Is it too cliched to say High Hamstring Tendinopathy
is a Pain in the Butt for Runners? Probably! Ok so in this video, I’m going to show you
five exercises we almost always give to runners who present with cases of high hamstring Tendinopathy. First we need to understand the nature of
the injury. The clue’s in the title here; high up at
the top end of the hamstring muscles we find their common origin, where their tendons insert
onto the ischial tuberosity of the pelvis, that’s the bony part towards the bottom of
your butt cheek. Being a tendinopathy we know that it’s this
conjoined tendon that currently in dysrepair. This is very much one of your typical overuse
type running injuries, and in my experience comes as a result of chronic overload of the
hamstring tendons, usually with a more acute trigger. What do I mean by overload? Well, if there’s one thing that tendons
don’t particularly enjoy it’s the combination of being compressed while under high tensile
loads. They are great at dealing with tension when in an optimal position, but when you
add compression, it’s a simple trigger for tendon problems. Now, because of the specific way in which
the tendon attaches to the rear part of the ischial tuberosity near your butt crease,
loading the hamstrings in increased amounts of hip flexion will begin to compress the
hamstring tendon against the bone. Repeat this excessively and you’re on a fast track
to high hamstring tendinopathy. So what kinds of exercises load the hamstrings
in this high hip flexed position? Well anything that’s going to force an increased
stride length, such as speed work and hill reps. These are also often the aggravating
factors that trigger symptoms when runners are trying to train-through cases of high
hamstring tendinopathy. Now, when it comes to rehabbing the injury,
it’s important we take this understanding of the injury and it’s anatomy into account.
As with most tendinopathies, we need to load the hamstring tendons to stimulate healing
and repair, and to build strength in the hamstring muscles themselves – muscular weakness is
also a risk factor to tendon problems, don’t forget! We need to ensure however that we load the
hamstrings and their tendons in such a way that doesn’t create this combination of
tendon compression under tension. In other words, while initially rehabbing the injury
we need to look for hamstring exercises that avoid working into too much hip flexion. I’ll leave a link in the description below,
so that you can find the free high hamstring tendinopathy
download on the kinetic revolution website, containing more information on this frustrating
injury, and video demonstrations for some ideal rehab exercises. Be sure to check that out! To begin with we focus on isometric exercises
such as a simple double leg bridging exercise to help engage the glutes and hamstrings,
and load the hamstring origin tendon without flexing the hip. Try varying the position of this exercise;
as you start with your heels close to your butt, the exercise becomes more glute focused.
Conversely, if you set-up with your heels further away, creating a longer-lever, you’ll
be placing more of an emphasis on hamstring loading. You can build up to this! Aim for 10 sets of 10 seconds holding the
bridge position. A simple progression is to incorporate a single
leg variety of this isometric hold exercise. The single leg bridge. Most runners find this
much tougher than the standard double leg version! Again you can aim for 10 sets of 10 seconds
on each leg. When these become easier, you can progress
to working the hamstrings through range of motion at the knee, while still avoiding loaded
hip flexion. To begin with, we can use an unloaded exercise such as prone hamstring
curls, then add resistance from the other leg to increase eccentric demand on the hamstring
muscles and tendon. Aim for 3 sets of 20 on each leg, while maintaining
core control. Don’t let your back arch excessively. We can then add more complex exercises such
as swiss ball hamstring curls and single leg hamstring curls which being to re-introduce
a loading into hip flexion. At this point working into knee flexion and hip flexion
combined should be far less irritating on the proximal hamstrings tendon than if we
were to combine knee extension and hip flexion. Again aim for 3 sets of 20 with each of these
exercises. Of course there are other factors to take
into account when it comes to rehabbing high hamstring tendinopathy, such as dynamic control
of the pelvis, and running technique. I’ll leave links in the description to other videos
you might find helpful on these topics. Don’t forget to head on over to the kinetic
revolution website to download your free high hamstrings tendinopathy rehab guide. Best of luck, and I’ll speak to you soon. Bye now!