Rehabilitation of Proximal Hamstring Tendinopathy Utilizing Eccentric Training, Lumbopelvic Stabilization, and Trigger Point Dry Needling: 2 Case Reports
Authors: Dhinu J. Jayaseelan, DPT, OCS1, Nick Moats, MPT, OCS2, Christopher R. Ricardo, CSCS3
Published: Journal of Orthopaedic & Sports Physical Therapy, 2013 Volume:44 Issue:3 Pages:198–205 DOI: 10.2519/jospt.2014.4905
Study Design
Case report.
Background
Proximal hamstring tendinopathy is a relatively uncommon overuse injury seen in runners. In contrast to the significant amount of literature guiding the evaluation and treatment of hamstring strains, there is little literature about the physical therapy management of proximal hamstring tendinopathy, other than the general recommendations to increase strength and flexibility.
Case Description
Two runners were treated in physical therapy for proximal hamstring tendinopathy. Each presented with buttock pain with running and sitting, as well as tenderness to palpation at the ischial tuberosity. Each patient was prescribed a specific exercise program focusing on eccentric loading of the hamstrings and lumbopelvic stabilization exercises. Trigger point dry needling was also used with both runners to facilitate improved joint motion and to decrease pain.
Outcomes
Both patients were treated in 8 to 9 visits over 8 to 10 weeks. Clinically significant improvements were seen in pain, tenderness, and function in each case. Each patient returned to running and sitting without symptoms.
Discussion
Proximal hamstring tendinopathy can be difficult to treat. In these 2 runners, eccentric loading of the hamstrings, lumbopelvic stabilization exercises, and trigger point dry needling provided short- and long-term pain reduction and functional benefits. Further research is needed to determine the effectiveness of this cluster of interventions for this condition.
Level of Evidence
Therapy, level 4. J Orthop Sports Phys Ther 2014;44(3):198–205. Epub 21 November 2013. doi:10.2519/jospt.2014.4905