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Proximal hamstring tendinopathy; expert physiotherapists' perspectives on diagnosis, management and prevention
Anthony M Nasser1, Tania Pizzari2, Alison Grimaldi3
1La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia; University of Technology Sydney, Graduate School of Health, Australia.
Objectives:
To explore and summarise expert physiotherapists' perceptions on their assessment, management and prevention of proximal hamstring tendinopathy (PHT).
Methods:
We conducted semi-structured interviews with expert physiotherapists until data saturation was met (n = 13). Interviews were transcribed verbatim and data were analysed systematically and organised into categories and sub-categories according to study aims.
Results:
Experts report using a clinical reasoning-based approach, incorporating information from the patient interview and results of clinical load-based provocation tests, in the physical examination to diagnose PHT. Experts manage the condition through education and progressive loading targeting the hamstring unit and kinetic chain, avoiding provocative activities in positions of compression in early-mid stage rehab and a gradated and controlled return to sport. Passive therapies including injection therapies and surgery were believed to have limited utility. Prevention of recurrence primarily involved continuation of hamstring and kinetic chain strengthening programs and management of physical workload.
Conclusion:
Experts rely on a combination of information from the patient interview and a battery of pain provocation tests to diagnose PHT. Education and graded exercise of the hamstring group and synergists, minimising early exposure to hip flexion, were the foundation of management of the condition.
