Hamstring Tendonitis

What is it and how is it treated?

What is hamstring tendonitis?

Hamstring tendonitis is a common injury to the large hamstring tendon that attaches the hamstring muscle to the lower part of the pelvic bone. We see this overuse injury in endurance runners, triathletes, and team sports such as hockey, rugby, and football.

Also, tendonitis occurs at the attachment of the hamstring to the inside of the knee. This condition is also known as pes anserine bursitis. Rather than bursitis, this injury is a tendon overload close to the knee. Treatment of pes anserine bursitis is similar to hamstring tendonitis. 

Hamstring tendon pain

Typically, people report a gradual onset of pain in the lower buttock. In some cases, the pain moves down to the upper part of the hamstring muscle. Pain is worse after walking and running and better with rest. In severe cases, pain occurs with sitting or driving. Sometimes, people feel numbness and pins and needles in the back of the thigh caused by irritation of the large nerve close to the tendon. In rare cases, entrapment of the proximal sciatic nerve by the hamstring tendon causes symptoms down the leg, a condition similar to piriformis syndrome.

Generally, it is important to confirm that the hamstring tendon as the cause of pain. We perform an examination to rule out other causes of buttock pain such as a pinched nerve from the low back. Imaging such as ultrasound or MRI is useful to confirm hamstring tendonitis in difficult cases. For example, some changes of the hamstring tendon on MRI are thought to be related to pain. 

What causes hamstring tendonitis?

Hamstring tendonitis is caused by an overload of the tendons. Generally, overload is caused by a change in running or sport. Occasionally, tendonitis is caused by an acute injury such as ‘doing the splits’ during sport.

Hamstring tendonitis treatment

Exercises for high hamstring tendonitis

In general, we treat hamstring tendinopathy effectively with exercise. This study outlines the exercise treatment options for hamstring tendonitis well. We think that exercise works by gradually strengthen the muscles around the tendon such as the large hamstring and gluteal muscles. By strengthening the muscles, we apply less force to the tendon allowing healing. Exercise programs are more successful if supervised by a therapist. Overall, it is important that patients understand that exercise produces small but gradual improvements in pain over many months. This blog outlines how to manage hamstring tendonitis in runners. 

Although most hamstring tendonitis responds to exercise, some cases require extra treatment. Shockwave therapy is a treatment where pressurised air delivers sound waves directly to the tendon. The sound waves start inflammation, which stimulates the body’s healing capacity. Shockwave treatments are weekly for up to a total of 5 sessions. Alternatively, in some cases, injections into the tendon can help pain and improve exercise. There are different types of injections with no clear favorites for hamstring tendonitis. The injection selected depends on patient choice when taking into consideration potential benefits and risks.  You can read my research summarising injections for tendonitis here.  After any injection, it is important to rest your hamstring tendon for at least a week followed by a careful return to running or sport.

Finally, surgery should only be considered with a partial ‘interface’ tear of the tendon attachment to the bone, and only when other measures have failed. Hamstring tendon surgery recovery is prolonged and not always successful.

Final word from Sportdoctorlondon

Hamstring tendonitis is common in endurance runners and players in team sports. Typical features include pain during or after walking or running. Treatment consists of exercises to strengthen the muscles on the buttock and hamstring. Finally, other treatments such as shockwave therapy or injections can improve the outcomes of surgery.

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.

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