In this article, you will find out everything you need to know about high hamstring tendinopathy and the most effective ways to treat it, including an advanced treatment called Prolotherapy.

Effective Strategies for Managing High Hamstring Tendinopathy

Key Takeaways

• High Hamstring Tendinopathy (PHT) is caused by repetitive stress, leading to tendon inflammation and injury.
• Diagnosis involves clinical assessment, physical tests, and often MRI imaging.
• Conservative treatments include load management, rehab exercises, manual therapies, and innovative non-surgical interventions like ESWT and PRP injections.

Understanding High Hamstring Tendinopathy (PHT)

High hamstring tendinopathy results from repetitive strain on the hamstring tendon at its attachment to the ischial tuberosity (sit bone). This leads to inflammation, pain, and sometimes chronic dysfunction if not managed early and effectively.^[1]

The Anatomy Involved

The hamstring group (biceps femoris, semitendinosus, semimembranosus) is essential for hip extension and knee flexion. These muscles originate at the ischial tuberosity, making them vulnerable to overuse injuries and tendinopathy. The proximal hamstring tendons anchor these muscles and are prone to inflammation with repeated stress.

Identifying the Pain

Symptoms of high hamstring tendinopathy develop gradually and include deep buttock pain, posterior thigh discomfort, and pain during hip flexion or prolonged sitting. The pain often worsens with stretching, exercise, or sitting, and may radiate down the leg if the sciatic nerve is irritated.^[2]

Causes and Risk Factors

• Repetitive tension from running, sprinting, or sudden increases in training intensity
• Insufficient rest and recovery
• Previous injuries, muscle weakness, excess weight, and aging
• Poor posture and prolonged sitting

Training errors, overuse, and sedentary habits all increase the risk of developing PHT.

Diagnosis of Proximal Hamstring Tendinopathy

Diagnosis starts with a clinical evaluation, including history and physical tests (e.g., Puranen-Orava, bent-knee stretch). MRI is often used to confirm tendon thickening, tears, or inflammation at the ischial tuberosity.^[3]

Conservative Treatment Approaches

• Avoid activities that worsen symptoms for more than 24 hours
• Begin with isometric exercises, progressing to isotonic and eccentric loading as pain allows
• Manual therapies: soft tissue mobilization, joint manipulation, and proprioceptive exercises
• Adjuncts: NSAIDs, corticosteroid injections, electrical stimulation, and ultrasound
• Innovative options: Extracorporeal Shock Wave Therapy (ESWT) and Platelet-Rich Plasma (PRP) injections

Prolotherapy for High Hamstring Tendinopathy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat high hamstring tendinopathy.^[4][5]

Published research has proven its pain-relieving, anti-inflammatory, and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with high hamstring tendinopathy.

As prolotherapy is helping to treat the root cause of high hamstring tendinopathy, it is deemed to be a permanent fix, preventing the symptoms from returning.

Rehabilitation and Return to Activity

• Start with isometric and pain-free isotonic exercises
• Gradually progress to higher hip flexion and eccentric strengthening (e.g., Nordic curls)
• Reintroduce running and sport-specific activities cautiously
• Strengthen the entire kinetic chain: glutes, adductors, calves, quadriceps, and core

A phased approach, with careful load management and progressive strengthening, is key to successful recovery and return to sport.^[6]

Preventing Recurrence

• Maintain flexibility and strength in the hamstrings and surrounding muscles
• Incorporate eccentric and lengthened position exercises
• Enhance lumbopelvic control and core stability
• Monitor training loads and avoid sudden increases in intensity

When Is Surgery Necessary?

Surgery is reserved for severe cases (e.g., tendon rupture or avulsion) that do not respond to conservative and non-surgical treatments. Surgical options may include tendon debridement or reattachment, followed by a structured rehabilitation program.^[7]

Frequently Asked Questions

What is High Hamstring Tendinopathy (PHT)?

High Hamstring Tendinopathy is inflammation and pain at the upper hamstring tendon, where it attaches to the ischial tuberosity, often due to repetitive stress or overuse.

What are the symptoms of PHT?

Deep buttock pain, posterior thigh discomfort, pain with hip flexion, and increased pain during sitting or activity.

What are the leading causes of PHT?

Repetitive strain from running, sprinting, or sudden increases in activity, as well as prolonged sitting and poor posture.

How is PHT diagnosed?

Through clinical evaluation, physical tests, and often MRI to confirm tendon changes and rule out other causes.

What are the treatment options for PHT?

Load management, rehabilitation exercises, manual therapies, ESWT, PRP injections, and in some cases, Prolotherapy or surgery.

Case Study: Prolotherapy for High Hamstring Tendinopathy

Case: A 38-year-old runner with chronic high hamstring tendinopathy unresponsive to physiotherapy and ESWT underwent three sessions of Prolotherapy at ProHealth Clinic. The patient reported a 75% reduction in pain and returned to running within two months, highlighting the potential of regenerative treatments for persistent PHT.

Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call

Don’t let high hamstring tendinopathy control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.

Get in Touch
Phone: +44 1234 380345
Email: info@prohealthclinic.co.uk

Our Clinic Locations
London: 104 Harley Street, Marylebone, W1G 7JD
Manchester: The Hadley Clinic, 64 Bridge Street, M3 3BN
Bedford: The Village Medical Centre, Kingswood Way, MK40 4GH

All clinics offer the same award-winning prolotherapy treatment with convenient appointment times, including evenings and weekends.

Author Bio

Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating high hamstring tendinopathy, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with high hamstring tendinopathy and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
LinkedIn profile: Oliver Eaton

References

1. Lempainen L, Sarimo J, Mattila K, Heikkilä J, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med. 2009;37(4):727-734.
2. Goom TS, Malliaras P, Reiman MP, Purdam CR. Proximal hamstring tendinopathy: clinical aspects of assessment and management. Br J Sports Med. 2016;50(10):597-605.
3. Connell DA, Schneider-Kolsky ME, Hoving JL, et al. Long-term prognostic value of clinical and MR imaging findings after hamstring injury. Radiology. 2004;232(3):712-718.
4. Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Prim Care. 2010;37(1):65-80.
5. Hauser RA, et al. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159.
6. Askling CM, Tengvar M, Saartok T, Thorstensson A. Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings. Am J Sports Med. 2007;35(2):197-206.
7. Wood DG, Packham I, Trikha SP, Linklater J. Avulsion injuries of the hamstring origin: surgical technique. Oper Tech Sports Med. 2012;20(2):138-144.