The hamstrings are three muscles (the semimembranosus, the semitendinosus and the bicep femoris) which run through the back of the thighs. The hamstrings function to flex the knee and assist in hip extension and so are active at multiple points of the yoga asana practice. Accordingly, hamstring injuries are common amongst yoga students due to the excessive repetition of hamstring contraction.
Hamstring injuries suffered on the yoga mat are usually high tendon injuries at the point of the hamstring origin (the sit bones). Such injuries are usually referred to as “hamstring tendonitis”. However, the name “hamstring tendinopathy” may be a more accurate description of high hamstring tendon injuries as research suggests that this injury is more a degenerative than inflammatory process.
Hamstring Tendon Injuries
Tendons are bands of connective tissue which attach muscle to bone. The point at which a muscle meets a tendon is known as the musculotendinous junction and the point at which a tendon inserts into a bone is known as the the osteotendinous junction.
Yoga based high hamstring tendon injuries tend to occur at the musculotendinous junction in one of the tendons of the hamstring muscles at the origin point of the sit bone. These injuries develop over time as the the collagen fibrils which make up the tendon become frayed and damaged as a result of:
(1) Excessive tension of the hamstring tendons
This is caused by excessive hamstring contraction from doing too many intense hamstring stretches and/or overstretching the hamstrings in certain postures. The amount of tension placed on the tendon is influenced by factors such as volume (time spent under contraction), frequency (number of times on the yoga mat per week) and the intensity of the contraction.
(2) Insufficient rest to allow the healing of tiny tendon tears
Any time you stretch a muscle, it pulls on its tendons, creating microscopic tears. If you wait 24 to 48 hours between practice sessions then these tiny tears heal. However, it is common for yoga students and teachers to proceed with their practice following a “little niggle” to the top of the hamstrings. Yet this little niggle is a tiny tear to the hamstring tendon which will eventually form adhesive scar tissue intended to protect the tendon as it heals. Unfortunately, this scar tissue can also limit circulation to a tendon (which already has a poor blood supply) and will ultimately make it harder for the injury to heal.
Weak hamstring tendons (as a result of weak hamstring muscles) or a failure to adequately engage the hamstring muscles can also be a factor in the development of a high hamstring tendon injury.
(1) Pain/discomfort at the back of the top of the thigh and into the buttock
(2) Pain/discomfort when placing deep pressure at the point of the sit bones
(3) Pain/discomfort when sitting on a hard surface
(4) Pain/discomfort which is exacerbated by forward folding asanas such as Standing Forward Fold (Uttanasana) and Intense Side Stretch Pose Parsvottanasana.
Yoga students with hamstring tendon injuries often report feeling their hamstring “go” as though it is an acute injury done on the mat in a specific stretch. However, hamstring tendon injuries tends to be caused by excessive weakening of the tendon over time as a result of excessive over stretching and insufficient rest.
Continuing to practice on a injured tendon will result in an injury which will continue to cause you pain and is unlikely to ever fully heal.
Treatment for high tendon hamstring injuries begins with an initial rest period followed by a programme to strengthen the hamstrings. However, if you have moderate to severe pain, or pain that persists despite a period of rest then you need to seek treatment from your GP or physio.
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