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Proximal hamstring tendinopathy: causes, symptoms, treatment, and prognosis.

What is proximal hamstring tendinopathy?

The hamstring muscles are located in the back of the thigh. They include the biceps femoris, the semitendinosus, and the semimembranosus. The hamstrings flex the knee and extend the hip. They are very important in decelerating the leg when walking, running, or kicking.

Hamstring tendon pathology can be classified into three categories:

  • Proximal hamstring tendonitis is acute inflammation of the tendon. This occurs after an injury or trauma.

  • Proximal hamstring tendon tears can occur after severe injuries.

  • Proximal hamstring tendinopathy is chronic overuse or overload of the tendon. This usually occurs after prolonged repetitive and overuse activities. Read more about tendinopathy here.

How does proximal hamstring tendinopathy occur?

Proximal hamstring tendonitis can occur after high impact activities that cause inflammation of the tendon. People with tendonitis can usually pinpoint a specific activity or injury that triggered the symptoms.

Proximal hamstring tendinopathy results from repeated stress of the hamstring tendon. Those with proximal hamstring tendinopathy tend to have pain that gets worse over the course of days to weeks.

Proximal hamstring tendinopathy symptoms

Proximal hamstring pain is usually located around the buttocks at the sit bone. Moving the hip can reproduce the pain. Sitting for long periods of time also provokes pain. Severe pain may cause a limp while walking.

Diagnosis of proximal hamstring tendinopathy

Proximal hamstring tendon dysfunction can be diagnosed with a thorough physical exam. There can be tenderness at the sit bone as well as along the proximal hamstring tendon. Testing hip range of motion may provoke pain. Strength testing can reproduce pain.

X-rays may be necessary in the setting of injury or trauma to rule out fracture.

Ultrasound can look for inflammation and assess the integrity of the tendon.

Proximal hamstring tendinopathy treatment

Initial treatment involves resting and protecting the ankle. Avoid or modify activities that exacerbate pain. Once pain improves, gradually increase physical activity.

Acute pain

  • Icing the area can help reduce pain and swelling. Apply ice 15-20 minutes at a time. Do this every 4 hours for the first two to three days or until pain improves.

  • Oral or topical anti-inflammatory medications can help decrease inflammation and control pain.

Persistent symptoms

  • Patients with persistent pain or symptoms may need injections.

  • Cortisone injections can help decrease pain and inflammation. This can reduce symptoms so that it is easier to perform effective rehabilitation.

  • This study showed platelet rich plasma injections can help hamstring tendon healing.

Proximal hamstring tendinopathy rehabilitation

The goal of rehabilitation is to return to activity as quickly and as safely as possible. Returning too soon can exacerbate symptoms. It can also weaken the tendon and lead to tendon tears.

A home exercise program will help improve range of motion, stability, and strength. Some people choose to participate in physical therapy. Physical therapists assess, guide, and teach you exercises and stretches. They also individualize a training program for you and your body.

Here is a link to a great example of a home exercise program for proximal hamstring tendinopathy:

Try to do your home exercise program twice a day. When pain is severe, focus on stretching and range of motion. Include strengthening exercises as pain improves.

Recovery for proximal hamstring tendinopathy

Recovery is determined by the duration and severity of the injury. The longer you have symptoms, the longer it will take to get better. Use symptoms as a guide for progression. Avoid using time in days or weeks as a marker for recovery.

Decrease the frequency of your home exercise program as your symptoms improve. For example, if doing the exercises twice a day, decrease to once a day. Do this for about one week.

Many people choose to incorporate these exercises into their weekly workout routine. This can help prevent reinjury as well as maintain strength, mobility, and range of motion.


Some pictures were taken without permission from the Sports Medicine Patient Advisor. They are intended for educational purposes only.


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