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Your upper body weight pushes through your hamstring tendons. However, your semimembranosus hamstring tendon is copping most of the pressure due to it’s position.
There’s three tendon parts attaching the three hamstring muscles to the ischial tuberosity (area of the pelvis).
My semimembranosus tendons (my case was bi-lateral) were the affected parts. I had a paperless desk job. So no reason to get up and walk about. 10 Hours of sitting a day plus driving to and from work equalled 12 hours of sitting.
After 3 months of the paperless job, my proximal hamstring tendons were a 7 – 8/10 on the VAS scale and I could hardly sit. I continued to drive to work for another 6 months and stood at my desk all day.
Standing for long periods of time is not a good idea. Too much of any activity will put a strain on groups of muscles and tendons, potentially causing more injuries.
I asked for a better chair and an up down desk which wasn’t forthcoming so had no option but to go off sick as I was unable to continue.
The next two years were spent standing as I could no longer sit down at all and having exhausted treatments available in the UK, after hours and hours of research, I flew to Finland and had a bi-lateral proximal hamstring tenotomy.
Don’t despair, most people recover before surgery becomes an option. Surgery is the absolute last resort.
My surgery was successful. Just a side note, Finland is a wonderful country and so too it’s people. We had a great time and want to go back and see some more of it.
However, my re-hab at home was not so good so I’m still recovering…. forever hopeful.
Sit on a thick spongy, pillow or cushion. Carry this about with you. Take it to work and use it for driving. Heads-up here, obviously it puts you in a different driving position so take it easy to start with. Take time to adjust.
You can buy a cushion/seat pad on Amazon designed for PHT. There’s holes cut out for the sit bones (ischial tuberosities). However, people have said it’s chance if the holes line up in the right position for your bone structure and it’s quite pricey. On the flip side, others have found it helped with their recovery and rated it highly.
As an alternative, people buy gardening kneeling cushions, measure up and cut their own holes. This apparently has worked very well and is a cheaper option.
Another pain reliever is the Wondergel seat pad. Community member recommeded:
Don’t sit for longer than 15 – 20 mins without getting up and walking about. This takes practice, especially at work. You get into what you’re doing and before you realise, an hour or more has gone by.
Standing takes the pressure off your tendons, allowing blood through and walking about causes the blood to flow quicker, taking oxygen and nutrients to the injured area and toxins away. However, standing all day isn’t good for you either so mix sitting, standing and walking about if you can.
Ask for or purchase an up/down desk.
This one has been recommended by a member of the Facebook PHT community:
Price £79.99 UK
If you want something ergonomic, portable and are concerned about the environment, try these natural products made by carpenters and cabinet makers and sold by Deskstand, Cape Town. This company also comes recommended by a PHT member so tried and tested!
I noticed an improvement in the quality of my tendons after using a pillow. They felt less ropy so these measures can help with recovery.
I also used a simple pacing and grading Word table after I hadn’t sat for two years. If you don’t sit on your tendons, they become deconditioned. So I started at 30 seconds on a soft surface, then a minute and increased the time every two days by 30 seconds, until I reached 10 minutes. Then I went up by a minute every two days and brought in a slightly harder surface alongside starting at 30 seconds with that. If you don’t want this hassle, don’t stop sitting completely.
Keep your water levels up and don’t skip meals…. more reasons to get up.
Talk to other people with PHT to understand how they manage sitting: https://www.facebook.com/ProximalHamstringTendinopathy
Hope this helps with improving your pain levels and your recovery.
Stuart Butler, private physiotherapist and Medical Lead at England Athletics has kindly written a blog for the PHT website and community giving his expert opinion on what we should expect from our physiotherapist as patients.
This article is also an excellent guide for physiotherapists. Knowledge is key with this injury.
Fifteen years in track and field athletics, particularly around runners, has taught me a lot about PHTs: their diagnosis and management. This blog is my personal reflection on how I think these should be treated and how to keep runners running. It’s based on my clinical experiences of both positive and negative cases that helped me to learn and develop. It is written from a physio perceptive, but should help those with a PHT to better understand what ideal care should look like.
Be wary of simple answers because simple answers only answer simple questions and alas PHTs are often not a simple question.
This doesn’t mean that they’re insurmountable injuries that will change someone’s life, but you do have to consider the numerous factors that are involved.
Everyone who suffers from a PHT is a unique individual, with their own unique set of circumstances, history and goals. Spend time listening to the person, allowing them to tell their story, their understanding of what’s going on, and what they want to get out of physio in order to assist their specific goals. Two people can present with the same injury, but the context may be very different. Many PHT patients suffer with a decreased sitting ability. This would affect a mechanic, who stands for most of his day, differently to an office worker, who sits all day at work, so be aware of the context of the injury for each individual.
The diagnosis of proximal hamstring tendinopathy is complex. We must often exclude other potential diagnosis, whilst understanding that simple things like stress, anxiety, and a lack of sleep can ‘heighten’ the pain response. In my own clinical practice I often describe these as ‘rusty’ tendons. They’re a little thicker and can get in the way, stiff and slow to get going, but often if you build the load progressively they’ll function perfectly for your needs. Be wary of those that don’t quite fit like the hypermobile individual and acknowledge how other conditions may influence the outcome.
Manage expectations of both the therapist and the patient. If we’ve listened well we should be able to set specific goals for the individual, focussed on what they want or need. This may be very different for someone two weeks prior to a marathon versus someone on a couch-to-5km plan. Both are equally as important and we don’t want to stop runners running if possible. We need to design a plan tailored to each individual, empowering them to make decisions on a day to day basis about their ‘load’. I’ll always be honest and say that because these involve tendons, which are stubborn and really slow to let us know somethings going wrong, that to have a positive influence on them we’ll need a minimum of a month (you may see change earlier) and you’ll need to work at this for 3-4 months. The perfect scenario is where the patient has a set of ‘skills’ (exercises / solutions) that they can dip into when they need to.
Many PHT’s are simply a case of doing too much too quickly and acutely increasing the load through the hamstrings. An increase in running volume or intensity, more uphill running or increased sitting on hard surfaces may cause a previously dormant tendon to start causing pain. Often through managing the ‘load’, deloading and then progressively reloading, the symptoms will go away. Physios / physical therapists will often supplement this with some form of exercises. In my own personal practice I tend to use isometric (static) exercises to help with pain and eccentric loading to cause the hamstring tendons to positively adapt, but this always depends on the individual I have in front of me: their needs and goals. Running is an interesting area, and not something I like to take away from someone, so if possible I like to keep people running. It may mean changing sessions and it’s probably best to run alternate days to allow tendons to adapt. Tendons respond to load, and if we take the load away completely (ie: stop running) it can make those rusty tendons a lot stiffer and more painful, so almost all PHT patients need to be loaded on an individually specific plan.
Make sure you have outcomes. These are ways of showing improvement, because tendons often improve their functionality before they start to feel better or easier. Physiotherapists / Physical Therapists should provide comparative data for each side. I’m a big fan of strength testing. This can be done in numerous formats, from single leg bridges to hand-held dynamometry or isokinetic dynamometry, depending on the patients needs / clinician’s available resources. I use hand-held dynamometry in the clinic, utilising a couple of positions to provide a baseline score / numbers for the patient. It also allows me as the clinician to check that my prescription of the home exercise plan is being effective and to give patients confidence that they’re on the right path. This information will allow me to change or alter the program as and when needed.
I’m a self-confessed hamstring geek, therefore in clinic I tend to see a lot of hamstring injuries. I’m not saying I ‘fix’ all of them, but what saddens me most is when a patient presents with a long and complex history, having had X, Y and Z done to them when fundamental loading issues which haven’t been addressed. I’m not saying X,Y and Z don’t have a place but I see a lot of weakened, apprehensive hamstrings with no clinical outcomes used, that haven’t been loaded appropriately and do really, really well with simple home exercise plans. Marginal gains is a great concept, but please do the 99% else right first before worrying about the 1%.
What can you see? As someone who likes to utilise MSK sonography in clinical practice, we have to be very careful, especially around the proximal hamstrings. It’s a complex area that isn’t well explored in the scientific literature (both ultrasound and MRI), and as with many areas of the body (i.e. low back) we find lots of pathology (abnormal anatomy) in people with no pain or clinical signs. If we perform diagnostic ultrasound we must remember that tendons don’t tend to change their appearance on scans over time. Therefore scans are a useful modality to prove our diagnosis, rather than a monitoring tool for progression.
Proximal Hamstring Tendinopathies are often as complex as the person with them. They are not insurmountable and many people do exceptionally well. Listen to the patient, find shared goals and set good clinical outcomes that can be monitored to show progression. Help to provide context by understanding the causes and empower the patient to appropriately load the tissues. Rehab: Get the basics of loading right, keep running if appropriate, and you should achieve a positive outcome.
Stuart can be contacted at:
80 New Road
Surrey GU4 8LU
Always check with your physiotherapist first.
I’m the founder of the Proximal Hamstring Tendinopathy Help and Support Group and was invited to talk about living with proximal hamstring tendinopathy for a decade by Brodie on his podcast series. I discuss the causes of my PHT, the failed treatments I’ve had, sitting and the challenges of everyday life, mental health, surgery in Finland and supplements.
With the right clinician, most people recover within two years or less without the need for surgery. Mine is an exceptional case. I hope this podcast helps you feel less alone and isolated.
The PHT support group is at www.facebook.com/proximalhamstringtendinopathy
Hannah Erl – marathon runner talks about the timeline of her PHT and insertional hamstring tears, the treatments she had prior to surgery, how she decided surgery was the answer, the procedure and the difficult emotional journey along the way that many of us have had.
Hannah’s surgery was performed by Dr. Lasse Lempainen at the Mehilainen Neo Sports Hospital, Turku, Finland. Dr. Lempainen is widely considered the best in his field.
Maryke from Sports Injury Physio talks about why we develop PHT. Maryke explains the causes and treatments, the effects of some inflammatory diseases, the menopause, relative rest and what exercises to do and why.
All information on Proximalhamstringtendinopathy.org is based on the experience of the author who suffers from PHT and is not provided by a qualified medical professional.
The information is intended to motivate readers to make their own health decisions after consulting with their health care professional. The author is not medically qualified and takes no responsibility for others decisions about their health.
The information on this website is not intended to replace a one to one relationship with a qualified health care professional and is not intended as medical advice.
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