Proximal Hamstring Tendinopathy

There are three muscles that form the hamstrings which are situated on the posterior thigh. These are the semimembranosus, semitendinosus and bicep femoris are response for generating knee flexion and hip extension based movements.

These muscles originate from the ischial tuberosities (the bony prominence that you sit on) and attach below the knee joint line on the medial tibia and the head of fibula. 

With any type of tendon pain there is usually a multitude of factors which contributed to the development of pain however typically the tendon becomes symptomatic due to a rapid increase in activity which subsequently increases the load through the tendon. 

People who experiencing PHT typically report:

• Pain localised to the ischial tuberosity / gluteal fold

• Initial stiffness after prolonged inactivity, with symptoms that appear to settle somewhat with activity but can become more sore afterwards.

• Activities such as squats or lunges, going upstairs or uphill makes symptoms worse.

• When severe it would be difficult to sit for any period of time

• Pain increases with repetitive activity, particularly those that require hip flexion

• Gradual onset of symptoms

• Continued exercise causes more pain, particularly stretching.

• Due to the proximity of the sciatic nerve to the hamstring origin as it passes through the pelvis, irritation to the proximal hamstring tendons can also lead to irritation of the sciatic nerve, leading to symptoms that extend into the rest of the posterior thigh and lower limb.

Following a thorough history of your symptoms and functional limitations, it’s important that a thorough objective assessment is performed as other conditions could present with similar symptoms. Your aggravating symptoms and range of movement of the hip will be examined to see if your symptoms can be illicted and to rule out other conditions such as:

• Referred pain from the lower back, particularly if buttock symptoms correspond with the onset of back pain

• Pain within the buttock itself (more higher up) could be indicative of deep gluteal syndrome

• Sciatic nerve irritation

• Avulsion injury amongst adolescents

• Ischiofemoral impingement

How Can Physiotherapy Help?

Once an accurate diagnosis has been performed, physiotherapy can help with:

• Advice and Education
• Activity modification
• Soft Tissue Massage
• Assessment of the rest of the kinetic chain
• Graded exercise programme