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Shockwave therapy for hamstring tendinopathy


The hamstring is comprised of three muscles; semitendinosus, semimembranosus, and bicep femoris at the back of the thigh. Its main job is to bend the knee, aid extension of the hip, and deceleration of the lower leg when it swings forwards in running and other movements.

Injuries to the hamstring (strains and tears) are the most common types of injuries that occur in professional sport. There are two different types of hamstring injury; those caused by sprinting, and injuries resulting from over-stretching the leg. Research suggests that hamstring injuries which occur from running fast take longer to heal, with the average being 4-6 weeks before the sufferer is able to return to playing sports. However, recovery will take longer if the sciatic nerve has also become irritated. The risk of hamstring injury increases with age, lack of conditioning and if there has been a previous hamstring injury. If you have injured your hamstring the symptoms are usually a sudden sharp pain in the back of the thigh. You may feel a popping sensation with a more severe tear.

Immediately after suffering a hamstring injury, it is advisable to apply ice, compression and to take painkillers. Then once the initial symptoms have subsided, you can start to do some hamstring conditioning exercises. Our Strength and Conditioning Coach Phil Doyle has put together some exercises for this purpose (see below).

We Are Here to Help

At the Perfect Balance Clinic we help many patients with hamstring injuries. Our highly skilled physiotherapists can assist in your rehabilitation, enabling you to enjoy a full recovery in a short period of time, which will allow you to return to sporting activities as quickly as possible. You will also be less likely to suffer the same injury in the future. Receiving physiotherapy for your hamstring injury also has the benefits of pain reduction and improvements in muscle length.

Chronic Hamstring Tendinopathy

Also common in athletes, hamstring tendinopathy is a more chronic condition. Unlike an acute tear, the pain comes on gradually and is worsened by repetitive activities like cycling, and by sitting for long periods of time. The Perfect Balance Clinic is at the forefront of clinics using Shockwave Therapy for this condition.

What is hamstring tendinopathy?

Hamstring tendinopathy is an often-overlooked diagnosis for acute and chronic ongoing buttock pain. The symptoms often mimic sciatic symptoms and indeed there may be co-existent sciatic nerve irritation also. The Hamstring tendon attaches deep to the gluteus maximus muscles on either buttock region, onto the ischial tuberosity just beside the sciatic nerves path and is responsible for hip extension and knee flexion. The injury is very common in long-distance runners and is often aggravated by running, acceleration, and direct pressure to the hamstring tendon (at the upper end) as a result of high force in the downward motion of the leg when running. Pain when sitting is normally the result of severe tendinopathy.

The hamstrings (semimembranosus, semitendinosus and the long head of biceps femoris) are prone to damage during the eccentric phase of the running gait (mainly when the eccentric load is applied to the hamstring muscle group).

The most eccentric load is placed on the hamstring tendon during the phase of running when the hip is flexed and the knee is extended (when the quads are fully active and the lower leg is accelerating forwards and upwards around the knee joint).

There are numerous biomechanical factors that are believed to contribute to hamstring tendinopathy. It is important these are addressed also, and working with a physiotherapist or sports therapist to address the underlying issues is key. The common biomechanical factors we see which relate to the development of hamstring tendinopathy include;

  1. Hamstring tightness
  2. Poor warm-up (this can be reviewed by your therapist to maximise and personalise your warm up)
  3. History of previous injuries to the hamstring
  4. Poor quad to hamstring ratio (this may be by strength, length, or quality of activation)
  5. Pelvic instability
  6. Poor running biomechanics (a therapist or running coach can assess and correct this)
  7. Poor core stability

What other treatments are available for hamstring tendinopathy?

Other treatments that are available for hamstring tendinopathy include the following;

  1. Steroid Injection (Zissen et al 2010)
  2. Surgery (Benazzo 2013)
  3. Eccentric loading
  4. Shockwave therapy for hamstring tendinopathy (Cacchio 2011)
  5. Anti-inflammatories (oral or injectable)
  6. PRP injections
  7. Hamstring stretching
  8. Pelvic Alignment (Kristen 2010)
  9. Hamstring Strengthening

It should be noted that surgery and injections are often used as a last resort option to fix this issue and are used mainly in severe cases.

How is Shockwave therapy for hamstring tendinopathy carried out?

Shockwave therapy for hamstring tendinopathy is applied following a set protocol. The clinician will carry out a thorough case history taking which isolates the area that is painful and begins to understand the clinical history behind the condition. It is important to make sure that the condition being treated is actually hamstring tendinopathy and is therefore treatable with shockwave therapy.

During the examination period, a tender point where the pain is maximal will be located, upon which a water-based medium will be applied. This aids the transmission of the impulses into the desired area.

The probe will then be placed over the desired area and then treatment for your hamstring tendinopathy will begin. At first, the clinician will ensure the discomfort is kept to a minimum. After a while, as the impulses increase little pain is felt. Although, more often than not there is some pain felt over the area of application. After treatment, you should feel very little pain and this may last for a few days. After this, an aching sensation can occur. Following subsequent treatments, there will be a definite improvement in symptoms leading to reduction in the original pain felt.

How long will Shockwave therapy for hamstring tendinopathy take to work?

Generally, most applications of shockwave for hamstring tendinopathy and most conditions will resolve within 3-4 sessions of 30 minutes (roughly). This obviously can depend on the exact presentation of the condition. Making sure you see someone quickly to have the condition diagnosed can reduce the number of sessions needed.

Professional athletes who received shockwave treatment saw significant results when reporting a follow up after the treatment (Cacchio et al., 2011). 

It is vital that you continue to work with a physical therapist to maintain the exercise regime you should already be carrying out for hamstring tendinopathy, prior to consulting for shockwave treatment. This will involve balancing exercises, strength exercises, and a good eccentric loading programme depending on your stage of hamstring tendinopathy.

How do I know Shockwave therapy for hamstring tendinopathy will work?

A recent randomised controlled trial demonstrated the potential benefit of shockwave therapy for hamstring tendinopathy. Forty professional athletes with proximal hamstring tendinopathy were divided into 2 groups, one receiving shockwave therapy and 1 receiving non-steroidal anti-inflammatory drugs, ultrasound, and physical therapy exercises. After 3 months, 80% of the athletes in the shockwave therapy group were able to return to their pre-injury level of sport, compared with none of the athletes in the control group.? There was also a significant reduction in pain in the shockwave therapy group (Cacchio 2011).

Furthermore, many practitioners are embracing the benefits of shockwave therapy informing people that this form of intervention helps more in comparison to surgical or medicinal procedures by helping athletes to recover without having to write off their season or stop playing their sport completely (Sports medicine practitioners embrace benefits of extracorporeal shock wave therapy – Mayo Clinic, 2019).

Where can I get Shockwave therapy for hamstring tendinopathy?

One is able to get shockwave therapy for hamstring tendinopathy at a few specialist clinics in the UK. There are a growing number of clinics providing this specialist form of treatment which goes to show how effective it is as more clinics are taking it on. It is beneficial to make certain the type of machine they use is a swiss dolor clast machine as this is the only one that has been tested to a high level in research papers.

At Perfect Balance Clinic, we often see people with different types of Tendinopathy who have tried other forms of treatment. Shockwave therapy for hamstring tendinopathy for us has been the one form of treatment that has consistently delivered results for Tendinopathy.

How long will the Shockwave therapy for hamstring tendinopathy treatment last for?

If everything goes to plan with your shockwave therapy for hamstring tendinopathy then the treatment should make a significant contribution to reducing the pain and improving the function of your hamstring tendinopathy. In most cases, the shockwave will get rid of the hamstring tendinopathy.

With some tendon surgery, there is a 75% success rate at 18 months, with shockwave for the same condition it has been shown that up to 80% of patients who have received the shockwave therapy at 18 months have a good to excellent result. Shockwave is better than surgery for certain tendinopathy and more research is being done with this in mind.

For more information about  Shockwave therapy for hamstring tendinopathy

This article was written by our team of specialist therapists at Perfect Balance Clinic. If you would like more specific advice about how our team can help you with this condition or symptoms you may be having, please complete the contact form below and one of the team will get back to you shortly.

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