Shockwave Therapy for Hamstring Tendinopathy

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.  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).  Pain when sitting is normally the result of a severe tendinopathy.
The hamstrings (semi-membranosus, semi-tendinosus 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
  3. History of previous injuries to the hamstring
  4. Poor quad to hamstring ratio
  5. Pelvic instability
  6. Poor running biomechanics
  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 (Cacchio 2011)
  5. Anti-inflammatories (oral or injectable)
  6. PRP injections
  7. Hamstring stretching
  8. Pelvic Alignment (Kristen 2010)
  9. Hamstring Strengthening

How is shockwave therapy applied to the hamstring tendinopathy?

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 a 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 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.
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.

What is the evidence for shockwave therapy and this condition?

A recent randomized controlled trial demonstrated potential benefit of the shockwave treatment. 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).

Where can I get shockwave therapy for this condition?

One is able to get shockwave therapy at a few specialist clinics in the UK.  There are a growing number of clinics providing this specialist form of treatment.  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 high level in research papers.
At Pefect Balance Clinic we often see people with different types of Tendinopathy who have tried other forms of treatment.  Shockwave for us has been the one form of treatment that has consistently delivered results for Tendinopathy.

How long will the 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 patellar tendinitis.
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.

References

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