Treatment of tendinopathy in runners

High hamstring tendinopathy is relatively rare in the general population. However, chiropractors who have a large clientele among athletes, particularly middleto
long-distance runners may see such cases on a semi-regular basis. Some case studies have shown that this condition may benefit from being treated by a combination of treatments, including the instrument assisted soft tissue mobilization.

Symptoms and cause

Patient complaints will usually involve describing a persistent, deep gluteal pain that may be aggravated by acceleration during running. It will be particularly noticeable during interval or hill running, or running on uneven ground, such as trails. In more severe cases, there may also be noticeable gluteal pain when sitting on hard surfaces. Patients may also mention noticeable hip weakness on one side or the other, accompanied by a shortened stride. Rest and ice may give temporary relief, but symptoms will quickly return once the patient begins training again.

The hamstring tendon consists of three muscles: semimembranosus, semitendonosus, and the long head of the biceps femoris. This group of muscles is responsible for extending the hip and flexing the knee. The most force is placed on the hamstring when it is in this position. Because mid-to-long-distance runners exert a great deal of force on their hamstrings in this position, they are particularly prone to tendinopathy. This can become even more aggravated with sprint or hill training.

Diagnosis and treatment

In most cases, patients who have high hamstring tendinopathy will have several telltale signs, including weak hip abductors, pelvic joint dysfunction, tight hamstrings, and ischial tuberosity tenderness. Other clinical findings might include overpronation, proprioceptive weakness, and lumbar dysfunction. Testng for proprioception difficulties, such as standing on one leg with the eyes closed, may help in the diagnosis. Tendinopathy can be confirmed by imaging, which will show significant fluid around the hip joints.

Treatment will generally incorporate a variety of methods, including instrument assisted soft tissue mobilization to the affected hamstring and illiotibial band, triggerpoint massage, myofascial release, and stretching exercises to do at home. In some cases, custom orthotics may be recommended for the patient to wear specifically while running.

Because the hamstring tendon has poor vascularity, an overload of abnormal stress may not produce an inflammatory response. It is thought that the use of instrument assisted soft tissue mobilization induces a local inflammatory response, which augments the production of fibroblasts. This, in turn, will promote the healing process around the affected hamstring. Once this inflammatory response has started, the patient can begin a stretching routine to help build up strength in the hamstring.

Patients who are serious athletes may present with injuries that chiropractors would not expect to see in an average patient. Repeated, intense stress on the muscles and tendons from training may cause recurring injuries. In the case of runners, instrument assisted soft tissue mobilization may help them recover more quickly from high hamstring tendinopathy and get them back to their regular training schedule.