Hamstring Tendinopathy

Hamstring Tendinopathy is caused by overuse of the tendons at the back of the thigh. These tendons connect the hamstrings to the ischial tuberosity (sit bone) and the back of the knee. They play a crucial role: they provide stability to the pelvis and knee, extend the hip, and flex the knee.

How does hamstring tendinopathy develop?

Hamstring tendinopathy usually develops gradually. Whether a tendon becomes overloaded depends on the balance between stress and the tissue's capacity to withstand it. Simply put: if the stress is greater than what the tendon can handle, the risk of injury increases.

With repetitive stress on the hamstring attachment, this load can accumulate. The tendon tries to adapt to this pressure, but this is only successful if the tissue is strong enough and there is sufficient recovery time. If one of these factors is missing, the body responds with an inflammatory reaction in the tendon. This is a protective mechanism indicating that the tendon is overloaded.

To promote recovery, it is crucial to adjust the load and specifically work on strengthening the tendon. This improves the load-bearing capacity and reduces the risk of recurring symptoms.

When a tendon becomes overloaded, this process usually goes through three phases:

• Chronic phase: With prolonged overuse, the tendon can sustain serious damage, resulting in scar tissue and an increased risk of tears. Treatment in this phase becomes more extensive and can range from targeted exercises to injections or even surgery.
• Reactive phase: With a sudden, heavy load, the tendon reacts by becoming thicker and painful. In this phase, temporarily reducing the load can help give the tendon a chance to recover.
• Structural change phase: If the overuse continues, the structure of the tendon begins to change. It remains thick and can feel stiff. In addition to reducing the load, specific exercise therapy in this phase is essential to make the tendon stronger and more functional.

With overuse of this tendon, you may feel pain at the back of the hip, at the level of the ischial tuberosity. This can radiate downwards.

Usually, you will experience discomfort when sitting for long periods (especially on hard surfaces), driving, walking, exercising, stretching (hip flexion with a straight knee), etc.

The treatment for hamstring tendinopathy depends on the severity of the injury. If there is a tear in the tendon, surgery (hamstring repair) may be necessary.

• Specific exercise therapy
• Lifestyle adjustments
• Injection

We will discuss with you which treatment option is most suitable based on your specific situation and needs.