In this article, you will find out everything you need to know about hamstring tendinopathy and the most effective ways to treat it, including an advanced treatment called Prolotherapy.
Table of Contents
- Understanding Proximal Hamstring Tendinopathy
- The Role of Isometric Hamstring Load in Tendinopathy Recovery
- Progressing to Isotonic Hamstring Load with Careful Hip Movement
- Advanced Strengthening: Heavy Slow Resistance Training
- Enhancing Flexibility and Range of Motion
- Prolotherapy for Hamstring Tendinopathy Exercises
- Energy Storage Loading for Dynamic Movement Restoration
- Monitoring and Adapting: The Pain Monitoring Framework
- Returning to Sports and Activities
- Summary
- Frequently Asked Questions
- Contact ProHealth Clinic
- Author Bio
- References
Understanding Proximal Hamstring Tendinopathy
Proximal hamstring tendinopathy is characterized by persistent pain near the sit bone, often during or after running, squatting, or sitting. It involves the proximal hamstring tendon, which connects the semimembranosus, semitendinosus, and biceps femoris muscles to the ischial tuberosity. Risk factors include overuse, improper training, sudden increases in activity, and insufficient rest. Recovery is possible with a structured rehab program, typically over 3–6 months. Learn more about hamstring recovery timelines.
The Role of Isometric Hamstring Load in Tendinopathy Recovery
Isometric exercises are essential in early recovery. They stimulate the muscle-tendon unit and help reduce pain. Perform five sets of 30–45 seconds at about 70% of your maximum effort, keeping the hip neutral or in minimal flexion to avoid tendon compression. Repeat these holds several times daily.
Recommended Isometric Exercises
- Isometric bridges
- Wall sits
- Single-leg bridge holds
These exercises should cause only mild discomfort that resolves within a day. The goal is to load the tendon without aggravating pain.
Progressing to Isotonic Hamstring Load with Careful Hip Movement
As pain improves, add isotonic (concentric and eccentric) exercises. Start with low intensity and high reps, avoiding deep hip flexion early on. Examples include:
- Prone hamstring curls
- Single-leg deadlifts
- Single-leg bridges
- Hip extensions (prone)
- Nordic hamstring exercise (with assistance if needed)
Gradually increase intensity and range as tolerated, focusing on single-leg work to address imbalances.
Advanced Strengthening: Heavy Slow Resistance Training
Once pain-free with earlier exercises, progress to heavy slow resistance (HSR) training. This phase uses slow, high-resistance movements to build tendon and muscle strength. Start with 15 reps, progressing to 8 reps at higher loads, for 3–4 sets per session. Include:
- Single-leg bridges
- Prone hamstring curls
- Nordic hamstring curls
HSR training is highly effective for tendon rehabilitation and should be performed with slow, controlled movements.
Enhancing Flexibility and Range of Motion
Improving hamstring flexibility is vital for recovery and performance. Incorporate both dynamic and static stretches, such as:
- Lying towel hamstring stretch
- Seated hamstring stretch
- Standing hamstring stretch
Stretching reduces stiffness, restores range of motion, and helps prevent future injuries.
Prolotherapy for Hamstring Tendinopathy Exercises
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat Hamstring Tendinopathy Exercises.
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 Hamstring Tendinopathy Exercises.
As prolotherapy is helping to treat the root cause of Hamstring Tendinopathy Exercises, it is deemed to be a permanent fix, preventing the symptoms from returning.
Energy Storage Loading for Dynamic Movement Restoration
In the final rehab phase, add plyometric and energy storage exercises to restore dynamic movement:
- Vertical and horizontal jump progressions
- Loaded split squat jumps
- Sprinter leg curls
- Skipping and mountain climbers
These exercises help the hamstring tendon store and release energy, preparing you for return to sport.
Monitoring and Adapting: The Pain Monitoring Framework
Track your pain daily and adjust exercise load accordingly. If pain persists for more than 24 hours after activity, reduce intensity or frequency. Stable symptoms that resolve within a day indicate appropriate loading. Use a pain monitoring framework to guide safe progression.
Returning to Sports and Activities
Before returning to sport, ensure you can tolerate all rehab exercises and sport-specific drills with minimal symptoms. Gradually increase intensity and volume, focusing on strength, flexibility, and neuromuscular control. Objective measures like strength tests and pain-free walking are key criteria for safe return.
Summary
Hamstring tendinopathy recovery is a stepwise process involving isometric and isotonic exercises, flexibility work, advanced strength training, and plyometrics. Monitor pain, progress gradually, and consider advanced treatments like Prolotherapy for stubborn cases. With patience and a structured plan, most people can return to full activity.
Frequently Asked Questions
What is proximal hamstring tendinopathy?
It’s a condition causing pain near the sit bone, often during running, squatting, or sitting, due to tendon overload or degeneration.
What are isometric exercises, and why are they beneficial?
Isometric exercises involve contracting the muscle without movement (e.g., holding a bridge position). They help reduce pain and begin tendon loading safely in the early stages of hamstring tendinopathy rehab.
What are some critical isotonic exercises for hamstring strength?
Key isotonic exercises include prone hamstring curls, single-leg deadlifts, single-leg bridges, and Nordic hamstring curls. These exercises build strength through both muscle shortening and lengthening phases.
How can I use the pain monitoring framework to manage symptoms?
Track your pain before, during, and after exercise. If pain increases and lasts more than 24 hours, reduce exercise intensity or frequency. Stable or improving pain means you can safely progress your rehab.
What are the criteria for a safe return to sports after hamstring tendinopathy?
You should be able to perform all rehab and sport-specific drills with minimal or no pain, demonstrate adequate strength and flexibility, and walk pain-free before returning to full sports participation.
Contact ProHealth Clinic Today for Your FREE 15-Minute Discovery Call
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating Hamstring Tendinopathy Exercises, 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 Hamstring Tendinopathy Exercises 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.
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References
- Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med. 2009;43(6):409-416. https://bjsm.bmj.com/content/43/6/409
- 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. https://bjsm.bmj.com/content/50/10/597
- van der Made AD, Wieldraaijer T, Kerkhoffs GM, et al. The hamstring muscle complex. Knee Surg Sports Traumatol Arthrosc. 2015;23(7):2115-2122. https://link.springer.com/article/10.1007/s00167-014-3206-2
- Case Study: Prolotherapy for chronic hamstring tendinopathy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659574/
- ProHealth Clinic. Prolotherapy for hamstring tendinopathy. https://prohealthclinic.co.uk/pain-and-injury-clinic/