Hamstring Tendonitis
What is it and how is it treated?
Hamstring Tendonitis: Causes, Symptoms and Treatment
Hamstring tendonitis, also called a hamstring tendon injury, affects the tendons connecting the hamstring muscles to the bone. It is a common overuse injury in endurance runners, triathletes, and team-sport athletes in hockey, rugby, and football. Dr Masci treats hamstring tendonitis as a tendon specialist at his London clinics.
Hamstring tendonitis comes in two forms, depending on which end of the muscle is affected — and the distinction guides the whole assessment.
The two types of hamstring tendonitis
Upper (proximal) hamstring tendonitis affects the tendon attaching the hamstring to the sitting bone (ischial tuberosity), causing lower buttock pain. This is by far the more common form, often called the “runner’s curse”. Our complete high hamstring tendinopathy guide covers its diagnosis and injection treatment in depth.
Lower (distal) hamstring tendonitis affects the tendon attaching to the inside of the knee, causing pain at the back of the knee toward the inside. It overlaps with pes anserine bursitis and semimembranosus tendonitis.
This page gives the overview; the linked guides go deeper into each.
Hamstring tendon pain: what it feels like
Proximal hamstring tendonitis usually starts gradually as lower buttock pain, sometimes spreading down into the upper hamstring. Pain worsens after walking and running and eases with rest. In severe cases, it hurts to sit or drive.
Some people feel numbness or tingling down the back of the thigh, caused by irritation of the nearby sciatic nerve. Rarely, the swollen tendon entraps the sciatic nerve and produces leg symptoms resembling piriformis syndrome or deep gluteal syndrome.
Confirming the tendon as the source matters, because many conditions cause deep buttock pain — a pinched nerve from the lower back, ischiofemoral impingement, and others. Ultrasound or MRI confirms the diagnosis when it is unclear, and some MRI changes in the hamstring tendons correlate with pain.
What causes hamstring tendonitis?
Overload. A change in running or training loads the tendon faster than it can adapt. Occasionally an acute injury — “doing the splits” in sport — triggers it, and at the more severe end this becomes a proximal hamstring tendon tear.
How is hamstring tendonitis treated?
Exercise comes first
Exercise is the most effective treatment. Gradually strengthening the hamstrings and glutes reduces the force on the tendon and lets it heal. Supervised programmes work best, and improvement is small but steady over several months. Our proximal hamstring tendinopathy exercise guide, written with physiotherapist Scott Newton, sets out the full step-ladder programme.
When exercise isn’t enough
Shockwave therapy delivers sound waves to the tendon to stimulate healing, typically over five weekly sessions. Tendon injections can reduce pain and unlock rehab in some cases — there are no clear favourites, so the choice between cortisone and PRP depends on your circumstances and the balance of benefit and risk. Dr Masci has co-authored the published evidence review on tendon injections, and performs each injection under ultrasound guidance as a one-stop visit. Our high hamstring tendinopathy guide details the injection options and prices. After any hamstring injection, rest the tendon for at least a week, then return to running gradually.
Surgery is the last resort
We reserve surgery for a partial ‘interface’ tear that has failed everything else. Recovery is prolonged and not consistently successful.
Frequently asked questions about hamstring tendonitis
What’s the difference between hamstring tendonitis and a hamstring strain?
A strain is an acute muscle tear, usually with sudden mid-thigh pain during sprinting. Hamstring tendonitis is a gradual overload of the tendon at its bony attachment — buttock pain (proximal) or inner-knee pain (distal). The two need different treatment.
Why does my hamstring tendon hurt when I sit?
Sitting loads the proximal hamstring tendon directly against the sitting bone, so sitting and driving pain is a classic sign of proximal hamstring tendonitis. Our high hamstring tendinopathy guide explains why — and what to do.
How long does hamstring tendonitis take to settle?
Typically 3–6 months with consistent strengthening, sometimes longer in chronic cases. The large majority recover without injections or surgery.
Final word from Sport Doctor London about hamstring tendonitis
Hamstring tendonitis is a common cause of buttock or inner-knee pain in runners and athletes. The foundation of treatment is strengthening the hamstrings and glutes, with shockwave or tendon injections reserved for stubborn cases and surgery only for failed partial tears.
To book a one-stop hamstring assessment with Dr Masci in London, contact his team here or call +44 (0) 203 488 0350.