myosesh Musculoskeletal post Proximal hamstring tendinopathy

Proximal hamstring tendinopathy

Hamstrings tendinopathy often occurs where the origin is which is lower hip. Hamstring consists of 4 muscles which are biceps femoris long head, short head, semitendinosus and semimembranosus. They originate from ischial tuberosity sharing common tendon apart from biceps femoris short head and inserts into the head of fibula, lateral collateral ligament and lateral tibial condyle.

Biceps femoris long head

 Origin: Ischial tuberosity

 Insertion: head of fibula, lateral collateral ligament and lateral tibial condyle

 Action: Knee flexion, external rotation of knee and extension of the hip

 Innervation: Tibial nerve (S1-S3)

Biceps femoris short head

Origin: head of fibula, lateral collateral ligament and lateral tibial condyle

Insertion: lateral surface of the head of the fibula

Action: flexes and externally rotates of knee

Innervation: Common fibular nerve (L5-S2)


Origin: ischial tuberosity

Insertion: Proximal and medial shaft of tibia via pes anserine tenon

Action: Flexes and internally rotates the knee

Innervation: Tibial nerve (L5-S2)


Origin: Ischial tuberosity

Insertion: Posterior surface of the medial condyle of the tibia

Action: Flexes and internally rotates the knee

Innervation: Tibial nerve (L5-S2)


  • Middle age
  • Occupational strains (hip flexion)*3
  • Overuse and repetitive loading *5
  • Young athletes
  • Track and field, and soccer player
  • Weak hamstrings muscles
  • Previous hamstrings injury
  • Overstretch

Proximal hamstrings tendinopathy is often provoked by prolonged eccentric overload on hamstrings especially where the origin is.

Signs and symptoms

  • Pain and tenderness in lower gluts area sometimes radiating to the posterior thigh
  • Stop patients from doing activities
  • Burning and sharp pain
  • Pain during running at a faster pace*3
  • Pain with prolonged sitting *3
  • Weak hip muscle (anterior pelvic tilt)


  • Rest for the initial phase
  • Ice if it is inflamed
  • Strengthen exercise (Eccentric exercise) *5
  • Dry needling *5
  • TENS machine
  • NSAIDs
  • Surgical treatment if it is chronic and conservative treatment dost not show any progress.

Exercise variations

Tests for Hamstring tendinopathy

Normal bridge can be used to see whether or not pain is reproduced or not. The purpose of hip bridge is to activate and strengthen hip muscles. If hamstrings get fired up, that patient tends to activate hamstrings first before gluts.

 Hamstrings issues are the common injury especially in sports. Hamstrings muscles do extend the hip and rotate the tibia but they are not prime mover. When they get tight, it pulls pelvis posteriorly. Tight hamstrings can cause lower back pain and restrict ROM of the hip. Although overload on hamstrings triggers proximal hamstring tendinopathy, that might be coming from different issues such as anterior or posterior pelvic tilt.


  1. Jayaseelan DJ, Moats N, Ricardo CR. Rehabilitation of proximal hamstring tendinopathy utilizing eccentric training, lumbopelvic stabilization and trigger point dry needling: 2 case reports. J Orthop Sports Phys Ther. 2014;44(3):198–205
  2. Brett R. Martin Multimodal care in the Management of a Patient With Chronic Tendinopathy of the Biceps Femoris: A Case report J Chiropractic Medicine 2017 16(2):156-162
  3. Lasse Lempainen, Kristian Johansson, Ingo J. Banke, Juha Ranne, Keijo Makela, Janne Sarimo, Pekka Niemi and Sakari Orava Expert opinion: diagnosis and treatment of proximal hamstrings tendinopathy 2015 Muscles Ligaments Tendons. Journals 5 (1):23-28
  4.  Kannus P. Etiology and pathophysiology of chronic tendon disorders in sports. Scand J Med Sci Sports. 1997;7(2):78–85
  5. Jayaseelan DJ, Moats N, Ricardo CR. Rehabilitation of Proximal Hamstring Tendinopathy Utilizing Eccentric Training, Lumbopelvic Stabilization, and Trigger Point Dry Needling: 2 Case Reports. J Orthop Sports Phys Ther. 2013;44(3):198–205.
  6. Francesco Benazzo, Matteo Marullo, Giacomo Zanon, Christian Indiano and Francesco Pelillo Surgical management of chronic proximal hamstrings tendinopathy in athletes: a 2 to 11 years of follow-up 2013 J Orthop Traumatol 14 (2):83-89

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