths, weaknesses, flexibility and muscle activation patterns. From here we were able to start Mrs X on a comprehensive strengthening program, including specific hold-like exercises to address the injured tendon.

Following a few weeks of these kind of exercises we managed to get Mrs X’ pain under control.  Then we could start strengthening her hamstring in a multitude of positions. She also joined AF rehab, a class held at the Athlete Factory, which focuses on full body strength and flexibility under the supervision of a Strength and Conditioning coach and Physiotherapist.

We gradually introduced a return-to-running program, specific to her goals and injury restraints. Her exercise program also gradually became more dynamic to include plyometric exercises specific to running.

Now, a few months following her initial appointment, Mrs X can run 10km pain-free, faster and stronger than before!

If caught early enough, this injury is very easy to treat with a few exercises and adjustment to training. If you are experiencing any of the common features of this injury, please book in to see us today so we can help get you back to doing what it is you love!

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