{"id":15074,"date":"2023-02-27T11:27:40","date_gmt":"2023-02-27T10:27:40","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=condition&p=15074"},"modified":"2026-08-13T13:21:23","modified_gmt":"2026-08-13T11:21:23","slug":"proximal-hamstring-tendinopathy","status":"publish","type":"condition","link":"https:\/\/www.physiotutors.com\/conditions\/proximal-hamstring-tendinopathy\/","title":{"rendered":"Proximal Hamstring Tendinopathy"},"featured_media":15075,"template":"","tracking_tag":[2196,2313,2201],"class_list":["post-15074","condition","type-condition","status-publish","has-post-thumbnail","hentry","tracking_tag-hip","tracking_tag-lower-extremity","tracking_tag-muscle-tendon"],"acf":{"sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":15075,"background_image_alt_text":"Proximal Hamstring Tendinopathy"},"heading":"Proximal Hamstring Tendinopathy | Diagnosis & Physio Treatment","subheading":"Hip","content_editor":"","button_type":"url","button_label":"","button_style":"button-five","button_internal_link":4646,"button_anchor":"","button_url":"https:\/\/study.physiotutors.com\/course\/the-big-3-advanced-rehabilitation-of-hamstring-quadriceps-and-calf-muscle-and-tendon-injuries\/","button_file":"","label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Introduction & Epidemiology","button_internal_link":null,"button_anchor":"section-number-3","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Clinical Picture & Examination","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Treatment","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null},{"button_type":"anchor","button_label":"The Big 3 Online Course","button_internal_link":null,"button_anchor":"section-number-6","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Course Reviews","button_internal_link":null,"button_anchor":"section-number-7","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"Become a member","button_style":"button-three","button_internal_link":22104,"button_anchor":"","button_url":"","button_file":""},"button_description":""},{"acf_fc_layout":"content-with-sidebar","content_editor":"

Proximal Hamstring Tendinopathy | Diagnosis & Physio Treatment<\/h2>\r\n
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Introduction & Epidemiology<\/strong><\/h3>\r\nWhereas proximal hamstring injuries are less frequent with sports engagement, musculotendinous junction injuries are more frequent. These injuries have a wide variety of appearances, from complete proximal avulsion injuries to partial-thickness tears to persistent insertional tendinopathy. These injuries frequently go undiagnosed or are treated slowly because of their low incidence and diverse appearance, which leads to extended periods of incapacity. In order to increase knowledge, speed up diagnosis, and ensure effective care, this blog post will explain the normal presentation, physical examination, diagnostic imaging, and therapeutic treatment choices for each of these entities (Degen 2019<\/a>).\r\n\r\nProximal hamstring tendinopathy is most prevalent among fast walkers, distance runners, sprinters, and athletes performing change-of-direction activities such as football, soccer, or hockey.\r\n\r\n<\/div>"},{"acf_fc_layout":"content-with-sidebar","content_editor":"

Clinical Presentation & Examination<\/strong><\/h3>\r\nIf you are a regular visitor to our webpage, then you might have seen or watched our\u00a0 video on 6 tips to diagnose lower limb tendinopathy<\/a>.\r\nLower limb tendinopathy can be diagnosed with the help of the following 6 points:\r\n
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  1. Epidemiological data (see above)<\/li>\r\n \t
  2. Highly localized pain at the tendon enthesis<\/li>\r\n \t
  3. Muscle wasting<\/li>\r\n \t
  4. Hallmark signs<\/li>\r\n \t
  5. Pain onset 24 hours after high+fast load activities<\/li>\r\n \t
  6. A proportional load-pain relationship.<\/li>\r\n<\/ol>\r\nIn this blog, we will specify those 6 points for the proximal hamstring tendon and look at possible differential diagnoses.\r\n
    \r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=wBO-5ZvFBI4[\/embed]\r\n\r\n<\/div>\r\nPalpation<\/strong><\/em>\r\n\r\n[caption id=\"attachment_15076\" align=\"alignright\" width=\"720\"]\"Tuber Highly localized pain at the tuber ischiadicum is a typical sign of Proximal Hamstring Tendinopathy[\/caption]\r\n\r\nPalpation should confirm well-localized pain at the ischial tuberosity. Be aware that proximal hamstring tendinopathy is one of the few tendinopathies that can present with diffuse referred pain to the back side of the hamstrings as well. As with other tendinopathies, symptoms usually become less prominent after a short warm-up period. The pain location requires an extensive differential diagnosis.\r\n\r\n \r\n\r\nDifferential Diagnosis<\/strong><\/em>\r\n\r\nDifferential diagnoses, with more diffuse symptoms are:\r\n
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    1. Sacroiliac joint pain which can be in and excluded with the Cluster of Laslett<\/a>.<\/li>\r\n \t
    2. Referred pain from the lumbar facet joints of commonly L4\/L5 and especially L5\/S1, which can be examined by 3D extension PIVMs<\/a> and PA provocation testing.<\/li>\r\n \t
    3. The sciatic nerve can become irritated in the deep gluteal area, so what was formerly called piriformis syndrome and nowadays called deep gluteal syndrome.<\/li>\r\n \t
    4. Next to palpation of the deep gluteal muscles, there are a couple of tests to help with this diagnosis of exclusion which all stretch or contract the deep gluteal muscles to entrap the sciatic nerve. You can also perform neurodynamic tests such as the Slump test<\/a> which you\u2019d expect to show up with positive findings<\/li>\r\n \t
    5. Furthermore, in female runners with pain medial to the ischial tuberosity we have to take an Ischial ramus stress fracture into account. The diagnosis can ultimately only be made by imaging.<\/li>\r\n \t
    6. In adolescent kicking athletes we have to take apophysitis into account and in post-adolescent athletes, in their 20s and 30s an unfused growth plate could be responsible for non-response to conservative therapy<\/li>\r\n \t
    7. In the case of acute onset, we have to consider partial and full ruptures of the proximal hamstring tendon into account, which often happen with an audible pop in extreme hip flexion combined with knee extension.<\/li>\r\n \t
    8. At last, a patient can suffer from Ischiofemoral impingement, which happens when the lesser trochanter of the femur impinges against the ischial bone during external rotation of the hip.<\/li>\r\n<\/ol>\r\n \r\n\r\nMuscle Wasting<\/strong><\/em>\r\n\r\nIn the case of proximal hamstring tendinopathy, the literature describing atrophic changes is sparse. As a general rule of thumb for tendinopathy, the muscle of the affected tendon and the muscles of the kinetic chain distal to that muscle are affected. To examine muscle wasting in this case, observe the hamstrings and calves for muscle bulk and differences and palpate them for tone, which is often reduced if patients have not been using them much.\r\n\r\n \r\n\r\nHallmark Sign<\/strong><\/em>\r\n\r\nThe hallmark sign of proximal hamstring tendinopathy is sitting pain on the tendon insertion as it is getting compressed between the sitting surface and the ischial tuberosity.\r\n\r\n \r\n\r\nPain onset\/exacerbation 24 hours after high-load activities<\/strong><\/em>\r\n\r\nPain onset or exacerbation 24 hours after high+fast load activities: In the case of the proximal tendon you have to specifically ask for an increase in volume, intensity, or frequency of sprinting, lunging, hurdles, or hill running which has led to the onset of symptoms. This is often the case after a prolonged break as well. And secondly, the pain usually increased 24 hours after those high and fast load activities. Be aware that activities that require static stretching such as yoga or pilates and even simply sitting can induce tendinopathy as well.\r\n\r\n \r\n\r\nProportional Load-pain relationship<\/strong><\/em>\r\n\r\nLike with every tendinopathy you are looking for an increase in pain with an increase in load on the proximal hamstring tendon. A good starting provocation test can be a double-leg bridge, followed by a single-leg bent knee bridge. Then continue with a bridge with a long lever and progress to higher load and speed like in catches for example. A very intense test is asking a patient to perform a double-leg deadlift, which is again progressed to a single-leg version with added load and speed. Pain levels have to increase with increasing difficulty, so if the single-leg bridge was scored with a 3 out of 10, a long lever bridge with added load and speed should be higher with the highest scores at single-leg deadlifts with added load and speed.\r\n\r\nThe literature describes 3 common orthopedic tests to diagnose proximal hamstring tendinopathy. They are:\r\n