Proximal Hamstring Tendinopathy

Proximal Hamstring Tendinopathy is a painful condition of the tendons that join the hamstring muscles in the back of the thigh, to the sitting bones. Pain is felt directly over the sitting bones when seated and/or during activities such as bending over or during walking and running, particularly up hills.  

The hamstring muscles (semimembranosis, semitendinosis and biceps femoris muscles) in the back of the thigh help to extend the hip (take the thigh backwards), but also bend the knee. This combined function makes the hamstring muscles very important muscles for transferring forces between the hip and lower leg in actions such as running, kicking, lifting and lunging.  

The hamstring muscles in the back of the thigh attach deep in the buttock, onto the sitting bones (ischial tuberosities). They attach onto the bone via elastic, fibrous tendons, together referred to as the proximal hamstring tendons. Proximal simply refers to the end of a structure closer to the head-end of your body.

Directly on top of the hamstring tendon attachments is a small flat, fluid-filled cushion (the ischial or ischiogluteal bursa) . This helps reduce friction and allows smooth gliding of the largest buttock muscle (gluteus maximus) over the hamstring tendons.

Pain where the hamstring tendon attaches, due to this tendon, is known as Proximal Hamstring Tendinopathy.  The bursa can at times also become painful, known as bursitis.

Injury to the hamstring tendon can occur rapidly, such as with a slip or a fall, but usually it occurs more as a slow gradual build up.  This is often following a change in activity or the amount of activity you do, for example walking or running more hills, or walking or running faster.

Read more in our Lower Buttock page, under the Soft Tissue Related Pain tab.

References

Nasser A, (2018) Proximal hamstring tendinopathy: a systematic review of interventions. JSAMS, Volume 21, Supplement 1, Pages S96–S97

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