Proximal Hamstring tendonopothy/tendonosis

Has anyone had any experience in treating a proximal hamstring tendonopothy. I would be interested in some treatment options. I have it at both hamstrings and very restrictive when trying to sprint. Am trying acupuncture at the moment. Any advice is appreciated. cheers

This is a post from last year. Hope it helps.

First, I want to let you know that this will be a slow process. Tendinopathy is different that a strain. Tendons do not have a good blood supply and I think that it is crucial to get blood in the area to promote healing. It is also imperative that you keep moving BUT you have to make sure that everything you do does not stress that area of your hamstring. I also tried to rush the rehab process a few times but to no avail. Plan to take it slow and it will get better and you will be able to run faster later. Just be patient. The process took me 2-3 months before I started back with running and acceleration work. I kept those early runs submax too.

Here is the general plan:
-Perform isometric for hamstrings daily aiming for 2-5min of total hold time
-Perform standing HSC for higher reps if no pain 3-4x/wk
-Perform massage and graston on the area, later on move on to deeper tissue work
-Perform core work to make sure those muscles are able to control pelvis
-Begin with glute bridges if no pain is reproduced progressing to hamstring bridges (i.e. reverse plank) and eventually single leg hamstring bridge/reverse plank
-Perform negative GHR progressing to negative accentuated and controlled concentric to explosive

A few key points in relation to the above:
-Do not do anything if it creates pain. In this case, pain will only set you back. Progress slowly.
-Hamstring curls are probably better performed standing so you do not stretch proximal hamstring. Also higher reps should be done to increase blood flow. This way we can get more blood to the area without working it directly.
-Isometrics seem to help tendons to heal
-Begin with gentle massage as that area does not typically respond well to aggressive soft tissue work initially. Graston did seem to help more than just using hands in this case. Later on I really liked rolling that area with one of the massage balls with the spikes on it. That helped loosen everything up in the latter stages.
-Proper exercise execution is key for GHR. You must make sure that you do not break at your hips. This will require activation of your core and you are working on some hip extension that will help get that proximal hamstring to work. This can be progressed from double leg to single leg as well.
-Once you are able to do the single leg hamstring bridge/reverse plank equally with both legs, you will be ready to start running again.

Those are the things that helped me get back to the track. I am sure other things could be added/substituted but this worked well for me and the equipment I had available. Let me know if you have any questions. I can also share more science behind the thought process if people are interested.

Thanks man for that. Not quite what I wanted to hear- 2-3 months. We are right in the middle of our season now. Not sure which way to go. Once again, appreciate the extended response.

Hi grooster,

I started the thread last year as I was the one suffering from this annoying setback. I first noticed the aching pain in my butt in January of 2015, and it was only this fall that it finally seemed to be gone for good. The last year and a half has been more of a lesson in what not to do than what to do to recover from proximal hamstring tendinopathy. I’ll share what I learned through trial-and-error. In the end it, the true answer might just be “it takes time,” so my advice might end up being along the lines of how not to make matters worse.

Quick background on my story. I hit all PRs in 2014 (7.06 and 22.42 indoor; 10.81 and 21.69 outdoor). I became a dad in the fall of 2014 and tried training at the same intensity as the year before. High Load + Lack of Sleep --> over-training. Everything blew up on me in the second indoor meet of the 2015 season. I still felt pain throughout the 2016 season with horrible times of 7.34 and 23.74 indoors followed by 11.29 and 22.86 outdoors. I called it a season early to focus on recovery. I ran a 7.16 a couple weeks ago in a preseason meet and am finally racing pain-free. It’s been a long process, but I’m back within 1% of my best training times.

I learned to cut out anything that created irritation to the area. The more I did something that elicited pain, the more the disability was reinforced in my motor patterns. I almost got to the point of feeling pain just thinking about contracting my posterior chain Even when pain wasn’t present, this resulted in some sort of neural inhibition. It was as if I had an internal governor stopping me from going beyond a certain speed. I eventually realized that I needed to teach my body and brain that it’s ok to sprint again. To do so, a long progression of positive training experiences was necessary.

What I Cut Out (most are contracting while hip is in flexion–especially when in a fatigued state)
[li] Running A’s[/li][li] Rowing[/li][li] Tempo Running[/li][li] Skips for Distance[/li][li] Skips for Height[/li][li] Hip Extension Machine[/li][li] Hill Sprints[/li][li] Falling Starts[/li][li] Specific Rehabbing of Injured Area[/li][/ul]

Contrary to a lot of the advice I received, I ended up abandoning a focused rehab protocol. I found that working the injured area specifically just created more irritation and led to disability reinforcement. Rather, I eventually settled on a general approach of getting stronger on the whole at manageable intensities. For the first time in many years, I actually ran intensive tempo to increase the body’s and brain’s exposure to progressively increasing intensities. I did this throughout the summer of 2016. Once the intensity got high enough, I transitioned back into a true speed / ext tempo split. But it took a while.

My key takeaways were as follows:
[li]Treat the leg and body as a single unit. Don’t spend too much time focusing on the actual injured area.[/li][li]The brain matters! You have to avoid sending negative feedback to it when training. The more you run injured and with worry, the deeper the hole you’ll dig for yourself.[/li][li]The best rehab takes place in the environment of the end goal. I’ve never found a connection between some hamstring-specific strength exercise and sprint readiness. Do what you can on the track and lift in a general manner.[/li][li]There may be something to training the healthy leg. The crossover effect appears to be a real thing. If you’re set on specificity, start there to create a positive feedback loop with the brain (“contracting these muscles is ok”).[/li][/ul]

Some of my advice may contradict that of others. I, in no way, believe my words are the gospel. They’re simply one set of empirical data.

Thanks heaps for that Actuary 400. It is a really detailed explanation that I will take on board. At the moment I am getting relief with dry needling and eliminating exercises that cause pain as you suggested. As we are in the middle of our season I am not yet ready to give up on it. This maybe foolish but I am making progress and hopefully will be able to race in the back end of the season. At the completion of the comps then I can see if resting from running eases it. cheers

I’ve also been dealing with proximal hamstring tendinopathy over the past year. I would have recovered faster if I didn’t fucking stretch it, massage it and foam roll it. It started to feel better when I stopped doing these things and when I started doing isometric single leg bridges, both with the knee extended (lie on back with leg straight and heel on a bench. Contract the hamstrings & glutes to bring your body all the way up, then hold position for 30 seconds. Repeat 3 times. Progress gradually to holding for up to 1 min or longer). You can then to 2-3 sets of 10-20 reps (concentric and isometric) with the leg in the same position.
If you’re too sore to do single leg bridges, do them with both legs for a while. Also do bridges with the knee flexed at 90 degrees for reps of up to 20. As you progress, you can hold a 50lb weight plate on your hip flexor area.
Do these exercises every second day. You will get a bit of pain initially, but that will lessen over time. You can do other exercise like squats, step ups, Bulgarian split squats and single leg leg press with foot low on platform. It’s best to avoid deadlifts from the floor until you have no pain. Don’t do exercises like stiff leg deadlifts or RDL’s either as they put the hamstring on a stretch. Avoid all exercises that provoke pain, except for the bridges, which should cause just a little pain. That’s ok though, after several weeks the pain will become a lot less. If you’re running you should really be careful that you don’t run too fast. You can do slow tempo, but you must concentrate on short rear side mechanics. If your rear side mechanics are too long, it will exacerbate your pain. That’s why things like bounding and hill running should be avoided until you have no pain. As soon as your foot lands, bring it straight up to the butt then take another stride.


All of the bold lines are consistent with my experience. Creating tension when the hamstring was stretched definitely caused the most problems for me. I learned that further irritating an irritated area via massage is about the dumbest thing you can do. Don’t touch the area; there’s likely little you can actually do anyway. Based on my experiences, I truly believe there was little actual mechanical damage. Rather, the area and movements were hyper-sensitive (if that’s even a word). If you using massage, work around the area. Create sensations on other parts of the leg/chain. Don’t create more pain. The more you think about it, the worse it seems. Create a positive training environment and progressively increase intensity. But, note that this progression takes a lot longer than a typical hamstring strain.

Good points. I think the same can be applied to other tendon injuries. I had a chronic adductor tendon injury, which only went away when I stopped stretching it. There is always a temptation to stretch because these things always feel tight and in need of stretching and massage. You just have to resist that temptation. Massaging directly over the area is a mistake, but a lot of physiotherapists/physical therapists and massage therapists tell patients that’s what they need to do. Don’t watch Kelly Starrett’s videos or videos on active isolated stretching. Any kind of stretching will make it a whole lot worse.
You can massage the belly of the muscle, but never over the tendon as that will just cause further irritation.
Excellent point about trying not to think about it too. Don’t touch it and don’t think about it. Mine went away when I went on vacation for a couple of weeks and had other distractions. I still continued to do the bridges, but didn’t massage it, stretch it or even touch it.

Here are some good podcasts on proximal hamstring tendinopathy. Both of these experts confirm that stretching is the worst thing you can do for this injury, yet there are dickheads like Kelly Starrett who has a very large online following saying stretching is the best thing for it. Absolute bullshit!

I haven’t seen much research on proximal hamstring tendinopathy, but in general terms a huge amount of research shows that chronically injured (i.e. degenerated/disorganised) tendons need to be placed under tension to heal. This can be done through eccentric loading or stretching. There is a lot of research on this with regards to achilles and patellar tendinopathy as well as tennis elbow, and in my experience it also applies to adductor tendinopathy, which I’ve had a few times and which did not go away with rest but only with adductor strengthening exercises. However, this type of work has to be done in a pain free or minimal discomfort zone and then progressed gradually and slowly as the tendon becomes stronger. If the exercise elicits too much pain the muscles attached to the injured tendon may go into protective spasm which will make matters worse. Maybe the hamstrings are more likely to overreact to pain compared to other muscle groups and one thus has to be extra careful in this case.

Thanks everyone for the detailed responses, I am at the stage of having a break from running for a couple of weeks and rehabbing the site. Beginning with the bridges and progressing as required, This is my last attempt at trying to salvage something for the season. If this doesn’t work then will have as long a break from running as required . Cheers for all the advice , really helpful.

I’ve had adductor tendinopathy too. Like proximal hamstring tendinopathy, it only began to feel better when I stopped stretching it and stopped doing side lunges and began doing adductor bridges (side lying with top leg on bench) held for progressively longer periods. It can be tricky to find the optimal exercise frequency and optimal number of sets per session. If you do the exercises too often, as physios often recommend, it can set you right back further. If you do everything right, proximal hamstring tendinopathy takes 3-6 months to recover from, but more often 6-12 months and it can easily come back down the track if you make the same errors you did before developing the condition. Proximal hamstring tendinopathy is the slowest of all tendinopathies to heal.

Mine took around 18 months until I truly felt like myself again (perhaps due to doing the wrong stuff so frequently during the first few months). But as you noted, I can definitely tell that certain exercises will bring issue right back. I’ve tried reintroducing a few elements and noticed a heightened sensitivity in the following days. Those were immediately eliminated from future consideration.

Which exercises cause the most problem for you? For me, it’s heavy deadlifts from the floor, stiff leg deadlifts, RDL’s, reverse leg press and heavy sled pushing. Heavy sled pushing is actually what brought it on in the first place. After 1 year I haven’t been able to go back to it.

Consider a filter such as this:
[li]essential- what, absolutely, must be done
[/li][li]possible- everything that can effectively be done
[/li][li]useful- all that is possible reduced to what passes cost:benefit relative to your particulars and supports the essentials

Would you care to offer some suggestions?

As has been elucidated thus far by you and others, there are a defined set of particulars specific to each athlete (what one tolerates well the other does not and vice versa). Therefore, the only applicable rules for all are what is already known about sprinting and transfer from the standpoint of biodynamics.

The three broad kinematic categories of the 60m or 100m, for example, are the positions of the start, acceleration, and upright max V (with as many subdivisions of the acceleration position as you like) and associated kinetics.

Therefore we have the dynamics (kinematic/kinetic) of the start, acceleration, and upright sprinting that provide the reference points from which preparatory derivatives may be drawn and, starting from the top, we have our essentials.

Each of you may then consider where you stand relative to the essentials and their derivatives and utilize those sets of information to base your decisions.