A career centred around runners has taught me a lot about Proximal Hamstring Tendinopathies (PHT). They have many clinical nuisances, we borrow a lot of principles from other tendons and they're uniquely specific to the individual.
This 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, both positive and negative, that have helped me to learn, develop and create a clinical formula. It is written from the clinicians perspective, and is my view on the management and diagnosis.
“Be wary of simple answers, because simple answers only answer simple questions and PHTs are NOT simple."
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 and create a bespoke plan for the individual.
Key Points:
Keep the patient at the centre.
Understand the physiology of what's going on.
Manage expectations.
There is no perfect prescription.
Select the best available outcomes, assess and reassess.
Don’t over complicate the problem.
Imaging?
The Person
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.