Proximal Hamstring Tendinopathy and Early Stage Rehabilitation Exercises
Proximal hamstring tendinopathy occurs due to an overload of the hamstring tendon inserting into the buttock bone, the ischial tuberosity. It is quite common in runners also in sports/activities which require repetitive tension on the hamstrings plus increased forward trunk lean.
It’s caused by a sudden change in volume, frequency or intensity of exercises, or exposed to high compressive loads such as hill walking/running or forward lean position. Both these activities increased the strain on the proximal tendon. Running technique plays a major role, including an increased stride length or trunk lean puts increased tension on the tendon combined with any major changes in running load.
Much like other tendinopathies of the patella and achilles, pain can initially come on with running then have a ‘warm up’ effect, then return post activity with stiffness the following morning. In more severe cases pain comes on during the run and remains throughout.
Assessment is performed through progressive loading of the hamstring tendon to reproduce pain, in addition to palpation over the tendon. Ruling out other diagnosis such as involvement of the lumbar spine and sciatic nerve involvement are important.
Treatment is aimed at load modification, but just as importantly performing progressive targeted, non-compressive loading of the tendon to enhance its tolerance to load. This starts off with isometrics, dependent on the patient’s irritability but then progressing towards gym-based strengthening and sports specific exercises.
With respect to running, working on reduce stride length, increasing cadence and avoiding hills will assist with reducing stress on the tendon.
Early stage isometric exercises include: 5 reps, 30-45 seconds hold and can be performed daily prior and post runs. These also act as ‘panadol’ to assist with pain relief.
Single Leg Bridge Hold
Prone Hamstring Curl Isometric
Chronic Ankle Instability
Ankle inversion injuries, commonly known as a rolled ankle, are prevalent in court sports such as basketball, netball and tennis and field sports including AFL football and soccer. They affect the lateral ligament complex, which is important for stabilising the ankle joint.
Chronic Ankle Instability
Ankle inversion injuries, commonly known as a rolled ankle, are prevalent in court sports such as basketball, netball and tennis and field sports including AFL football and soccer. They affect the lateral ligament complex, which is important for stabilising the ankle joint.
The lateral ligament complex consists of the anterior talofibular (ATFL), calcaneofibular (CFL) and posterior talofibular ligaments (PTFL). The most commonly affected ligament is the ATFL. In more severe injuries, the CFL and PTFL are affected.
Common mechanisms of injury include landing, stepping on another play’s foot or change of direction.
Although acute ankle injuries are initially managed with ice, compression, rest and taping, many people suffer from ongoing issues such as ongoing pain, swelling, joint instability and recurrent sprains which impact on sport performance. Risk factors for recurrent ankle issues include a previous sprain, insufficient rehabilitation and earlier than recommended return to sport.
Chronic ankle instability (CAI) describes the ongoing limitations following an acute ankle sprain, including ankle instability during load bearing activities and perceptions of your ankle giving way.
In a systematic review by Doherty et al 2013, they found that upto 40% of intial ankle sprains will develop chronic instability within the 12 months following an injury.
Treatment and Prevention
Firstly, its important to identify any risk factors including muscle strength deficiencies, static and dynamic balance deficits or any structural issues. This is performed using functional assessments which consist of a number of ankle specific tasks including balance and various hopping drills to asses the extent of instability.
Following assessment, the implementation of an appropriate rehabilitation program addressing any identified deficits in balance and muscle strength with the aim of progressing to sport specific movements to ensure a safe return to sport. Once returned to sport, performing maintenance strengthening exercises will assist with reducing the risk of re-injury. Taping has also shown to be beneficial in reducing the risk of re-injury, with effectiveness increased with a concurrent preventitive exercise program.
If you are having persistent ankle pain or stability issues during sport or daily life, book in with us for a thorough assessment and plan.
References
1. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. SPORTS MED [internet]. 2013[cited 2020 Nov 10];44(1):123-140. doi:10.1007/s40279-013-0102-5.