What is Hamstring Tendinopathy?

Hamstring tendinopathy is an overuse injury that affects the hamstring tendons, most commonly at their origin at the ischial tuberosity (high hamstring tendinopathy). It leads to pain in the buttock or posterior thigh, particularly when running, sprinting, or engaging in prolonged sitting.

What happens in Hamstring Tendinopathy?

The tendon becomes overloaded due to repetitive strain or sudden load increases, leading to microtears, degeneration, and chronic tendon pain. Athletes often describe stiffness at the start of an activity that eases with a warm-up but worsens afterwards.

Common causes

  • Repetitive sprinting or high-speed running
  • Sudden increases in training volume or intensity
  • Prolonged sitting on hard surfaces
  • Poor gluteal and core activation
  • Previous hamstring strains leading to tendon overload

Who is most affected?

  • Sprinters and track athletes
  • Football, rugby, and AFL players
  • Rowers and endurance runners
  • Middle-aged recreational athletes
  • In Australia, hamstring injuries are among the most common in AFL, with tendinopathy being a frequent chronic presentation

Symptoms of Hamstring Tendinopathy

  • Deep buttock or posterior thigh pain
  • Pain worsens with running, sprinting, or kicking
  • Pain after prolonged sitting
  • Stiffness at the start of activity
  • Tenderness at the ischial tuberosity

📞 If you have deep buttock or thigh pain affecting your sport, book an assessment at Spinal and Sports Care Bella Vista or Parramatta.

Diagnosis of Hamstring Tendinopathy

Clinical Tests:

  • Palpation at the ischial tuberosity
  • Single-leg hamstring bridge test
  • Bent-knee stretch test

Imaging:

  • Ultrasound: May detect tendon thickening or neovascularisation
  • MRI: More sensitive for tendon degeneration and ruling out other pathologies

Treatment options

Most hamstring tendinopathy cases are non-surgical.

Non-surgical:

  • Load management and temporary reduction of sprinting/kicking
  • Isometric hamstring exercises for early pain relief
  • Progressive eccentric and heavy slow resistance strengthening
  • Core and gluteal strengthening to reduce tendon overload
  • Shockwave therapy as an adjunct

Surgical:

  • Rare, reserved for chronic cases unresponsive to 6–12 months of rehab

Role of physiotherapy

  • Guide safe and progressive tendon-loading exercises
  • Correct pelvic and running biomechanics
  • Strengthen glutes, hamstrings, and core
  • Plan a gradual return-to-sport program

Recovery timeline

  • Mild cases: 6–8 weeks
  • Moderate: 3–6 months
  • Severe chronic cases: 6–12 months

Injury grading

  • Stage I (Reactive tendinopathy): Pain after overload, reversible with rest
  • Stage II (Tendon disrepair): Persistent pain with tendon fibre changes
  • Stage III (Degenerative tendinopathy): Chronic thickening and pain, higher risk of partial tearing

Prevention of Hamstring Tendinopathy

  • Eccentric strengthening of hamstrings (Nordic curls)
  • Strengthen glutes and core
  • Gradual increases in sprinting and training load
  • Proper warm-up before high-speed running
  • Address previous hamstring injuries fully before returning to sport

Taping and bracing

  • Kinesiology taping may reduce strain temporarily
  • Bracing is rarely required

When to see a physiotherapist or chiropractor

📞 If posterior thigh or buttock pain persists longer than 2 weeks and interferes with sport, consult Spinal and Sports Care for diagnosis and treatment.

Frequently Asked Questions

An overuse injury affecting the hamstring tendons, often at their origin near the pelvis.

Hamstring injuries are the most common in AFL, with tendinopathy being a frequent chronic issue.

Sprinting, AFL, football, rugby, rowing, and athletics.

A strain is an acute muscle tear, while tendinopathy is chronic tendon overload.

Through clinical tests and imaging, such as ultrasound or MRI.

Progressive tendon-loading exercises combined with glute and core strengthening.

From 6 weeks in mild cases to 12 months in severe chronic cases.

Rarely, only in cases not responding to rehab over 6–12 months.

Continuing to overload the tendon without rehab usually worsens symptoms.

High in elite athletes if biomechanics and strength deficits are not addressed.