Many athletes encounter the frustrating sensation of "a pain in the butt," specifically a high hamstring pain that, when left unattended, can persist and significantly impact training and performance. This discomfort often stems from proximal hamstring or high hamstring tendinopathy, emphasizing the importance of a thorough understanding of this injury, especially for athletes over 30.
Anatomy of High Hamstring Tendinopathy
Central to high hamstring tendinopathy is the irritation and inflammation of tendons anchored to the ischial tuberosity, a bony prominence at the base of the pelvis. These tendons connect to the hamstring muscles—semimembranosus, semitendinosus, and biceps femoris—which play a crucial role in hip extension and knee flexion. The location of the ischial tuberosity makes it prone to strain during activities such as running, cycling, or sprinting.
Causes and Considerations for Athletes Over 30
While the causes align with those affecting younger athletes, individuals over 30 face additional considerations. Overuse, biomechanical imbalances, and abrupt increases in training intensity contribute, but aging introduces reduced muscle elasticity, joint stiffness, and potentially longer recovery times. The cumulative effects of years of physical activity amplify the risk, emphasizing the need for a nuanced approach when addressing this injury in the 30-and-above athletic demographic.
Management Strategies
Effectively managing high hamstring tendinopathy demands a multifaceted strategy. Athletes in their 30s must be attentive to potential longer healing times. Key components include rest, avoiding aggravating activities, and applying ice and anti-inflammatory medications for pain relief. Working with a physiotherapist, especially in the early stages, remains crucial for a correct diagnosis and to receive treatment tailored to address age-related considerations and potential imbalances.
Exercises for Rehabilitation
Isometric Exercises:
Isometric exercises form a cornerstone in high hamstring tendinopathy rehabilitation, involving muscle contractions where the length remains constant. These exercises provide vital tendon strengthening without subjecting aging joints to excessive stress.
Two very effective isometric exercise for hamstring tendinopathy are:
Single Leg Hip Bridge.
1. Lie on your back with your knees bent and feet flat on the floor.
2. Lift one foot off the ground, extending the leg. If the load is too much, you can begin on two legs.
3. Push through the heel of the grounded foot to lift your hips towards the ceiling.
4. Hold the bridge position for 30-45 seconds, gradually increasing the duration.
5. Lower your hips and repeat on the other leg - do 2 to 3 sets on each leg.
Wall Sits
1. Assume a seated position against a wall with your knees bent at a 90-degree angle.
2. Hold for 20-30 seconds, gradually increasing the duration up to 60 seconds over time.
Eccentric Hamstring Exercises:
Eccentric exercises involve lengthening a muscle under tension, emphasizing controlled movement during the elongation phase to enhance strength and flexibility.
Eccentric Hamstring Curls
Perform slow and controlled curls on a prone leg curl machine. Use two feet to lift the weight up, then remove one foot and slowly (count of 5) use one leg to lower the weight down to the starting position. This approach helps build strength without causing undue stress on the tendons.
Eccentric Hamstring Slider
This is a hamstrings tempo exercise that uses eccentric loading to aid tendon recovery. Lie down on your back with your heels tucked towards your buttock on a slider disc or hand towel. Keep the core braced to maintain a neutral spine and lift the pelvis up. Slowly at a 5-7 second tempo, slide your feet out while maintaining a neutral hip position. Rest the pelvis and pull the heels back in, repeating as required. This can eventually be progressed to do one leg.
Strength Building Exercises:
It is very important to build strength by adding in squat and deadlift variations. Progressively increasing the load is a critical part of rehabilitation and future prevention
Exercise prescription can include exercises such as
Nordic CurlsÂ
Smith rack squats
 Back squats increasing in range and load as time progresses
 Romanian deadlifts - both double and single leg
 Rear foot elevated split squats
Activities to Avoid or Modify
High-Impact Exercises: Steer clear of activities like jumping or running on hard surfaces to minimize strain on the hamstring tendons.
Explosive Sprints: Opt for gradual acceleration and deceleration to avoid sudden, explosive sprints that may place undue stress on the hamstrings.
Deep Squats and Lunges: Modify the depth of squats and lunges to reduce flexion at the hip and knee joints, minimizing strain on the hamstrings.
Prolonged Sitting: Limit prolonged sitting periods, as it can aggravate hamstring tendons. Incorporate breaks and gentle movements to maintain circulation and flexibility.
In navigating high hamstring tendinopathy, athletes over 30 should adopt a holistic approach that integrates anatomical understanding, targeted exercises, and mindful activity modification. Seeking guidance from healthcare professionals or experienced physical therapists is essential for a personalized and effective rehabilitation program. Consistency, patience, and a cautious approach to activities will be pivotal in overcoming high hamstring tendinopathy and sustaining long-term athletic vitality.
If you are eager to explore how strength training can transform your performance contact Coach Dave at +61426205277 or dave@masterscoaching.com.au
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