The hamstring muscle group are responsible for bending the knee and supporting the glutes with hip extension. During running (especially sprinting) they work really hard to decelerate the limb just before heel strike in the swing phase of the gait cycle. Some biomechanical studies show they forcefully activate in the final 25% of this swing phase, by assisting the glutes in providing hip extension and eccentrically resisting knee extension. Hamstring injuries are common in regards to strains, however sometimes often forgotten is that pathology to the tendons due to overload is possible.

Tendon reaction injuries are known as tendinopathies where the load (or total work done) exceeds the tendons capacity to tolerate and adapt. In the hamstring muscle group, a tendinopathy occurs at the proximal attachment where it is given the name proximal hamstring tendinopathy. These injuries are more prevalent in the running population and those who perform activities that involve kicking/jumping. The hamstring muscle group is made up of three muscles which originate in a conjoined tendon attaching at the ischial tuberosity of the pelvis (sit bone). The biceps femoris muscle sits laterally and actually has two heads; the long and short head. The short head, however does not attach at the ischial tuberosity and is not technically involved in this injury. The semimembranosus and semitendinosus hamstring muscles are located more medially, attaching at the ischial tuberosity. What is important to note however, is that the adductor magnus muscle may also be involved in this pathology. Often termed the ‘4th hamstring muscle’ due to its hamstring portion attaching at the ischial tuberosity and its action being hip extension.

What someone may feel with this injury is pain when sitting down, as the angry tendon is being compressed. Other movements that typically aggravate this injury are uphill walking/running and movements that involve trunk/hip flexion. Unfortunately, these injuries can be present on both sides at the same time.

The proximal hamstring tendinopathy needs appropriate loading for it to recover and improve its capacity to tolerate load. Determining that you are suffering with a hamstring tendinopathy is important, as the kicking type of hamstring strain can also resemble the symptoms of a proximal hamstring tendinopathy. The rehabilitation will be similar, however there are certain aspects that are crucial to differentiate.

At The Reform Lab Osteopathy we are passionate about these injuries and guide you through our rehabilitation inside the elite gym Project Reform.