Hamstring tendonitis, frequently referred to as proximal hamstring tendinopathy, involves the irritation or degeneration of the tendons anchoring the hamstring muscles to the pelvis. This condition usually causes pain deep in the buttock, near the ischial tuberosity (the sitting bone). Successful recovery involves a phased approach, starting with immediate symptom management and moving through structured physical conditioning.
Initial Self-Care for Acute Pain
When initial pain flares up, the priority is symptom management. The concept of relative rest is applied by temporarily avoiding activities that reproduce the pain, such as running, jumping, or prolonged sitting on hard surfaces. Complete immobilization is generally avoided, as controlled movement can maintain tissue health.
Applying a cold compress or ice pack to the painful area for about 10 to 20 minutes, several times daily, can help reduce localized discomfort. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also be used briefly to mitigate pain and any accompanying inflammation. These self-care measures are intended only for the initial acute phase, typically the first few days, and do not represent a long-term solution for healing the tendon.
The Role of Structured Rehabilitation
Healing a tendon requires a structured rehabilitation plan, which is the most successful long-term treatment strategy. The primary goal is to increase the tendon’s capacity to withstand load, correcting the underlying weakness or imbalance that caused the injury. A physical therapist guides the patient through a progressive loading program, beginning with exercises that cause minimal pain.
Early stages focus on isometric exercises, where the muscle is contracted without changing its length, which helps modulate pain while maintaining tendon load. As pain subsides, the program advances to isotonic exercises, gradually introducing movement and resistance. The most crucial component involves eccentric strengthening, where the hamstring muscle lengthens while under tension, such as during the lowering phase of a single-leg Romanian deadlift. Eccentric movements improve the structural integrity and strength of the tendon tissue.
Rehabilitation must also include strengthening the gluteal and core muscles to improve overall biomechanics and reduce strain on the hamstring attachment. Gentle, non-painful stretching may be incorporated later to address any residual tightness, but it is secondary to the strengthening work. The transition back to high-load activities, like sprinting, must be gradual and supervised, often requiring a minimum of 12 weeks to safely complete.
Advanced Medical Options and Surgical Considerations
When rehabilitation fails to resolve chronic pain after several months, advanced medical interventions may be considered. These treatments are reserved for persistent symptoms or cases where the tendon structure has significantly degenerated.
Corticosteroid injections deliver a potent anti-inflammatory medication directly to the area, providing temporary pain relief, especially if an associated bursa is inflamed. They are used sparingly due to the potential for negative effects on tendon tissue health. Other non-surgical treatments aim to stimulate a healing response within the chronic tendon.
Platelet-rich plasma (PRP) therapy involves injecting a concentration of the patient’s own platelets to promote tissue repair, though evidence for its effectiveness remains mixed. Treatments like dry needling or extracorporeal shockwave therapy (ESWT) are used to mechanically stimulate the tendon, attempting to restart the healing process in stubborn cases.
Surgical intervention represents the last resort for hamstring tendonitis. It is reserved for severe chronic pain that has not responded to a minimum of six months of high-quality rehabilitation, or for cases involving a significant, acute tendon tear. Complete tears, particularly those retracted more than two centimeters from the bone, often require surgical repair to re-anchor the tendon to the ischial tuberosity. Recovery following surgery is extensive, involving an initial period of non-weight bearing, followed by a lengthy, structured rehabilitation process.