The 3 stages of Proximal Hamstring Tendinopathy Rehabilitation

The Three Stages of Rehab for Proximal Hamstring Tendinopathy

Proximal hamstring tendinopathy is a painful and debilitating condition that can affect athletes and non-athletes alike. In this episode, we’ll explore the three key stages of rehab for this condition, helping you understand how to manage it effectively and dispel common misconceptions.

Stage 1: Settling Down Pain

If you’re experiencing a flare-up or an acute-on-chronic episode of proximal hamstring tendinopathy, the primary goal is to settle down the pain. Here are five essential tips for this stage:

1. Identify the Changes in Load

  • Learn from what may have caused the flare-up to avoid repeating the same mistake.

2. Temporarily Back Off

  • Take a break from exercises or activities for a couple of days to let the symptoms settle. When you resume, start at 50% of your previous level.

3. Implement Daily Modifications

  • Modify activities like sitting, walking uphill, or climbing stairs to reduce irritation to the sensitive tendon.

4. Consider Anti-Inflammatory Medication

  • You can use ibuprofen or anti-inflammatory medication for a short period (2-3 days) during the flare-up.

5. Trial Low-Level Exercises

  • Experiment with low-level exercises like long lever bridging to help stabilize your symptoms during the flare-up.

Pain during exercises is acceptable, as long as it’s below a 5 out of 10 and settles within 24 hours after the exercise. The pain during exercise should not be a cause for concern.

Stage 2: Building Strength

Once your symptoms have started to settle and become more stable, you can move on to stage two. This stage focuses on building strength and gradually introducing compression to the tendon. Start with exercises outside of compression, such as bridges and Swiss ball rollouts, and progressively work your way into compression exercises like deadlifts, lunges, and squats.

Compression Exercises

Compression exercises are those that put more pressure on the tendon. For example, in a deadlift, the hips are in flexion under the weight, creating compression on the tendon.

Stage 3: Speed, Power, and Kinetic Chain

In the final stage of rehab, you’ll work on speed, power, plyometrics, and kinetic chain exercises. These are essential if you want to return to high-level sports or activities. Some examples of exercises in this stage include kettlebell swings, rocket jumps, and single-leg deadlifts.

These exercises involve more force production, balance, and kinetic chain components. Gradually incorporating them into your rehab routine is crucial for a successful recovery.

Addressing Psychosocial Factors

It’s essential to consider the psychosocial factors that can affect your rehab journey. Beliefs about pain during exercise and its relationship to damage or weakness can have a significant impact. It’s crucial to understand that pain during exercise does not necessarily equal damage or weakness. Building self-awareness and addressing these beliefs can be key to a successful rehabilitation.


Proximal hamstring tendinopathy can be a challenging condition, but with the right approach, you can overcome it. These three stages of rehab, along with a clear understanding of the role of pain during exercise and addressing psychosocial factors, can help you regain control of your recovery journey.

For more in-depth guidance and visual demonstrations of exercises, you can consider Brodie Sharp’s Run Smarter series, which complements this podcast and offers a comprehensive video course on proximal hamstring tendinopathy.

Remember, knowledge is power, and by taking control of your rehab, you’re on the path to a pain-free future.