Overview

Hamstring tendinopathy is a load-related tendon problem in the hamstring tendons. It most often develops where the hamstring tendons attach at the sitting bone (ischial tuberosity), high in the back of the thigh — the pattern clinicians call proximal hamstring tendinopathy.

The same hamstring tendons continue down to the knee, and tendon pain can also be felt behind the knee or along the inner knee where the hamstring tendons meet the shin (the pes anserine area). Like other tendinopathies, this is a gradual load problem rather than a sudden tear.

Typical Pattern

Aching pain high in the back of the thigh at the buttock crease, or behind the knee
Pain that worsens with running, especially sprinting, hills or accelerations
Stiffness or soreness after sitting for a while, particularly on hard surfaces
Discomfort with hamstring stretching or loaded positions like lunges and hip hinge patterns
Symptoms that may ease briefly once warmed up, then return after activity

A sudden pop with bruising and weakness is a different problem — that pattern suggests a muscle tear rather than tendinopathy.

Why It Develops

The usual story is tendon overload without enough recovery: a jump in running volume or speed, more hill work, a return to sport after a break, or long hours of sitting that compress the tendon. It tends to build gradually rather than appear from nowhere.

Proximal hamstring tendinopathy is seen most often in runners and other athletes, but people who are less active can develop it too, particularly with prolonged sitting on hard surfaces.

How It Is Diagnosed

A clinician diagnoses it mainly through history and examination: tenderness at the ischial tuberosity, pain with resisted hamstring testing and reproduction with stretch or loading positions. Imaging is not routine but may be used when the picture is unclear or another cause is suspected.

Because pain in the high hamstring area can also come from the lower back (referred pain or sciatica), the hip joint or the hamstring muscle itself, sorting out which tissue is responsible matters.

Treatment

The core of care is education and progressive loading:

Adjusting aggravating loads — sprint volume, deep stretching positions and prolonged sitting on hard surfaces — rather than stopping all activity
Progressive strengthening of the hamstrings, with an emphasis on loading the tendon at increased length, which current reviews support
Lumbopelvic stability work to support the area
Using symptoms as feedback: discomfort that settles quickly after activity is often acceptable; sharp pain or symptoms that build from week to week mean the dose is too high
A graded return to running and sport once the tendon tolerates loading

Some guidelines and reviews mention shockwave therapy as a possible add-on for stubborn cases. Injections may give short-term relief in some situations but are not a substitute for a loading program.

When to Get Assessed

Arrange an assessment if pain is persistent, worsening or limiting running, sitting or daily activity. Seek prompt care after a sudden pop with weakness or bruising, if you cannot walk normally, or if pain radiates down the leg with numbness, tingling or loss of strength.

References

Goom TSH, Malliaras P, Reiman MP, Purdam CR. "Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management." Journal of Orthopaedic & Sports Physical Therapy. 2016;46(6):483-493. https://www.jospt.org/doi/10.2519/jospt.2016.5986
Dizon P, Jeanfavre M, Leff G, Norton R. "Comparison of Conservative Interventions for Proximal Hamstring Tendinopathy: A Systematic Review and Recommendations for Rehabilitation." Sports (Basel). 2023;11(3):53. https://www.mdpi.com/2075-4663/11/3/53

This information is for education only and is not a medical diagnosis. InjuryAtlas does not replace an assessment by a qualified health professional. If you have severe pain, visible deformity, numbness, loss of function, or symptoms that are getting worse, seek medical care promptly.

Hamstring Tendinopathy