THE MANAGEMENT OF PROXIMAL HAMSTRING TENDINOPATHY IN A COMPETITIVE POWERLIFTER WITH HEAVY SLOW RESISTANCE TRAINING - A CASE REPORT

Current and future advances in practice: tendinopathies of the hip

Tendinopathy describes persistent tendon pain and loss of function related to mechanical loading. Two common hip tendinopathies seen in practice are gluteal tendinopathy and proximal hamstring tendinopathy. Both conditions can be frustrating for patients and clinicians due to the delay in diagnosis, significant disability caused and lack of response to common treatments. Tendinopathy is a clinical diagnosis and can most often be made using findings from the patient interview and pain provocation tests, without the need for imaging. Specific education and progressive exercise offer a low-risk and effective option for gluteal tendinopathy and result in greater rates of treatment success than corticosteroid injection, both in the short term (8 weeks) and at 1 year. Proximal hamstring tendinopathy is a common, but less researched, and under-recognized cause of persistent ischial pain. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies.

Comparison of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation

Knowledge of muscular forces and adaptations with hamstring-specific exercises can optimize exercise prescription and tendon remodeling; however, studies investigating the effectiveness of the current conservative management of proximal hamstring tendinopathy (PHT) and outcomes are lacking. The purpose of this review is to provide insights into the efficacy of conservative therapeutic interventions in the management of PHT. In January 2022, databases including PubMed, Web of Science, CINAHL, and Embase were searched for studies assessing the effectiveness of conservative intervention compared with that of a placebo or combination of treatments on functional outcomes and pain. Studies that performed conservative management (exercise therapy and/or physical therapy modalities) in adults 18-65 years were included. Studies that performed surgical interventions or whose subjects had complete hamstring rupture/avulsion greater than a 2 cm displacement were excluded. A total of 13 studies were included: five studies compared exercise interventions, while eight studies investigated a multimodal approach of either shockwave therapy and exercise or a hybrid model incorporating exercise, shockwave therapy, and other modalities, such as ultrasound, trigger point needling, or instrument-assisted soft tissue mobilization. This review supports the notion that the conservative management of PHT may best be optimized through a multimodal approach incorporating a combination of tendon-specific loading at an increased length, lumbopelvic stabilization exercises, and extracorporeal shockwave therapy. With regard to hamstring-specific exercise selection, PHT may be optimally managed by including a progressive loading program at combined angles of the hip flexion at 110 degrees and the knee flexion between 45 and 90 degrees.

Isotonic and Isometric Exercise Interventions Improve the Hamstring Muscles’ Strength and Flexibility: A Narrative Review

Background: Hamstring weakness has been associated with an increased risk of hamstring strain, a common sports injury that occurs when athletes perform actions such as quick sprints. The hamstring complex comprises three distinct muscles: the long and short heads of the bicep femoris, the semimembranosus, and the semitendinosus. Methods: The researchers collected the data from different electronic databases: PubMed, Google Scholar, and the Web of Science. Results: Many studies have been conducted on the numerous benefits of hamstring strength, in terms of athletic performance and injury prevention. Isotonic and isometric exercises are commonly used to improve hamstring strength, with each exercise type having a unique effect on the hamstring muscles. Isotonic exercise improves the muscles’ strength, increasing their ability to resist any force, while isometric training increases strength and the muscles’ ability to produce power by changing the muscle length. Conclusions: These exercises, when performed at low intensity, but with high repetition, can be used by the healthy general population to prepare for training and daily exercise. This can improve hamstring muscle strength and flexibility, leading to enhanced performance and reduced injury risk.

Resistance Training Interventions for Lower Limb Tendinopathies: A Scoping Review of Resistance Training Reporting Content, Quality, and Scientific Implementation

The objectives of this scoping review were as follows: (1) to describe what exercises and intervention variables are used in resistance training interventions for lower limb tendinopathy,  (2) to assess the completeness of reporting as assessed by the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier framework, and (3) to assess the implementation of scientific resistance training principles. We searched MEDLINE, CINAHL, AMED, Embase, SPORTDiscus, and Cochrane Library databases. Randomized controlled trials, cohort studies, case series, case reports, and observational studies that reported using resistance exercises for lower limb tendinopathies were considered for inclusion, with 194 studies meeting the inclusion criteria. Completeness of the reporting of exercise descriptors and programme variables was assessed by the CERT and the Toigo and Boutellier framework. Reporting of exercise descriptor items from the Toigo and Boutellier framework ranged from 0 to 13, with an average score of 9/13, with only 9 studies achieving a full 13/13. Reporting of items from the CERT ranged from 0 to 18, with an average score of 13/19. No study achieved a full 19/19; however, 8 achieved 18/19. Scoring for resistance training principles ranged from 1 to 10, with only 14 studies achieving 10/10. Eccentric heel-drops were the most common exercise (75 studies), followed by isotonic heel raises (38), and single-leg eccentric decline squats (27). The reporting of exercise descriptors and intervention content was high across studies, with most allowing exercise replication, particularly for Achilles and patellar tendinopathy. However, reporting for some tendinopathies and content items such as adherence was poor, limiting optimal translation to clinical practice.