Tendon Compression Explained

Title: Understanding Proximal Hamstring Tendinopathy: Exploring Tendon Compression


In today’s podcast episode, we are delving deep into the world of proximal hamstring tendinopathy (PHT) and specifically focusing on a crucial aspect of this condition – tendon compression. Whether you’re an athlete or not, understanding this condition and its treatment options is essential. I’m Brody Sharp, an online physiotherapist, recreational athlete, and someone who has battled PHT. This podcast aims to provide you with the knowledge and evidence-based treatments you need to overcome this condition. Today, we are demystifying the concept of tendon compression in PHT.

The Importance of Tendon Compression

Many listeners of this podcast have reached out with questions about tendon compression, prompting the need for this episode. Tendon compression is a fundamental aspect of PHT rehabilitation, and grasping this concept is vital for effective treatment. While it may seem complex, I’ll do my best to explain it in a way that’s easy to understand, even if you’re not well-versed in anatomy and tendon function.

Understanding Tendon Anatomy

Before we dive into the details of tendon compression, let’s start by understanding the anatomy involved. The hamstring tendon, which plays a central role in PHT, attaches to the sitting bone, also known as the ischial tuberosity. Tendons act as anchor points, connecting muscles to bones and facilitating movement. In the case of the hamstring tendon, it wraps around and attaches behind the sitting bone.

Compression During Sitting

Sitting can be particularly uncomfortable for individuals with PHT. When you sit on a firm surface, your sitting bones make contact with the chair or surface. The hamstring tendon passes between your sitting bone and the chair’s surface, wrapping itself around the sitting bone. This compression, which occurs during sitting, can exacerbate PHT symptoms, causing pain and discomfort.

Compression during Exercise

Now, let’s move on to how compression relates to movement and exercise. Imagine a gym pulley system, which has a wheel with a groove where a cable wraps around. This cable represents your muscle and tendon. When you engage in exercises like bicep curls or hamstring curls, two forces come into play: tension and compression.

  • Tension: Tension is the force applied to the cable due to the weight you’re lifting. It stretches the cable, but because tendons don’t have much stretch, they don’t actually lengthen.
  • Compression: Compression is the force applied to the cable as it wraps around the wheel. It’s like pressing the cable into the groove on the wheel. This compression occurs when you pull the cable while it’s under tension.

Variability in Compression

The level of compression varies depending on the exercise and the angle of movement. To illustrate this, consider the following examples:

  1. High Compression: Exercises that involve deep hip flexion, such as deadlifts or deep lunges, generate high compression. These exercises primarily activate the hamstrings and involve significant compression as the tendon wraps around the sitting bone.
  2. Medium Compression: Exercises like seated hamstring curls, where your hips are bent at 90 degrees, result in medium compression. The tendon wraps around the sitting bone but not as extensively as in high-compression exercises.
  3. Low Compression: Prone hamstring curls, where you’re lying face down and lifting your heel toward your glutes, have low compression. The tendon doesn’t wrap around the sitting bone much in this position.

Importance of Tolerance in Rehabilitation

In PHT rehabilitation, it’s crucial to determine your tolerance for different levels of compression. Physical therapists can help you identify exercises with low, medium, or high compression and gradually build your capacity to tolerate higher levels of compression. This progression is essential for building tendon resilience and ensuring that you can perform daily activities without discomfort.


Understanding tendon compression is a fundamental aspect of managing proximal hamstring tendinopathy. Whether you’re sitting or engaging in exercise, the level of compression on your hamstring tendon varies. Rehabilitation involves finding your tolerance for compression and gradually increasing it to build resilience and restore functionality.

Thank you for tuning in to this episode, and if you have any questions or need further guidance on PHT, don’t hesitate to reach out. Remember that knowledge is power on your journey to overcome PHT.