Exercises for Proximal Hamstring Tendinopathy

 In Tendon Conditions


Do you experience pain in the back of your leg or into your buttock? Feel uncomfortable when you walk, bend forwards, sit, sprint or run uphill? You may have what is called proximal hamstring tendinopathy.

Proximal hamstring tendinopathy is characterised by thigh or buttock pain localised to the hamstring attachment at the origin, which is called the ischial tuberosity. It is most commonly aggravated by activities that involve compressive loads on the hamstring tendon for example when the hamstring is working with the hip flexed, long periods of sitting or driving, deep lunges, overstretching of the hamstrings and running at faster speeds and uphill. Although it is usually compressive loads, which lead to proximal hamstring tendinopathy, it does not necessarily need to be energy storage loads. Your pain may be due to increased load such as an increase in hill running, deeper lunges, deadlifts or stretches in yoga.

Proximal hamstring tendinopathy is characterised by thigh or buttock pain localised to the hamstring. #performbetter @pogophysio Click To Tweet

It is often described as a dull, aching soreness high up onto your hamstring and deep into the buttock. Pain is most regularly felt in the morning or initially when running and then “warms up” and disappears as they continue to run. Sitting on hard surfaces is another common source of pain as pressure is going directly through the ischial tuberosity. Pain is often delayed and felt 24-48 hours after exercise.

There are many hamstring-related injuries that can occur in athletes so having an accurate diagnosis is crucial to prevent delayed return to sport, injury reoccurrence and can affect clinical decisions on the best treatment options. So the first step to see if you do indeed have proximal hamstring tendinopathy is to get an accurate diagnosis by visiting a physiotherapist who will take a detailed subjective history followed by a thorough clinical examination. Diagnostic imaging may be requested to confirm the diagnosis or rule out any other causes of referred posterior thigh pain. Once you have a proper diagnosis of your hamstring pain, appropriate treatment and exercises can be made to ensure a quick, yet safe return to your desired sport.

Exercise is the most evidence based treatment for hamstring tendinopathy. Due to the nature of tendinopathies, loads must be managed in a way you do not overload your tendons causing more irritation or inflammation. Tendons should be loaded progressively so that they can develop better tolerance to the loads that are necessary for your individual day to day needs.  Exercises need to be monitored and eased into with the guidance of your physiotherapist.

Exercise is the most evidence based treatment for hamstring tendinopathy. #performbetter @pogophysio Click To Tweet

Active management through a home exercise program will usually be the main focus of your treatment. Early management of proximal hamstring tendinopathy will include load modification to avoid aggravating factors, and the introduction of isometric exercises that improve your pain. The following isometric exercises can be performed 2-3x/day, 3-4 reps, held for 30 seconds, progressing to 5 reps held for 45 seconds, but talk to your physiotherapist to see what is right for you.

Double leg isometric glute bridge

Hamstring Tendinopathy

Double leg glute bridge with leg lifts

Hamstring Tendinopathy

Plank with leg lifts

Hamstring Tendinopathy

Once you are comfortable and able to tolerate repetitions and isometric holds, you can incorporate isotonic exercises such as the following:

Single Leg bridge

Hamstring Tendinopathy

Prone Hamstring curl

Hamstring Tendinopathy

Supine hamstring curl with ball

Hamstring Tendinopathy

Hamstring Tendinopathy

These are a few exercises to rehabilitate and build strength through your hamstrings. Exercises need to be added gradually and strength needs to be maintained to prevent symptoms from returning. It is important to be guided by your physiotherapist for recommendations of repetitions and sets according to your requirements as everyone will respond differently to certain exercises.

Exercises need to be added gradually and strength needs to be maintained to prevent symptoms from returning. #performbetter @pogophysio Click To Tweet

For further help please refer to the below resource

  1. Listen to tendon expert physiotherapist and researcher Associate Professor Dr Peter Malliaras discuss the rehabilitation of tendon injuries on Episode 62 of The Physical Performance Show podcast HERE>>

Dr Peter Malliaras Dr Peter Malliaras Dr Peter Malliaras

Have fun with your exercises!

Natasha Chan (APAM)


Natasha Chan POGO Gold Coast physio


Clinical Edge. (2016). Proximal Hamstring Tendinopathy with Tom Goom. 046. 4 May 2016. Available from https://www.clinicaledge.co/podcast/physio-edge-podcast/physio-edge-046-proximal-hamstring-tendinopathy-with-tom-goom. [Accessed 14 September 2016].

Cook J, Purdam C: Is compressive load a factor in the development of tendinopathy? British Journal of Sports Medicine. 2012, 46:163-168.

Fredericson, M.; Moore, W.; Guillet, M.; Beaulieu, C., High hamstring tendinopathy in runners: Meeting the challanges of diagnosis, treatment, and rehabilitation. Physician and Sportsmedicine 2005, 33 (5), 32-43.

John Davis. 2016. Runners Connect Available at: https://runnersconnect.net/running-injury-prevention/high-hamstring-tendinopathy-injuries-a-pain-in-the-butt/. [Accessed 26 September 2016].

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