October 2020

What is proximal hamstring tendinopathy?

Proximal hamstring tendinopathy (PHT), sometimes called high hamstring tendinopathy, is a painful condition of the hamstring tendons. Tendons are fibrous structures that join muscles to bones. This connection allows your muscles to move your bones and body. The proximal hamstring tendons are the tendons at the top (proximal means closer to the head) of the hamstring muscles in the back of the thigh. These tendons join the hamstring muscles onto the sitting bones (ischial tuberosities).

Back view of body. Skin layer with red circle indicating region of proximal hamstring tendons
Back view of body. Skin layer with red circle indicating region of proximal hamstring tendons
Back view of body. Superficial muscle layer with red circle indicating region of proximal hamstring tendinopathy
Back view of body. Superficial muscle layer with red circle indicating region of proximal hamstring tendonopathy
Back view of body. Deep muscle layer indicating proximal hamstring tendinopathy
Back view of body. Deep muscle layer indicating proximal hamstring tendons

What are the Usual Symptoms of Proximal Hamstring Tendinopathy?

People with PHT have pain over their hamstring tendon attachment at the sitting bone. The pain may also extend a little way down into the hamstring muscle in the back of the thigh. The pain from the tendon does not usually continue past mid­thigh level. Any pain extending further down the thigh or past the knee is likely to have a different cause. In these cases, there may be some associated irritation of the sciatic nerve. The sciatic nerve sits right next to the hamstring tendons as it passes through the buttock to the thigh (the yellow line on the figure adjacent to this paragraph indicates the sciatic nerve). If the hamstring tendon is unhealthy, it can irritate the sciatic nerve as it passes by. This may result in symptoms of ‘sciatica’ (painful sciatic nerve). Pain can extend down the thigh, even all the way to the foot. Nerve irritation may result in sharp, stabbing, shooting or burning pain. There may also be feelings of tingling, buzzing, itching or numbness.

Pain from PHT is most commonly felt at the sitting bone, when:

  • Sitting, especially on a hard surface
  • Driving
  • Walking or running uphill or upstairs
  • Squatting/deadlifting
  • Lunging
  • Leaning forward (for example loading the dishwasher)
  • Running uphill or at higher speeds
Proximal Hamstring Tendinopathy

What Are The Causes of Proximal Hamstring Tendinopathy?

The pain of PHT may develop over time, without a clear injury.

This can be due to:

  • an increase in exercise, e.g. increasing the amount of walking, running or cycling uphill
  • a change in exercise, e.g. taking up exercises like split lunges, stair bounding or kettlebell swings
  • a prolonged period standing in a bent over position, e.g. weeding the garden
  • friction across the sitting bone, e.g. when rowing or paddling while sitting on a hard seat for long periods.
  • an injury or restriction at the knee or ankle, resulting in the hamstrings absorbing more load at the hip

However, for some people the pain may come on during or after a sudden hamstring strain or stretch. This might occur during water­skiing, martial arts or a slip into the splits position.

While too much load can lead to tendon conditions, too little load also reduces tendon health. Tendons that are not regularly exposed to physical load will not be as conditioned. There may reach a point where the tendon is unable to tolerate even everyday activities. Physical inactivity due to sedentary lifestyle, illness or injury elsewhere may contribute. Age and hormonal changes in women post­menopause may also reduce tendon health.

PHT is most common in middle to longer distance runners and triathletes. It may also affect cyclists who spend long periods hill climbing and on time­trial bikes. The hamstring muscles and tendons are also placed under high loads in other sports. Some examples include football, rugby, hockey, martial arts, long jump, ballet and yoga.

But you don’t need to be young and athletic to develop this condition. Older and/or sedentary people can have PHT too, due to relative under­loading (not doing enough) of the tendon. Less active people will be less conditioned and less able to tolerate physical load

Visit our Pain Locator Map to learn more about other causes of lower buttock pain. 

Running uphill can be the cause of proximal hamstring tendinopathy
poor hip position to do gardening that may contribute to the cause of proximal hamstring tendinopathy

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Check Out More You Can Read on this Area at HipPainHelp:

  1. Causes of Lower Buttock Pain: Learn about structures that may be linked to causes of lower buttock pain, including hamstring tendinopathy, ischiogluteal bursitis, ischiofemoral impingement, and pain from the deep hip rotator muscles
  2. Pain Locator Map  click on this interactive map to learn what may be causing pain in your area
  3. Hip Related Sciatica (piriformis syndrome, deep gluteal syndrome): what, where and how? Read more about possible cuases of pain higher in the buttock muscles
  4. Top Tips for Hip Pain Relief Sitting, when Socialising or Travelling.  If your nerve pain is exacerbated when sitting this blog may be extremely useful in suggesting ideas to help relieve this.

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