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Treatment of Proximal Hamstring Tendonopathy

March 27, 2018 by Rebalance Toronto

What is Hamstring Tendonopathy?

proximal hamstring tendonopathyThe hamstring muscles originate from the sitting bones and attach just below the back of the knee. Proximal hamstring tendinopathy (PHT) or high hamstring tendinopathy is a common, and frustrating pathology experienced among runners as a result of repetitive strain. Often, it is caused by an increase in load such as running at a higher speed, running uphill, or performing deeper lunges. It is aggravated when the hip is working in a flexed position, which may put a compressive load on the tendon.

Signs and symptoms of Hamstring Tendonopathy

  • Deep buttock pain just under the sitting bone
  • Worse with activities when the tendon is compressed e.g.: prolonged sitting, running, especially uphill
  • In early stages the pain may go away during running after the runner warms up
  • Soreness in the morning is also common

Diagnosis Of Hamstring Tendonopathy

hamstring tendon painClinical diagnosis is made by a detailed physical examination paired with the subjective history.  If required, MRI can detect tendon thickening, inflammation, and swelling.

Your physiotherapist will also assess the surrounding joints, nerves and muscles. Lumbar spine pain referral, sciatic nerve, sacroiliac joint, pelvic floor dysfunction can all cause pain in the area therefore creating the proper diagnosis is crucial for successful treatment.

Treatment of Hamstring Tendonopathy

What To Avoid?

The most important piece in the treatment of PHT is load modification to avoid aggravating factors. With PHT,  the tendon becomes sensitive and overworked. As a result the tendon’s capacity to accept load decreases.  This capacity can be improved with gradual loading. Stretching the hamstrings may also compress the tendon, thus prolonging the symptoms.  Positions or exercises involving hip flexion (bending hip forward) such as sitting, driving, lunging, cycling, sprinting should be avoided in the early phases of rehabilitation. Swimming or water jogging may be substitutes at this stage.

Exercises For Hamstring Tendonopathy

Below are two videos with sample PHT exercises.  Our physiotherapists will assess and help you find the optimal starting point in the gradual loading program. Isometric exercises are recommended in the early stages and they should be performed 3x 30 sec 2-3x a day, as they can help with pain relief. As the symptoms progress, further strengthening exercises can be added. These should be performed 3-4x a week.

Hamstring exercises for runners in early stages and advanced hamstring exercises for runners:

Shockwave therapy, dry needling and manual therapy techniques can also aid in the recovery of  PHT.  At Rebalance, our physiotherapists will create an appropriate treatment plan tailored to your injury and your specific goals.

Hamstring Tendonopathy and Running

When are you ready to run?

Returning to running can be a complex decision therefore guidance by your physiotherapist/ health professional is strongly recommended. Typically a period of rest, followed by hamstring and glute strengthening is recommended before returning to regular running. Cross training like water jogging is a great way to continue with cardio fitness while avoiding aggravation to the hamstring. In some cases, runners are able to continue with running throughout PHT by reducing mileage and speed. Mild pain is acceptable during running/exercising, however it should settle entirely within 24 hours.

Running analysis

Over striding, and running with a forward trunk lean can be a possible factor leading to PHT. Increasing running cadence (taking shorter steps), and running a bit taller may help with the symptoms. Our trained professionals will be able to analyze and provide you with feedback on your running form if needed.

If you think you have proximal hamstring tendinopathy, contact us to see one of our trained professionals.


  1. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management
    Journal of Orthopaedic & Sports Physical Therapy 2016 46:6, 483-493
  2. Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention
    Journal of Orthopaedic & Sports Physical Therapy 2010 40:2, 67-81
  3. Gait retraining for Proximal Hamstring Tendinopathy

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Rebalance Sports Medicine is a multidisciplinary clinic in downtown Toronto offering physiotherapy, chiropractic, registered massage therapy, sports medicine, naturopathy, Pilates and more.

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Yonge & AdelaideRebalance Clinic Yonge Adelaide
110 Yonge Street Suite 905
Toronto, ON M5C 1T4
T: (416) 777-9999
E: [email protected]
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155 University Avenue Suite 303
Toronto, ON M5H 3B7
T: (416) 306-1111
E: [email protected]

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