None listed
Conditions
Brief summary
Proximal hamstring origin tendinopathy (PHT) is a common condition in the active and sporting population, particularly in sports involving sprinting, jumping, kicking or distance running. It was first described in 1988 (Puranen & Orava, 1988) as ‘Hamstring Syndrome’. The condition presents as localized lower buttock pain, and is typically aggravated by prolonged sitting, running or walking (particularly uphill), lunging and squatting. The primary aim of this study is to compare the immediate effect of isometric and isotonic exercise on pain and strength in individuals with proximal hamstring tendinopathy. A secondary aim of this study is to examine force steadiness in isometric contraction in a population with proximal hamstring tendinopathy compared to a matched population without the condition.
Interventions
Isometric and Isotonic exercise
Isometric exercise:
One session of isometric exercise (5 repetitions of 45 seconds), administered face-to-face by an experienced physiotherapist. Intervention will take place at LaTrobe University.
Participants will be asked to perform a prone hamstring curl, with the knee at 45 degrees of flexion.
Isometric exercise will be undertaken at 50-65% of maximum voluntary isometric contraction, with the intensity measured using a Biodex dynamometer.
The duration of th
Isometric and Isotonic exercise Isometric exercise: One session of isometric exercise (5 repetitions of 45 seconds), administered face-to-face by an experienced physiotherapist. Intervention will take place at LaTrobe University. Participants will be asked to perform a prone hamstring curl, with the knee at 45 degrees of flexion. Isometric exercise will be undertaken at 50-65% of maximum voluntary isometric contraction, with the intensity measured using a Biodex dynamometer. The duration of the intervention is approximately 15 minutes including rest periods between repetitions. Participants will be asked to attend three sessions in total. Session one is an orientation session to the testing equipment. Sessions two and three are either of the isometric or isotonic intervention (the order is randomised). There is a 3-7 day washout period between all sessions. The total time commitment for session one is approximately 30-45 minutes The total time commitment for sessions two and three is approximately 90 minutes, including approximately 15 minutes of intervention.
Sponsors
LaTrobe University
Study design
Allocation
Randomised controlled trial
Intervention model
Crossover
Primary purpose
Treatment
Masking
Blinded (masking used) (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
Initial Phone Screening. Participants must meet all of the following criteria: 1. Reports of localised (defined as an area smaller than a tennis ball) ischial tuberosity region pain of gradual onset and at least 3 months in duration 2. Willingness to participate in three sessions of testing and intervention as part of the trial, over a 9 to 21 day period 3. Age between 18 and 60 inclusive 4. Fluency in English sufficient to complete questionnaires and to enable understanding to the intervention. 5. Agreeing to refrain from other interventions wherever possible for the treatment period of the trial, aside from consultation with medical practitioners and medication. 6. Agreeing to refrain from activity that would aggravate symptoms for 48 hours prior to each session. Clinical examination screening 7. Positive findings (reproduction of lower buttock pain) with single leg arabesque AND with 2 or more of three additional diagnostic criteria: o Supine single leg bridge with heel on standardised height platform (bent knee) o Prolonged sitting >30 minutes o Modified bent-knee hamstring stretch test (Cacchio, 2012) (Symptoms must be >=2/10 with arabesque only) 8. A clear increase in activity levels precipitating onset of symptoms A group of control participants without PHT are also being recruited. The inclusion criteria for this group is: 1. Willingness to participate in two sessions of testing and intervention as part of the trial, over a 3 to 7 day period 2. Age between 18 and 60 inclusive 3. Fluency in English sufficient to complete questionnaires and to enable understanding to the intervention. Clinical examination screening 4. Negative findings (lower buttock pain) with single leg arabesque AND with all three additional diagnostic criteria: o Supine single leg bridge with heel on standardised height platform (bent knee) o Prolonged sitting >30 minutes o Modified bent-knee hamstring stretch test (Cacchio, 2012) (Symptoms must be >=2/10 with arabesque only)
Exclusion criteria
Initial Phone Screening 1. Previous surgery to the hamstring complex, as we wish to study treatment effects independent to the effects of surgical procedures. 2. Previous injection to the hamstring tendon within the last 6 weeks, as we wish to study treatment effects independent to the effects of injections. 3. Previous imaging (MRI, Ultrasound) performed since onset of symptoms showing normal hamstring tendon appearance, as a radiologically normal tendon is unlikely to be pain generating. 4. Treatment with ESWT for PHT in the last 3 months, as we wish to study treatment effects independent to the effects of ESWT. 5. Current pregnancy, or recent childbirth (within 6 months) as this could impair ability to undertake testing and intervention. 6. Diagnosis with autoimmune disease as we do not wish to evaluate tendon response where there is a potential autoimmune influence 7. Previous imaging (MRI, ultrasound) showing perineural sciatic nerve oedema as this suggests a pain generator that is not the proximal hamstring tendon Clinical examination screening 8. Pain that is predominantly due to lumbar dysfunction including lumbar spine radiculopathy, or lumbar spine somatic referral 9. Pain that is reasoned from clinical examination to be predominantly due to other structures or conditions, including sciatic nerve entrapment, ischiofemoral impingement, hip joint, local sciatic nerve irritation, and adductor magnus tendinopathy
Outcome results
None listed