Hamstring Tendinopathy: Causes, Treatment and When to Get Assessed
- Emma Glynn
- 7 days ago
- 5 min read
Author: Emma | Senior Physiotherapist, The Hip & Knee Physio (Camberwell, Melbourne)
Estimated reading time: 6–8 mins
What is hamstring tendinopathy?
Hamstring tendinopathy is a common cause of persistent pain where your hamstring attaches onto your pelvis, especially near your sitting bone. It’s often called proximal hamstring tendinopathy (1).
Unlike a sudden tear or strain, tendinopathy tends to build slowly over time. It’s common in runners, field athletes, and also in gym-goers or active adults 40+ who do squats, deadlifts or lunges, often with poor load progression or technique issues (1).
This blog focuses on the typical pain patterns, rehabilitation, and when it’s worth seeking a proper assessment. It is general information only and does not replace personalised advice from a healthcare professional (2).
Typical symptom pattern
Deep buttock pain, especially on one side
Worse with sitting, sprinting, lunges or hills
Tender to press on the sitting bone (ischial tuberosity)
Sometimes feels like a “pull” or “grip” under load
Pain can hang around for months, especially if you’ve tried rest or stretching but haven’t followed a clear strengthening plan (3).
Common causes and contributing factors
1. Too much, too soon
This condition often builds from a sudden spike in running volume, adding in hills, or aggressive hamstring exercises without adequate progression (2).
2. Compression during loaded stretch
Movements that combine hip flexion and hamstring activation, like Romanian deadlifts or yoga-style stretches, can irritate a sensitised tendon (3).
3. Sitting loads
The tendon sits under your body weight when you’re sitting. Prolonged sitting or hard surfaces can contribute to irritation (3).
4. Poor glute strength or motor control
If your glutes aren’t firing well, your hamstring may try to compensate, particularly in hip extension tasks like running, stairs or lifting (3).
What to avoid
❌ Rest completely for weeks
This often leads to deconditioning and makes the tendon even more sensitive when you return to activity (4).
❌ Keep stretching the area
Stretching often makes it worse, especially “pulling” or folding stretches. Tendons respond better to progressive loading than to stretching (4).
❌ Ignore pain that’s interfering with function
A bit of tightness is normal, but persistent sitting pain, pain when driving or constant niggles during running warrant a proper rehab plan (4).
What rehab focuses on
✅ Strengthen the tendon - slowly and progressively
Early rehab often starts with isometric holds, then progresses to slow heavy loading, and eventually includes sport-specific drills (5).
Example exercise progression:
Supine hamstring bridge holds (bent knee)
Nordic regressions / slider curls
Romanian deadlifts with tempo
Step-ups, split squats, sprinter bridges (5)
✅ Modify aggravating positions
Use cushions when sitting
Limit hinge-heavy gym work until settled
Avoid “stretchy” exercises until symptoms are under control (5)
✅ Train the rest of the kinetic chain
Glute max, glute med, core and calf strength all matter
Movement retraining (e.g., landing mechanics, running technique) helps offload the tendon during sport (6).
How long does it take to improve?
It depends on:
How irritable the tendon is
How long symptoms have been present
The quality and consistency of rehab
Tendinopathies are slow - 3 to 6 months is not unusual for return to full sport, but many people notice improvements in 4–6 weeks with good management (6,7).
When to get assessed
Book an assessment if:
Pain interferes with sitting, sleep or training
You’ve tried to rest but symptoms keep flaring
You’re unsure how to modify load or train around it
You’ve had this issue more than 6–8 weeks with no progress
An experienced physiotherapist can help rule out other conditions (e.g., sciatic nerve entrapment, lumbar referral, gluteal tendinopathy), and guide your rehab based on strength, control, and tendon capacity testing .
FAQs
Q: Is hamstring tendinopathy the same as a hamstring tear?
A: No, tendinopathy refers to longer-term tendon overload, not a sudden strain or tear. The rehab approach is different.
Q: Should I get a scan?
A: Imaging (like MRI) may help if symptoms are severe or not improving with rehab, but most cases don’t need a scan early on .
Q: Can I keep running?
A: In many cases, yes, with load management. Pain should be tolerable (<4/10), not increase over time, and settle within 24 hours.
Q: How long does it take to go away?
A: Most people improve with 6–12 weeks of consistent rehab. Full resolution may take longer for athletes or more severe cases .
Q: Is surgery ever needed?
A: Rarely. Surgery is reserved for severe cases not responding to prolonged conservative care.
What next?
If you’re struggling with deep gluteal or hamstring pain that’s limiting your training or lifestyle, book a consult with The Hip & Knee Physio in Camberwell. We’ll assess your tendon capacity, movement mechanics, and develop a structured plan to rebuild strength and tolerance safely.
You can:
Call the clinic to discuss your symptoms
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References
Cook JL, Rio E, Purdam CR. Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research? Br J Sports Med. 2016;50(19):1187-1191.
Goom TS, Malliaras P, Reiman MP, Purdam C. Proximal hamstring tendinopathy: clinical aspects of assessment and management. J Orthop Sports Phys Ther. 2016;46(6):483–493.
Tom Goom. Managing Hamstring Tendinopathy. [Clinical Edge Podcast].
Lempainen L, Sarimo J, Mattila K, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med. 2009;37(4):727–734.
Rio E, Kidgell D, Purdam C, et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277–1283.
Malliaras P, Barton CJ, Reeves ND, Langberg H. Achilles and patellar tendinopathy loading programmes: a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness. Sports Med. 2013;43(4):267–286.
van der Made AD, Wieldraaijer T, Reurink G, et al. Proximal hamstring tendinopathy: a review of diagnostic, conservative and surgical treatment and return to play. J Sports Med Phys Fitness. 2015;55(6):560–571.
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