Buttock, hip and groin pain

Hi,
I have a strange one for you.
For a long time I have suffered from a pain in my buttock, where the hamstring joins the bottom bone. I have ignored this for a long time but I have got to the point where I need some help.
Just to clear the air, I have seen a physio and he has suggested it is something like hamstring insertion tendinopathy, he has given me a few stretches and advised me to stop running and I can only play field hockey if I do it gently.
I have done the stretches for a few weeks but there is no let up, so I am asking for more help if possible?
Let me explain the symptoms and reason I have sort help.
1, When warming up for hockey if we do high kicks with my right leg I get a sharp pain in my hamstring and hamstring connection to the bone, I also get a pain in my right hip.
2, If I do dynamic hamstring stretches it hurts in my hamstring and connection to the bone.
3, If I am walking uphill, I get a pain in my hamstring.
4,When touching my toes, I get a pain in the hamstring, connection, hip and groin once I get to a certain point it eases and I can keep going.
5, If I am sitting for a time period of an hour, or driving I get a lot of pain in my hip connection and groin and I have to get up and move around to try to alleviate it.
Has anyone got any ideas?
Thanks,
Anthony

Hi Anthony, thanks for your post. On reading your summary it does seem that you might well have an insertion tendinopathy. You might also like to know that I had one on my left hamstring perhaps made worse by a lot of road cycling, which unfortunately ruptured whilst kitesurfing (I now have two screws in there and some rope-work!). So I 'feel' your pain. And it took me a good 18 months to recover.

Let's first consider the tendinopathy as this is mostly a chronic (long time coming) issue that is usually the result of a multifactorial combination of both intrinsic and extrinsic factors, each of which needs addressing. To passively stretch the hamstring isn't really going to assist an attachment which has been overworked (for a long time) OR that was injured at sometime and no longer coping with the load placed upon it. It's also a very poorly vascularised area which means that any healing potential is also delayed and often limited once the inflammatory response has resolved.

I would approach this from a biomechanical perspective. As a therapist would want to consider the 'why' is this area not functioning normally. Is something causing it to be overloaded. Is there an asymmetry perhaps in the pelvis that has altered the mechanics on one side, to the point where the hamstring muscle now cannot behave in a normal fashion, and therefore the load is transmitted to the pelvic origin/attachment. This could be likely and is a common issue. When looking at exercises to assist it is often the eccentric contraction or the timing before the end of the eccentric load and then following concentric shortening of the muscle that are most beneficial in the rehabilitation. So with that in mind you can work with your therapist to come up with some exercises to mimic the range of movement where the dysfunction is more symptomatic. This might include something like box stepping.

Hockey is often played on a hard surface so there are some limitations if that is your sport and footwear could help or hinder the mechanics and loads when playing on such surfaces. The potential usefulness of some orthotics could therefore be investigated. Deep tissue release work also never hurts and I am a fan of getting deep tissue massage to the entire system, from the upper back, lumbar spine and into the thighs and calf complex. Calf strength too maybe worth considering in the overall function of the lower leg to see if they are doing their bit.

I think the important thing to note here is that your symptoms are your guide to how effective the treatment approach is being. If it is static, i.e. nothing is changing, then the current approach is not addressing the issue. An increase in symptoms/discomfort can mean at least you are getting into the right area (but you need ensure you have adequate recovery time to see if that is progressive in the medium term). It will take some time (often many months) to resolve as it would have taken a long time to becoming painful. Ensure diet is more than adequate and you may even consider some supplements to assist general recovery and nutrition.

See if you can work out a multifactorial approach to this with your therapist. Biomechanics, range specific and function specific exercise, diet and load progression. You will then become much more connected to the things that are working for you and will gain more insight into the actual root cause. I hope this advice and commentary are of use and do keep us informed as to how you get on.

Hi,
Thanks for the prompt reply to this one, its nice to know I am looking at the right problem.
The stretches I have been given are varied and I think are intended to build up the hamstring in my right leg as well. The stretches I have been given are below:
1, Tie my feet together with a rubber band, lie on my front and bend my right knee while keeping the left leg straight then slowly return my right leg back to the starting point.
2, Lay on my back with my feet pulled up to my bottom, then raise my pelvis up as high as I can, then slowly return to the floor.
3, Stand on a chair with both feet, then slowly lower my left foot to the ground then back up to the starting point.
4, Kneel with my lower legs secured and then keeping my body straight lean forward to around 15 degrees and then return to the upright position.
As well as this I spend a lot of time sitting on a foam roller on the area where the discomfort is, and I have found another stretch where I put my right foot on a chair and with my knee slightly bent lean slightly forward to stretch the affected area. This one seems to be the right area and is uncomfortable after I have finished.
Can you suggest anything else I should try or any of the above I shouldn't be doing?
Also do you sell patience at all? I think I need to get hold of some of that.
Thanks for your help,
Anthony

Hi again, those seem OK in some respects. The band on the feet one though is not really a functional exercise for the way the hamstring works or is involved in your discomfort. You need to consider 'Is the hamstring weak' or is it just functionally weak to due pain? If it is not weak it does not need to strengthen. It is perhaps overworked and might be stronger than the other side. I think the high stepping is a good way to go perhaps progressing that to a more plyometric movement e.g. small jump at the top (as symptoms resolve). Skipping might also be something to try if you want something extra that had a cardio element and also a calf/ankle component.

The stretch with the slightly bent knee is the true hamstring stretch which you can vary the amount of bend in the knee to alter slightly where you feel the pull. It seems that this one is telling us that it is indeed related to the hamstring origin issue.

Yoga ++ for patience. It's not what you gain with it, it's what you lose AND it's not so expensive ;-)

Hi,
Just to clarify the Physio did say that my hamstring and glute on my right hand side are less developed.
What is involved with the High Stepping?
Thanks,
Anthony

In terms of high stepping I am referring to something like this: How to Perform Step Ups - Exercise Tutorial - YouTube

Brilliant. Thanks again for all your help
Anthony