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Buttock Pain - High Hamstring Tendinopathy
Robert Filice, M.D. Former staff physician
Pain deep in the buttocks or upper back-side of the thigh can be due to
tendon injury near the origin of the hamstring muscle off of the
ischial tuberosity. That
is the name of the bone which bears body weight in the seated position.
It is an injury we see in mid to long distance
runners,
yoga practitioners, and
occasionally non-athletic individuals who have been injured by improper
chiropractic
adjustments or
physical therapy.
Occasionally the damage to the
tendon
in chronic cases can be severe enough to cause irritation of the nearby
sciatic nerve, thus producing symptoms of
referred pain down
the entire back of the leg which are more typically associated with
herniated lumbar disks. The pain is typically worse when the patient is
seated on a hard surface, and after running, especially at faster
speeds. There can be pain at rest in severe cases. The bent knee stretch
test is applied for the diagnosis of this condition with the patient
lying supine. The
hip
and knee are first maximally flexed towards the
patient’s chest, and then the knee is extended gradually. Pain at the
origin of the hamstring on that side which reproduces the patient’s pain
is diagnostic. Additionally,
Prolotherapy doctors rely on direct thumb
pressure over the proximal hamstring
tendon
in the buttocks, the so
called “jump sign” to reproduce the pain, localize the injury, and
determine the best treatment. Direct firm pressure on affected areas
causes the patient to “jump’ because of accentuation of the pain.
Finally, injection of a local anesthetic solution into the tendon-bone
junction of the affected hamstring tendon can cinch the diagnosis by
immediately eradicating all evidence of pain at rest or with motion or
sitting.
There are several other conditions that can produce a similar symptom
complex. Herniated lumbar disks and sacroiliac ligament strain both
refer pain into the deep buttock area. Spasm of the
pyriformis muscle is another common condition in athletes,
and in older individuals metastatic cancer to the bone, and pelvic
stress
fracture
must also be considered. Fortunately, all of these
conditions except for the latter two will respond to appropriately
applied
Prolotherapy, but making the differential diagnosis is critical
in order to achieve the most rapid response. When necessary, X-rays,
bone scan, or MRI imaging is ordered.
Prolotherpists approach the treatment of high hamstring
tendinopathy
much differently than most orthodedists and team or family physicians.
Ice and
anti-inflammatory
drugs (which, by the way, are not particularly
effective in this condition anyway) are never recommended. We also never
inject
steroids,
which is another favorite of orthodox physicians despite the fact that
long term outcome is clearly not improved by this approach, and there
are possible cadverse complications. Since steroids can weaken
tendons,
care should be taken to avoid injecting them directly into the tendon.
This is far different than
Prolotherapy injections,
(Watch where do
Prolotherapy injections go and do they hurt?)
which are safe and
all the more effective when injected directly into the site of the tendinopathy. The pelvis must be properly aligned, so chiropractic
intervention is requested when indicated. As I mentioned above, I have
seen some cases of high hamstring tendinopathy arise from over-exuberant
chiropractic adjustments, so be careful who adjusts you. Maintaining
flexibility of both hamstrings is also important, and so is strength
training. The former is accomplished with stretching, while the latter
with double leg isometric bridge exercises. With the patient on his
back, he activates the
abdominal muscles to raise his pelvis while
maintaining neutral position and alignment of the
shoulder, hips, and
knees. Hold this position for 10 seconds and then lower the pelvis back
to the floor. Progression of this exercise requires lifting and
extending one foot off the ground, and/or placing the arms across the
chest. In the early weeks of treatment, pool running rather than track
running is advisable to decrease impact trauma, but mobility should be
maintained as much as possible.
Prolotherapy injections are definitely the fastest route to recovery
from high hamstring tendinopathy. The only possible danger from prolo
for this disorder is the proximity of the hamstring tendons to the
sciatic nerve, but proper experience and technique will always avert any
problems in this regard. Should the nerve ever be touched by the slowly
advancing prolo needle (a precautionary measure on the
Prolotherapy doctor’s
part), there will be a quick electrical sensation down the leg. As the
needle is withdrawn or redirected, any discomfort will be mild and
temporary. Return to full athletic activity is speeded up by “prolo,”
and it is the only treatment of all available that actually stimulates
the body to heal the damaged and painful area, for permanent relief, via
the deposition of additional tissue strengthening collagen which becomes
an intrinsic part of the tendons treated, restoring strength,
elasticity, and functionality.
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Ask Dr. Hauser
About Prolotherapy
Dr. Hauser is one of the leading experts in the treatment of chronic pain and
sports injuries with
Prolotherapy.
Caring
Medical and Rehabilitation Services
Call
708-848-7789
Ross Hauser, M.D.
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