Understanding a painful strong tendon vs painful weak tendon

Understanding Painful Tendons: Strong vs. Weak – A Guide to Proximal Hamstring Tendinopathy

Proximal Hamstring Tendinopathy Explained

Welcome to the podcast dedicated to helping you overcome the challenges of proximal hamstring tendinopathy (PHT). Whether you’re an athlete or not, this condition can affect anyone. In this episode, we’re going to explore the difference between a painful strong tendon and a painful weak tendon. Understanding this distinction is crucial for effective management. So, let’s dive in and get the right knowledge to tackle this condition.

Recap: Weakness vs. Sensitivity

Before delving into the topic of painful strong versus painful weak tendons, let’s recap a fundamental concept from a previous episode (Episode 29) – Weakness vs. Sensitivity. This concept is essential in understanding how your tendon responds to various situations.

Imagine you’re rehabbing your PHT, and you decide to increase the intensity of your deadlifts. Suddenly, you experience more pain, increased sensitivity, discomfort while sitting, and even pain during your runs. It can be alarming, making you wonder if your tendon is getting weaker.

However, it’s crucial to shift your perspective. In most cases, your tendon is not actually weaker; it’s just more sensitive at that moment. The tendon’s structure hasn’t changed; it’s still strong and robust. The heightened sensitivity leads to pain when you demand more from it. So, remember, sensitivity doesn’t equal weakness.

Painful Strong Tendon

Let’s start by discussing a painful strong tendon. This is a scenario where your tendon is sensitive, but it rebounds quickly. Here’s how you can identify it:

1. Short Recovery Time: If your tendon becomes sensitive after an activity, but the pain subsides within 24 to 48 hours, it’s a sign of a strong tendon.

2. Resilience: A strong tendon can handle occasional flare-ups due to activities like long drives, intense workouts, or strenuous races. These flare-ups typically resolve relatively quickly.

3. Encouraging Signs: You feel confident that even if you experience a flare-up, you’ll return to baseline symptoms rapidly without losing strength or fitness.

Managing a Painful Strong Tendon

  • Celebrate Small Wins: Acknowledge your progress and don’t dwell on minor setbacks.
  • Less Worry: Avoid excessive worry or negative thoughts when experiencing sensitivity. Trust in your tendon’s strength.
  • Continuous Progression: Keep pushing your limits, gradually incorporating speed, different types of exercises, and challenges to further strengthen your tendon.

Painful Weak Tendon

Now, let’s discuss a painful weak tendon. This situation occurs when your tendon remains sensitive for an extended period, indicating potential weakness. Signs of a painful weak tendon include:

1. Extended Recovery: If your tendon remains sensitive for several days, such as 4, 5, or even 6 days, it suggests weakness because it’s not returning to baseline quickly.

2. Persistent Discomfort: Pain while sitting, standing, or during daily activities continues for an extended period without improvement.

3. Vulnerability: A painful weak tendon is less resilient to flare-ups and takes longer to recover.

Managing a Painful Weak Tendon

  • Find Your New Adaptation Zone: When dealing with a painful weak tendon, don’t push through the pain. Identify exercises and loading strategies that stay within your new, sensitive adaptation zone.
  • Avoid Complacency: While you may be cautious, don’t become complacent. Continue to progress and challenge your tendon to regain strength and resilience.
  • Consider a Biopsychosocial Approach: Address pain as a multifaceted issue, including the physical, psychological, and social aspects. Don’t isolate yourself during flare-ups; seek social support and manage stress.


Understanding the difference between a painful strong tendon and a painful weak tendon is vital for effective PHT management. Remember, sensitivity doesn’t equate to weakness. Celebrate your progress, stay proactive, and find your adaptation zone, whether you have a strong or weak tendon. By following these guidelines, you’ll be on the path to overcoming proximal hamstring tendinopathy and achieving your fitness goals.

Stay tuned for our next episode, where we’ll explore when it’s appropriate to stretch your hamstring tendon. Until then, take control of your rehab journey, and remember that knowledge is power.