Hamstring tendinopathy

The hamstring muscle is made of three muscles, which all originate from the bony prominence in the middle of the buttock. You can feel this bone under your buttock in sitting position, if you put your hand under the buttock, i.e. the bone you sit on. This area where the tendon originates from can become painful/sensitive which we call proximal hamstring tendinopathy.

Our tendons (which attach muscle to bone) undergo various stress and strain during our day to day activities. They adapt and recover from these on a daily basis. When the demand placed on these tendons exceeds their recovering capability they can become painful. We understand that multiple aspects affect the demand as well as the recovery of these tendons. The common ones being age and the demand placed on the tendon. If the demand we place on the tendon is higher than its capacity to recover if not given enough time, the tendon can become painful. As we get older the recovery of the tendons slows down too. We also know that stretching and compression of the tendon worsens the pain.

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Causes and symptoms

Causes of hamstring tendinopathy

Sudden increase in activity where the tendons recovery capacity is exceeded by the demand
Peri-menopausal women
Older age

Symptoms of hamstring tendinopathy

The most common symptoms of a proximal hamstring tendinopathy are:

Pain and tenderness deep in your buttock
Pain with sitting
Pain when bending forward or stretching your hamstrings

Diagnosis of hamstring tendinopathy

Imaging has no role in the diagnosis or management of a proximal hamstring tendinopathy. Diagnosis is done via a clinical examination of the tendon. Imaging is rarely needed unless another pathology is suspected.

Self management of hamstring tendinopathy

Weight loss

If you are overweight you are putting extra load through your knee. This will be contributing to your condition. Therefore, losing weight will improve your symptoms. There are useful tools to find out if your weight is contributing to your arthritis and advice on losing weight on the NHS website:

BMI calculator Weight loss plan Exercise advice

Stopping smoking

Smoking is a well recognised risk factor in the development of achilles tendinopathy, it is therefore important to try and stop.

Stop smoking

Footwear

Tight fitting footwear, especially around the heel, is a common cause of hamstring tendinopathy. If you feel this is the case you may want to try different footwear.

Activity management

Reduce your levels of activity to a point where you feel no pain. Maintain this level of activity and the tendon may settle in as little as 5–10 days. However, it may take several weeks to fully settle. For mild cases you may be able to continue some normal activities as long as you’re able to keep it relatively pain free.

Diabetes/raised cholesterol

If you suffer with these conditions it is important to ensure they are well controlled. Speak to your healthcare professional for advice on improving your control.

Exercises for hamstring tendinopathy

Exercise 1: standing knee bend

Stand with the use of a chair for balance if required
Bend your knee, bringing your heel as close to your bottom as you can manage, then return to the starting position
Do not bend at the hips
Try to stand as straight as you can

Exercise 2: bridge

Lie face up on the floor, with your knees bent and feet flat on the ground
Keep your arms at your side with your palms down
Lift your hips off the ground until your knees, hips and shoulders form a straight line
Squeeze your buttocks
Hold your bridged position for a couple of seconds before easing back down

Exercise 3: elastic band – hip extension

Stand with an exercise band attached to your ankle and the other end fixed to a firm point
Hold onto a chair or table
Draw your leg back behind you
Keep your knee straight the entire time

Exercise 4: single leg mini squat

Stand on your affected leg
Bend your knee slightly and the return to your starting position

Exercise 5: chair squat

Stand in front of chair of an appropriate height (a lower chair increases the difficulty and a higher chair is less difficult)
With your feet about shoulder width apart, sit with your hips back as if to sit into a chair whilst raising your arms front of you
Touch the chair with your bottom and then return to standing whilst lowering your arms

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.

Page updated 01/12/2020. Review date 01/01/2024

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