Proximal Hamstring Tendinopathy: Symptoms, Causes, Treatment, Exercises

Key Takeaways

• Proximal Hamstring Tendinopathy (PHT) presents as deep pain near the buttocks that worsens during activities like running, jumping, or prolonged sitting.

• PHT commonly affects athletes in sports requiring explosive movements or sudden direction changes, but can also develop from non-sport causes like prolonged sitting.

• Treatment approaches include rest, targeted exercises, taking anti-inflammatory medications, and physiotherapy techniques focused on eccentric strengthening.

• Prevention strategies involve proper warm-ups, addressing muscle imbalances, and consistent flexibility training to maintain hamstring health.

• MSK Doctors offers specialised care for PHT with direct access to orthopaedic consultants, advanced diagnostic tools including musculoskeletal MAI Motion AI, and personalised treatment plans. 

Introduction to Proximal Hamstring Tendinopathy

Peak athletic performance is often met by injuries that are inevitable. One such injury that often plagues athletes, particularly those involved in running and sports that require sudden changes in direction, is Proximal Hamstring Tendinopathy (PHT). 

This condition is also known as high hamstring tendinopathy or hamstring origin tendinopathy. It is characterised by pain and dysfunction at the site where the hamstring muscles attach to the pelvis (image courtesy of PHT Organisation). 

For athletes, PHT can severely impact performance, limiting the ability to train and compete effectively. More so, if left untreated, PHT can lead to chronic pain and a prolonged recovery period - making early recognition and intervention critical. 

Recognising Symptoms

Pain Patterns

The most common symptom of PHT is a deep, aching pain located near the buttocks, where the hamstring attaches to the pelvis. This pain often intensifies during activities that place stress on the hamstring tendons, such as running or sitting for extended periods. 

In some cases, the pain may radiate down the back of the thigh, adding to the discomfort.

Activity-Triggered Discomfort

Another common sympton of PHT is discomfort triggered by specific activities. Movements that involve hip flexion, such as sitting or squatting, can exacerbate the pain. Similarly, activities requiring explosive power, like sprinting or jumping, may also trigger discomfort.

Identifying Severity Levels

Generally, the condition can be categorised into three levels:

Root Causes

Common Triggers in Athletes

Athletes often face unique challenges that can contribute to the development of PHT. One of the most common triggers is repetitive strain from high-intensity activities such as running, sprinting, or jumping. These activities place significant stress on the hamstring tendons - often when performed without adequate rest or recovery time.

Sports that involve sudden changes in direction, such as soccer or basketball, can also increase the risk of PHT - the abrupt movements required in these sports can lead to excessive strain on the hamstrings.  

Non-Sport-Related Causes

PHT isn't exclusive to athletes and can affect anyone whose lifestyle or occupation involves significant hamstring strain.

Prolonged sitting, for example, is a common non-sport-related cause. This position places the hamstrings in a stretched position for extended periods, leading to increased tension and potential injury over time.

More so, activities such as heavy lifting without proper technique or engaging in repetitive movements in daily life can also contribute to the development of PHT. 

Physical and Mechanical Factors

Poor biomechanics, such as incorrect running or movement patterns, can lead to imbalances and increased stress on the hamstring tendons.

Muscle imbalances, where certain muscle groups are stronger or more developed than others, can also contribute to PHT. For instance, weak gluteal muscles can force the hamstrings to overcompensate, leading to strain and injury. 

Effective Treatment Options

Rest is often the first step in treatment so that the affected tendons can heal and recover from the strain. However, rest alone is rarely sufficient, and medical interventions and physical therapy play a crucial role in recovery. 

Medical Interventions

For more severe cases of PHT, medical interventions may be necessary. These interventions can include anti-inflammatory medications like ibuprofen reduce pain and swelling - or corticosteroid injections for more immediate relief.

In some instances, more advanced treatments such as platelet-rich plasma (PRP) therapy may be considered. PRP involves injecting a concentration of the patient's own platelets into the affected area, promoting healing and reducing inflammation.

Physiotherapy Techniques

Manual therapy techniques, including soft tissue mobilisation and nerve gliding, can effectively complement exercise interventions by addressing associated muscle tension and neural sensitivity. 

A comprehensive rehabilitation approach typically incorporates motor control training and functional movement patterns specific to the patient's activities or sport, ensuring proper biomechanics during hip extension movements to reduce tendon stress.

Beneficial Exercises

Strengthening Exercises

Strengthening exercises can enhance the resilience of the hamstrings and supporting structures. Eccentric exercises, in particular, have been shown to be highly effective in promoting tendon health and recovery.

Exercises such as Nordic hamstring curls, where you slowly lower your body while maintaining tension in the hamstrings, can significantly improve strength and function (image courtesy of Youtube). 

Flexibility and Mobility Drills

Improving flexibility and mobility is key to managing PHT and preventing future injuries. You can include specific drills into your routine to enhance your range of motion and reduce tension in the hamstrings.

Active stretching exercises, such as leg swings and walking lunges, are excellent for warming up the muscles and increasing flexibility. 

Safe Practice Tips

When performing flexibility and mobility drills, prioritise safety to avoid further injury. Always begin with a proper warm-up to increase blood flow and prepare the muscles for stretching.

Listen to your body and avoid pushing through pain during exercises. Instead, focus on gradual improvements in flexibility and mobility over time. Consistency yields results, and with regular practice - you'll notice increased ease of movement and reduced discomfort.

Prevention Strategies

Warm-Up Importance

A targeted warm-up routine increases blood flow to the hamstring tendons, preparing them for the increased loads and reducing strain at the proximal attachment. 

Gradually increasing activity intensity during warm-up allows the body to transition safely from rest to exercise, potentially reducing the risk of aggravating or developing PHT.

Long-Term Health Practices

Regularly engage in a balanced exercise routine that includes strength training, flexibility exercises, and cardiovascular activities.

Pay attention to your body's signals and avoid overtraining, allowing adequate time for rest and recovery. 

Your Path to Hamstring Recovery

At MSK Doctors, we understand how PHT can sideline your active lifestyle and cause persistent discomfort. Our specialised approach to PHT combines comprehensive diagnostics with personalised treatment plans that address the root causes of your condition, not just the symptoms. 

Our orthopaedic consultants are experts in sports injuries and can implement a progressive rehabilitation program suited to your specific needs and activity goals. 

Experience the MSK Doctors difference with direct specialist access, evidence-based treatments. 

Book your consultation with MSK Doctors today for a personalised approach that will benefit your PHT rehabilitation journey - we got you! 

Frequently Asked Questions (FAQ)

How do I know if I have Proximal Hamstring Tendinopathy (PHT)?

PHT typically causes deep pain at the sitting bone that worsens with running, jumping, or sitting. The pain may radiate down the back of the thigh and intensify during activities requiring hamstring engagement.

How long does it take to recover from PHT?

Recovery time varies based on severity, typically ranging from 6-12 weeks with proper treatment. Severe or chronic cases may require 3-6 months of consistent rehabilitation.

Can I continue to exercise with PHT?

Yes, but modify activities to avoid movements that trigger pain. Low-impact exercises and specific rehabilitation protocols can maintain fitness while allowing healing.

What makes PHT different from a hamstring strain?

PHT is a chronic overuse condition affecting the tendon where it attaches to the pelvis. A hamstring strain is an acute injury to the muscle belly itself, often occurring suddenly during activity.

Why should I choose MSK Doctors for PHT treatment?

MSK Doctors offers direct specialist access without GP referrals, advanced diagnostic technology including MAI-Motion AI, and comprehensive treatment options ranging from conservative approaches to cutting-edge regenerative therapies.