Thigh Pain: Hamstring Tendinitis and Inflammation


Hamstring tendinitis is inflammation of the hamstring tendons, most commonly at the points where the muscles become tendons. Since the proximal tendons of this muscle group extend relatively far down the back of the thigh and the distal tendons extend up the back of the thigh pain caused by hamstring tendinitis can be felt in the mid-thigh even though the injury is not in the muscle belly. Overuse and lack of warm-up are usually to blame. This condition has a high tendency of reoccurrence, 25% among athletes. Two noted characteristics among people affected by hamstring injuries include; a stark imbalance between strength of the quads and the hamstrings and a discrepancy in strength between the left and right legs. To some degree, imbalance is normal because the quads are intrinsically stronger. When hamstring strength is less than 60% as strong as the quadricep muscle in the front of the leg there is an increased susceptibility to strains and pulls of the hamstrings. Additionally, if one leg is more than 10% stronger than the other there is a higher incidence of hamstring injury.

For acute injuries, immediately begin RICE; compression is extremely important to minimize swelling and inflammation. For chronic injuries; since muscle imbalance is associated with hamstring injuries, it’s imperative to stretch and strengthen the front and back of both legs. Stretching should only be done after warming up the muscle and should never be painful or uncomfortable. Stretching is important not only in increasing the flexibility of the muscle, but it also helps the scar tissue that forms as part of the healing process to line up with the muscle and tendon fibers. Overzealous stretching can do more harm than good, tearing the fibers further. Eccentric exercise is particularly important because it strengthens the muscle in a functional way, the way it’s typically used for activity. For chronic tendinitis, cold therapy is key after activity to decrease the inflammation. Over-the-counter NSAIDs for 7 to 10 days may also help reduce pain, inflammation and discomfort. Minimize activity that aggravates the injury and wear a compression brace or neoprene sleeve.

For complete healing of a minor injury allow 10 to 21 days, but more serious and chronic injuries may take upward of 6 months. Cycling and stair climbing are good alternative exercises that don’t stress the hamstrings. Once the pain is gone gradually reintroduce exercises. Warm-up and stretch and don’t exercise and play when fatigued as most hamstring injuries occur early or late in a game. Thereby indicating that the body is better protected when it’s limber before stepping onto the field or beginning a hard workout.

Inflammation of the bursa on the outside of the hip area is called greater trochanteric bursitis. This injury causes nagging hip pain on the outer upper part of the thigh. It’s caused by a number of factors including a leg-length discrepancy, tightness of the ITB, weakness of the muscles that abduct the hip and running on a banked road or track. Treat the inflammation first; cold therapy, NSAIDs and rest from the offensive activity. After the acute pain has subsided, be sure to include stretches for the ITB and strengthening for the hip abductors. A heel lift may be required if when suffering from a leg-length discrepancy.

Microscopic cracks in the shaft, the long part of the bone, neck, the area connecting the shaft to the head, or head, the ball part of the ball-and-socket hip joint, of the femur can be caused by overuse and over-stress. Although strong and thick the femur is still the primary conduit for transferring and absorbing large amounts of force between the upper and lower extremities, 10 to 20 times body weight when engaged in various sporting activities. If the fracture is in the head or neck, expect to experience diffuse pain when active, either in the area of the groin or along the front of the thigh. At rest, however, there will be no discomfort. Stress fractures along the shaft are vey difficult to spot as sometimes pain is only evident when there is direct bending pressure along the front of the leg, over the area of injury.

If a stress fracture is diagnosed at the femoral head or neck, careful diagnosis is necessary in order to make sure that the situation doesn’t progress to a complete fracture, which could threaten the blood supply to the femur and cause a displaced fracture, necessitating surgery. In the vast majority of cases, however, reduction of activities for 8 weeks will allow the injury to resolve itself. In the interim, light cycling and swimming can be performed to maintain aerobic fitness. After recovery, stretching and strengthening exercises targeting the front and rear muscles of the thigh and hip are important to prevent muscular fatigue and imbalance that precipitates stress fractures.