Massage therapy · Kitchener–WaterlooHamstring Origin Tendinopathy

Hamstring tendinopathy (previously known as hamstring tendonitis) is a painful condition of the hamstring tendon where it attaches to the back of the pelvis. It is now understood as a problem caused by the tendon being overloaded, rather than mainly an inflammation (Rich et al., 2025). It causes deep pain in the area of the sitting bone (the ischial tuberosity, at the back of the pelvis), which can be worse when sitting or after activity (Calderdale and Huddersfield NHS Foundation Trust, n.d.). Pain is often made worse by running, sitting and lunging (Dizon et al., 2023), and by positions that press on or stretch the tendon, such as hamstring stretches, deep squats and sitting for long periods, especially on hard surfaces (Rich et al., 2025).

Hamstring tendinopathy is mostly caused by overloading the tendon. It is common in long-distance runners, sprinters and people who play sports involving changes of direction, such as football and hockey, but it can also affect people who do not play sport, through overload or a lack of fitness that leaves the tendon weak and painful (Calderdale and Huddersfield NHS Foundation Trust, n.d.; Rich et al., 2025).

Hamstring tendinopathy can also be affected by how the rest of the leg and trunk are working. For example, problems with surrounding muscles can place more strain through the hamstring, as can weakness or poor control of the hips and pelvis.

Hamstring Origin Tendinopathy Anatomy

Hamstring muscles run down the back of the thigh. Three hamstring muscles make up the area: the semitendinosus, the biceps femoris and the semimembranosus. They begin at the bottom of the pelvis, on the ischial tuberosity. They cross the knee joint and end at the top of the lower leg. Hamstring muscle fibres join with the tough connective tissue of the tendons near the places where the tendons attach to the bones. The hamstring muscles help you to extend your leg straight back and to bend your knee (AAOS, n.d.).

How to Treat Hamstring Origin Tendinopathy

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

• While the tendon is painful, avoid lots of hamstring stretching, as stretching presses the tendon against the bone and can make the pain worse (Rich et al., 2025).
• During high-speed activities, the hamstrings tend to tire more quickly than the quadriceps at the front of the thigh, which can lead to injury (AAOS, n.d.).
• When playing sports like football, basketball and soccer, make sure you warm up properly.
• Build up your training gradually, as overloading the tendon is the main cause of this condition (Calderdale and Huddersfield NHS Foundation Trust, n.d.).

This tendon doesn't like being squashed or stretched, and it doesn't like sudden jumps in training. My aim is to calm it down by changing what's irritating it, then build the tendon and the muscles around your hip back up gradually so they cope with sitting, running and sport again.

I start by assessing how you move, walk and run, testing your hamstring, hip and trunk strength, and asking about your training, sitting and what brings the pain on. The tendon attaches to the sitting bone, so any work near the buttock is only with your informed consent and a written consent form.

Calming It Down

• Cutting back the speed, intensity or amount of training rather than stopping completely
• Sitting less on hard surfaces, using a cushion, and easing off hamstring stretches, deep squats and lunges while it's painful
• Pain-free holds, such as pressing your heel into the floor or holding a bridge, to start loading the tendon without irritating it
• Warm or cool applications in the clinic

Building Strength

• Building from holds to slow strengthening through more range, then heavier work such as hamstring curls, Romanian deadlifts and, later, Nordic curls
• Strength for the hips and trunk so the whole leg shares the load
• Using how the tendon feels the next day as our guide: if pain is stable, we keep building; if it's climbing, we ease off
• A home programme between visits, then gym-based progressions and a graded return to running, sprinting and sport

Hands-On Treatment

1. Calderdale and Huddersfield NHS Foundation Trust (n.d.) Proximal hamstring tendinopathy. Available at: https://cht.nhs.uk/services/clinical-services/physiotherapy-outpatients/hip/proximal-hamstring-tendinopathy (Accessed: 7 October 2026).
2. Rich, A. et al. (2025) 'Treatment of proximal hamstring tendinopathy with individualized physiotherapy: a clinical commentary', International Journal of Sports Physical Therapy, 20(6), pp. 892–910. doi: 10.26603/001c.138308. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12129629/ (Accessed: 7 October 2026).
3. Dizon, P. et al. (2023) 'Comparison of conservative interventions for proximal hamstring tendinopathy: a systematic review and recommendations for rehabilitation', Sports, 11(3), p. 53. doi: 10.3390/sports11030053. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10053564/ (Accessed: 7 October 2026).
4. American Academy of Orthopaedic Surgeons (n.d.) Hamstring muscle injuries. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/hamstring-muscle-injuries/ (Accessed: 7 October 2026).