Chronic high hamstring tendinopathy earns its nickname — the runner’s curse — for good reason. This overuse injury plagues runners and players of football, rugby, hockey, and athletics, and it resists quick fixes. Dr Masci diagnoses and treats proximal hamstring tendinopathy at his London clinics, including ultrasound-guided hamstring injections as one-stop visits.
So what is high hamstring tendinopathy, how do we treat it, and when does a hamstring injection help?
Where is the proximal hamstring tendon?
High hamstring tendinopathy treatment
Treatment is challenging, and symptoms take time to settle.
Start by cutting training volume by 50% and avoiding provocative activities such as sprinting, hills, full squats, prolonged sitting, and hamstring stretching. Aim for stable pain — low-level, settling within 24 hours. Massage and a short course of ibuprofen (2–4 weeks) support the early phase.
The cornerstone is progressive strengthening. Our dedicated rehab guide covers proximal hamstring tendinopathy exercises and return-to-running in detail — written with physiotherapist Scott Newton, it takes you from hamstring bridges to plyometrics, with the strength goals we use in clinic.
When exercise stalls, adjuncts help: collagen supplements taken before loading sessions, and shockwave therapy — a study found radial shockwave effective for hamstring tendonitis, typically 4–5 weekly sessions.
Hamstring injection: what are the options?
For persistent cases, Dr Masci performs three types of hamstring injections, each under ultrasound guidance, as part of a one-stop visit — consultation, diagnostic ultrasound, and injection in a single appointment.
Cortisone injection — £400
Cortisone improves pain in the short term; long-term outcomes remain unknown. We inject the tendon sheath just outside the tendon — never into it — and always under ultrasound to protect the tendon and the nearby sciatic nerve. We use extra caution when a partial tear coexists, because cortisone can risk converting it into a complete tear.
High-volume nerve stripping injection
When the swollen tendons pinch the sciatic nerve, we inject cortisone and sterile water between the nerve and the tendon. This hamstring injection strips the nerve away from the tendon — the same principle as nerve hydrodissection, a technique Dr Masci teaches internationally.
PRP injection — ACP Max £1,350
PRP injections deliver growth factors to help regenerate the tendon. Results in hamstring origin tendinopathy are mixed, so we reserve PRP for tendons with partial tears that have failed other treatments. Evidence favours a higher platelet concentration — we use Arthrex ACP Max, which delivers a superconcentrated dose in one injection.
High hamstring tendinopathy surgery
Surgery is the last resort. Two procedures are available: tendon repair for significant tears and sciatic nerve release for nerve irritation. Both carry risks, and outcomes are unpredictable. Exhaust rehab, shockwave, and injections first.
Frequently asked questions about high hamstring tendinopathy
How long does high hamstring tendinopathy take to heal?
Months, not weeks — typically 3–6 months of structured rehab, sometimes longer in chronic cases. Persistence with strengthening pays off; most people improve without injections or surgery.
Is a hamstring injection safe near the sciatic nerve?
Under ultrasound guidance, yes. The sciatic nerve sits about 1.2 cm from the hamstring tendons, so blind injections here are genuinely risky. Dr Masci visualises the nerve throughout the procedure — never accept a blind hamstring injection.
How much does a hamstring injection cost in London?
At Dr Masci’s Chelsea clinic: a cortisone tendon sheath injection costs £400, and ACP Max superconcentrated PRP costs £1,350 — each as a one-stop visit including consultation and diagnostic ultrasound. Contact us for nerve stripping injection fees. Other clinic locations cost more. Full fees here.
Should I stretch my hamstring?
No, not in the early stages. Stretching compresses the swollen tendon against the sitting bone, worsening the pain. Strengthen instead.
Final word from Sport Doctor London about chronic high hamstring tendinopathy
Chronic high hamstring tendinopathy is common in runners and sportspeople — and commonly misdiagnosed, because so many conditions cause deep buttock pain. Get the diagnosis right first, commit to a structured strengthening programme, and reserve hamstring injections for the cases that genuinely need them.
To book a one-stop assessment with Dr Masci in London, contact his team here or call +44 (0) 203 488 0350.
Related conditions:
- Proximal hamstring tendinopathy exercises and running rehab
- Proximal hamstring tendon tears: how to manage
- Deep buttock pain: every cause explained
- Piriformis syndrome
- Deep gluteal syndrome
- Nerve hydrodissection
- Arthrex ACP Max PRP — £1,350
The title is correct: it is a curse. I had this problem for 4 or 5 years. I’m not a runner, I’m a cyclist and it kept me off my mountain bike for months at a time. I worked with a rehab pilates person. One day I was doing some zone 2 training on my Peloton and the instructor mentioned that it’s quite usual for the glute to not engage. I thought, “hmm, I don’t feel my glute ever get fatigued.” And I took that information to my rehab person. Well, we began exercises to “wake up” my glutes and in a matter of a couple of weeks it was gone. I continued to do a few glute exercises before every ride and I was not only feeling 90% better, but back to my sport! As time went on, I no longer needed to wake up my glutes prior to a ride, they just activate on the bike. Now when I’m getting fatigued my glutes are tired just like my quads and I don’t have “runner’s bum” any more.
One note though: I began weight training this year with a trainer. I did have to work up to doing dead lifts and goblet squats. At first it threatened the problem but we went slow and now I can do these exercises, no problem!
Hope this helps!