The hamstring muscles are located in the upper thigh and connected to the knee joint by a large tendon. They play an important role in the functioning of leg and movement of the knee. They help to extend the legs straight and bend the knee. The hamstring muscles help in performing normal daily activities like walking and sports-related activities. Hamstring tendinitis refers to pain and swelling in one or more of the hamstring tendons. It is often recognized as a knee problem.
When the hamstring muscle is stretched beyond its capacity or challenged with a sudden load, the tendon tends to get inflamed and the result is what we call as hamstring tendonitis. A hamstring injury can also occur due to direct injury or blow to the muscle, such as kick in the back of the thigh, or falling on the back of the thigh. Small tears are formed due to pressure created on the tendon due to reasons like overuse, injury, or stress. Certain activities such as running on uneven surfaces, lifting heavy weight, playing tennis or basketball are known to cause hamstring tendonitis. As one ages, he/she is prone to develop this condition. Since tendons tend to become brittle due to aging they are susceptible to tendinitis.
In mild injuries, the tear is minute and healing is faster, while severe injuries may have a completely ruptured hamstring muscle and healing period may be longer.
The symptoms of hamstring tendonitis depend on the extent of the injury. The first symptom is pain. Small tears which are formed in the muscle cause bleeding and subsequent bruising. Swelling is almost immediate. You may notice painful muscle spasms. Flexing and bending of the knee becomes difficult which may prevent you from walking. Pain gets worse with any movement or physical activity. The surrounding area of the knee is warm. The area becomes stiff particularly after performing exercise and even during the night when you are asleep.
Your doctor will ask you about the injury, how it occured, and the severity of pain. He will perform a physical examination on you to check your thigh. He will particularly look for tenderness or bruising. He may order for an X-ray to confirm if there is a tear in the tendon. In severe cases of tendonitis, a MRI scan is also suggested to capture the extent of injury.
Hamstring tendonitis treatment depends on the extent of your injury. Most of the patients with mild hamstring injuries respond well to simple, conventional, and nonsurgical treatment approaches. Plenty of rest to the leg and application of ice on the affected area for about twenty minutes two to three times a day can reduce swelling and pain. Restrain yourself from activities that may increase the pain and swelling. Elevate the affected leg above the level of your heart to reduce swelling. Resting the affected leg in this posture relaxes the muscles while sleeping, especially during night.
A physiotherapist can help you learn specific exercises to restore movement and strength of muscle and tendons. Use of compressive bandage may be advised to control swelling. Wraps or compressive (Ace) elastic bandages are wrapped to restrict the movement around the affected area. Your doctor may also recommend a brace or splint.
Your doctor may prescribe anti-inflammatory medicines to reduce discomfort associated with tendon injury. He may inject steroid injection into tissue around the injured tendon. Injections containing steroids reduce inflammation and can help ease pain. However, repeated injections may weaken the tendon or cause undesirable side effects. They may also increase your risk of rupturing a tendon.
Recent studies show that fluoroscopic (X-ray) guided steroid injections also offer a safe and effective alternative to the conventional treatment of hamstring tendinitis.
In severe cases of hamstring tendonitis, where a tendon is torn, reconstructive surgery may be required to repair the worn out tissue. Surgery involves pulling of the hamstring muscle back into place and removes any scar tissue. The tendon is then reattached to the bone using stitches or staples. After surgery you will be advised not to lift heavy weights in order to protect the newly repaired tissues. You may need to use crutches or brace to keep your muscle tendons in relaxed position.
A gradual return to physical activity or sports activity is necessary to recondition the hamstring muscle in a safe and effective manner. You will have to start on the physical therapy program with gentle stretch exercises to improve flexibility and movement. This will be followed by strengthening exercises. This rehabilitation program should be guided by your physiotherapist.
Read more about PRP for Hamstring Tendonitis / Tendinosis and how it can be an effective treatment option for you.
Sometimes bands of some scar like tissue may be formed on the tendon in chronic conditions which can irritate a nerve called sciatic nerve (sciatic nerve is the nerve which supplies the skin of the leg, the muscles of the back of the thigh, lower leg, and the foot). These bands may not respond to physiotherapy and may require surgery. Returning to sports without complete rehabilitation may lead to chronic hamstring pain and permanent injury.
Most patients return to normal life within few weeks with appropriate physiotherapy. In case of surgery, rehabilitation may take longer period of time between three to six months.
To minimize your chance of developing hamstring tendonitis perform warm up exercises before you start a physical activity. Wear a knee brace for extra support if needed. If you are an athlete take programs of cross-training to maintain hip strength and flexibility of knees.