Hamstring Tendonitis: Exercises and Treatment for Pain (2024)

Hamstring tendonitis results from inflammation of the tendons at the back of the thigh. The most common cause is overuse and insufficient rest from aggravating activities like running, sprinting, jumping hurdles, squats, and lunges.

Fortunately, rest and targeted rehabilitative exercises can help decrease hamstring tendon strain and improve the strength of the hamstring tendons to keep up with physical activity demands.

This article will review the causes and symptoms of hamstring tendonitis, rehabilitative guidelines, and treatment options for hamstring tendonitis.

Causes: How Does Hamstring Tendonitis Happen?

Hamstring tendonitis, like other conditions that affect tendons, results from repetitive stress and overuse. The tendons can become easily irritated if excessive physical activity without enough rest puts too much stress on the hamstring muscles. This includes movements like:

• Running
• Sprinting
• Jumping hurdles
• Squatting
• Lunging

This can also occur if there is weakness in the glute muscles. If the glutes are not strong enough to keep up with exercise, the hamstring muscles will kick into overdrive. This can strain the hamstring muscles too much, leading to tendonitis.

Symptoms and Location of Hamstring Tendonitis Pain

Hamstring tendonitis most often affects the upper hamstring tendons that attach to the ischial tuberosity, an area at the bottom of the pelvis bone. Pain and tenderness to the touch are often felt over this area.

Pain is also felt along the back of the thigh or bottom of the buttock, with the possibility of radiating down behind the knee.

Usually there is no swelling, bruising, or hamstring muscle weakness.

Hamstring tendonitis gradually builds up over time with no sudden trauma. Previous hamstring injuries, however, can increase the risk of developing hamstring tendonitis.

Pain from hamstring tendonitis typically worsens with aggravating movements like running, squats, and lunges. Prolonged sitting can also irritate symptoms due to pressure placed on the hamstring tendons.

Stretching of the hamstring muscles can irritate pain as well by placing increased tension on the hamstring tendons.

Because the sciatic nerve is located near the hamstring muscles, hamstring tendonitis can sometimes compress the sciatic nerve. This results in symptoms of sciatica, including pain, numbness, and tingling traveling down the back of the thigh.

How to Get Hamstring Tendonitis Diagnosed

Your healthcare provider can diagnose hamstring tendonitis, most often through a consultation and physical examination. During your visit, your healthcare provider will ask about your symptoms, how they began, and what activities or movements make them worse.

Your healthcare provider will also examine your hamstring muscles to see if anything is tender to the touch and perform maneuvers to your legs to see if your pain can be reproduced.

Sometimes, imaging will be used to help confirm a diagnosis of hamstring tendonitis. Magnetic resonance imaging (MRI) and ultrasound can show inflammation, swelling, or tearing of the hamstring muscles. These imaging methods can also help rule out any other conditions that can affect the back of the thighs.

Recovery, Rehabilitation, and Hamstring Tendonitis Exercises

Recovery from hamstring tendonitis starts with an initial period of rest. This will prevent aggravating activities from irritating your hamstring tendons further to allow inflammation to calm down.

In addition to resting, your rehabilitation will involve specific exercises to gradually increase the strength of your hamstring muscles while decreasing strain at the tendons. Exercises should gradually be increased in intensity and range of motion over time.

Eccentric hamstring exercises, in particular, can help with recovery from hamstring tendonitis. These types of exercises, such as Nordic curls, require the use of hamstrings. This helps strengthen the hamstring, which can decrease irritation over time.

Full recovery typically takes between one and three months.

Treatment Options for Hamstring Tendonitis

Besides exercises and physical rehabilitation, other treatment options can benefit hamstring tendonitis. Some of these treatment methods can be performed at home, while others require a medical professional to perform them.

Medication

Pain relieving medication like nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and aid in your recovery. This can help make everyday activities like walking and sitting more tolerable.

Cold Therapy

Applying ice or a cold pack to the painful areas of your hamstrings can help decrease pain and inflammation.

Injections

A corticosteroid injection into the hamstring tendons delivers anti-inflammatory medication directly to the site of irritation. This can help decrease inflammation and pain, and may make physical rehabilitation easier. Corticosteroid injections for hamstring tendonitis can provide pain relief within one month in about 50% of people who get them.

Platelet-rich plasma (PRP) injections are also being explored in the treatment of hamstring tendonitis and other tendon disorders. PRP injections involve injecting isolated platelets from a sample of your own blood into the site of pain. This is believed to promote your body’s natural ability to heal.

Shockwave Therapy

Shockwave therapy is a treatment method that delivers shockwave impulses over a painful area. The shockwaves are believed to help improve healing, especially at tendons that heal slowly, although there is no reliable good evidence to suggest that it is effective for treating hamstring tendonitis.

Surgery

When all other treatment methods fail to make a lasting improvement in your symptoms, your healthcare provider may consider surgery. Surgery for hamstring tendonitis is similar to adductor tenotomy performed for adductor tendonitis.

This procedure detaches the hamstring tendon from the semimembranosus muscle at the pelvis and reattaches it to the tendon of the biceps femoris, another hamstring muscle.

This helps redistribute the force transmitted through the tendon and decrease signals from painful nerve endings.Between 80–90% of patients return to exercise and sports between two and 12 months after surgery.

For a less-invasive option, percutaneous ultrasonic tenotomy may be considered. With this procedure, an instrument with a needlelike attachment emits ultrasonic waves through your skin to make short cuts lengthwise along the tendon. This helps to remove scar tissue and promote tendon healing.

How to Minimize Hamstring Tendonitis Injury

Because hamstring tendonitis is an overuse condition, making adjustments to your exercise routine can have a big impact on preventing tendonitis from occurring or coming back. Tips include:

• Increase your exercise volume and intensity gradually over time: This will prevent straining your hamstring muscles and tendons from too much activity too soon and without enough rest.
• Take rest days between your workouts: Too many consecutive days of exercise back-to-back doesn’t allow your muscles enough time to heal, which can increase strain on your tendons.
• Improve muscle imbalances: Weakness in other body areas, including the core and glutes, can cause other body parts like the hamstrings to work harder to compensate. This can lead to overuse injuries. Improving overall strength and balance within your body can help prevent injuries.
• Don’t overstretch your hamstrings: While flexibility in the hamstrings is important to decrease muscle strain and prevent injury, prolonged stretching can cause too much compression at the hamstring tendons. Try dynamic stretches that move your hamstring muscles through their full range of motion actively, rather than holding a stretch for a long time.
• Ease into aggravating movements: Sprinting, running uphill, and hurdles, in particular, can be intense, so slowly increase the intensity of your physical activity before you try these activities again..

When to See a Healthcare Provider

If you have persistent pain or worsening symptoms, contact your healthcare provider. While some cases of hamstring tendonitis can be managed on your own with rest and gradual return to exercise, other cases require more treatment.

If you’re unable to bear weight on your affected leg, contact your healthcare provider immediately or go to the emergency room. This is a sign of a severe injury that requires immediate medical attention.

Summary

Hamstring tendonitis is an overuse condition that develops when the hamstring tendons at the back of the thigh become strained with too much physical activity and not enough rest.

This causes pain at the back of the thigh or bottom of the buttock that worsens with exercises and stretches. Aggravating activities include running, sprinting, jumping hurdles, squatting, and lunging.

Your healthcare provider can diagnose hamstring tendonitis most often with a physical examination, but may also use an MRI or ultrasound.

Treatment involves rest from aggravating movements, physical therapy and rehabilitative exercises, and pain-relieving methods like medication, injections, ice, and shockwave therapy. For chronic hamstring tendonitis that does not improve after six months of trying treatment options, surgery may be considered.