Proximal Hamstring Tendinopathy

Proximal Hamstring Tendinopathy

Article by Zoe Russell

Proximal Hamstring Tendinopathy

What Is Proximal Hamstring Tendinopathy?

Proximal Hamstring Tendinopathy (PHT), commonly known as high hamstring tendinopathy, is an injury to the hamstring origin tendon. This injury occurs where the tendon attaches to the pelvis’s ischial tuberosity and often results in gluteal pain. Repetitive strain or overuse of the hamstring muscles typically causes the condition.

Who Does It Affect?

Athletes who engage in activities with repetitive hip extension, like running, sprinting, and soccer, frequently experience proximal hamstring tendinopathy. Manual labourers and gardeners are also susceptible due to the nature of their work, which often involves bending and lifting.

Symptoms and Causes of Proximal Hamstring Tendinopathy

Proximal Hamstring Tendinopathy
Proximal Hamstring Tendinopathy

Identifying the Symptoms

The condition usually develops as a gradual onset of pain, presenting as a deep, dull ache in the buttocks that worsens with specific activities. The pain may extend down the thigh, following the hamstring muscle path, and is often linked with activities that stress the hamstring muscles.

Understanding the Causes

High hamstring tendinopathy stems from the repetitive strain on the hamstring muscles, leading to tendon degeneration and inflammation. When the tendons are overloaded beyond their capacity to adapt and heal, this can lead to pain and a decreased ability to withstand activity.

Risk Factors and Phases of Tendinopathy

Recognising Risk Factors

Several factors can increase the likelihood of developing high hamstring tendinopathy. These include previous hamstring injuries, muscle strength loss, poor gluteal function, and an imbalance in pelvic alignment. Both intrinsic and extrinsic factors, such as training loads and equipment, play a role.

Phases of Tendinopathy

The condition progresses through several stages, starting with reactive tendinopathy, marked by pain and swelling, progressing to tendon dysrepair with ongoing degeneration, and possibly leading to a degenerative state where extensive tissue damage occurs. Read more: Tendinopathy Phases

Diagnosis and Treatment Strategies

How to Diagnose It

Diagnosing proximal hamstring tendinopathy involves a combination of patient history, physical examination, and, when necessary, imaging tests like MRI to confirm the diagnosis and assess the extent of the injury.

Effective Treatment Approaches

Treatment typically includes a combination of exercise therapy, load management, and pain management. A physiotherapist will tailor a rehabilitation plan, employing pain provocation tests to gauge recovery and determine when to resume sports safely.

Managing Exercise Load and Rehabilitation

Prioritising Load Management

Successful treatment hinges on managing activity loads to stimulate tendon growth without overloading. Physiotherapists may employ a traffic light system to help patients gauge the safe level of activity.

Progressing Through Rehabilitation

A patient’s prognosis with proximal hamstring tendinopathy can vary. Early and consistent treatment often leads to a complete recovery, whereas advanced cases may require extended rehabilitation.

Exercises and Adjacent Treatments

Selecting the Right Exercises

Avoiding exercises that trigger pain is critical. As recovery progresses, specific strengthening exercises, particularly eccentric ones, can be highly beneficial when introduced at the right time under a physiotherapist’s supervision.

Exploring Adjacent Treatments

Addressing lower limb biomechanical issues is part of comprehensive treatment. Additionally, novel therapies, such as injections, may be considered for some patients, though these require further validation.


Each case of proximal hamstring tendinopathy is unique, necessitating a personalised approach to rehabilitation. Consulting a qualified physiotherapist is crucial to design an effective treatment plan tailored to the individual’s specific needs.

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