Inflammation of Hamstring Tendons / Tendonitis
Hamstring tendons are the strong cords of fibrous tissue that connect the muscles at the back of the thigh to the lower leg bones. These can be felt as tough bands at the back of the knee. Inflammation of hamstrings leads to pain at the back of the knee and is common among soccer players, runners and other athletes.
The hamstrings are a group of three muscles: the biceps femoris, semi-membranous and semi-tendinosus muscles forming the main muscle mass at the back of the thigh. These muscles arise from the pelvis, travel downward at the back of the thigh, cross the knee and insert into the top part of the lower leg bones.
As the hamstrings cross two joints, they are responsible for movement along both these joints. The hamstrings extend the hip and bend the knee, two crucial actions that enable us to perform our daily activities such as walking, running, jumping, and climbing stairs and so on.
When hamstrings contract, their tendons stretch and they pull the bones towards the muscle. Repetitive or excessive stretching may damage the tendon, leading to its inflammation and/or degeneration, especially when the muscle is in poor condition or when faulty limb biomechanics are involved
- Repetitive running, jumping and kicking
- Sprinting with sudden starts and stops as in soccer, tennis, etc.
- A previous tendon injury that has not healed properly.
Factors that increase the risk of tendon damage and inflammation include:
- Stiff joints
- Weak or stiff muscles (especially quadriceps and hamstrings)
- Faulty biomechanics
- Poor technique
- Inadequate warm up
- Pain at the back of the knee, which starts gradually. In mild cases it may present as a dull ache, or in progressive damage it may radiate upwards at the back of the thigh or downwards to the calf.
- Stiffness of the joint, especially worse at night and after performing activities involving the hamstrings.
- Pain can be initiated or aggravated by bending the knee against resistance.
- There may also be redness and swelling of the joint.
- The area feels tender and warm to touch
Symptoms and physical evaluation usually are enough to make a clear diagnosis. Sometimes imaging techniques such as ultrasound, CT scan or MRI may also be required.
Immediate treatment is through the RICE protocol and taking painkillers.
Rest is the key to healing. The problem develops gradually so it is best to allow the tendons time to heal. Avoid any activity that causes pain. Continuing with the training will increase the risk of injury. Consult an expert and find out the causative factor, whether it is an incorrect training technique or a problem with lower limb mobility.
Apply ice and a compressive bandage to the painful area and elevate the leg above heart level. This decreases pain and swelling.
Ultrasound, manual massage and laser therapy all aid in healing.
Injecting the person’s own blood at the site of the inflamed tendon (autologous blood injections) has also been said to stimulate tendon healing.
For complete recovery and return to the original activity level it is always recommended to follow a thorough rehabilitation program. It helps to:
- Return gradually to normal activity level
- Improve joint mobility
- Strengthen the leg muscles for a better stabilised knee joint
A few considerations regarding rehabilitation:
- Allow time for the inflammation to subside completely, meanwhile supporting the inflamed tendon through rest, massage and medicine.
- Return to movement should be gradual, however stretching should be started early in the treatment as it helps to improve flexibility and speeds up recovery as well.
- Once movement is comfortable, start with muscle strengthening exercises. Strong hamstrings impose less stress on the tendons and there is less risk of developing tendonitis in the future.
Start with mild stretching. Stretch your hamstrings gradually and stop when it hurts. Hold each stretch for about 20 to 30 seconds, relax and repeat. Increase the stretch gradually, as indicated by the pain.
Once you regain adequate flexibility and range of motion, you can move on to strengthening exercises. Initially perform mild exercises, and then when you are comfortable performing them, proceed to a higher difficulty level.
Lying on a mat face upwards, the heel is brought slowly towards the buttocks, to the extent that it does not cause any pain. Repeat several times, avoiding pain. Later on the same leg curls can be performed in a standing position. Reverse straight leg raises or leg curls against resistance using ankle weights or gym equipment can be added on later.
Swimming, stationary cycling or treadmill walking can also be started, gradually increasing pace and duration.
This works by improving circulation to the area, thus aiding in recovery. It should be performed 2-3 times weekly. However, do not start massage until the knee is completely painless.
Rehabilitation is a slow process but it does guarantee complete recovery and a better chance of avoiding any such complications in the future.