What is a tendinopathy? Understanding the basics

Understanding Proximal Hamstring Tendinopathy: A Comprehensive Guide


Let’s unravel the mysteries of proximal hamstring tendinopathy. In this podcast episode, we’ll delve into the anatomy, causes, symptoms, and risk factors associated with this condition. So, whether you’re an athlete or not, you will gain valuable insights and debunk common misconceptions. Before we plunge into the specifics of proximal hamstring tendinopathy, let’s quickly recap our previous episode. If you haven’t tuned in yet, I recommend checking out Episode 1 for foundational knowledge on tendinopathy, as it lays the groundwork for our discussion today.

What is Tendinopathy?

Grasping the Essentials

  1. Definition and Continuum:
  • Tendinopathy is a disorder causing pain, swelling, and impaired function of the tendon.
  • Brodie introduces the tendon structure continuum, outlining phases from a healthy tendon to a reactive, disrepair, and degenerative stage.
  1. Types and Terminology:
  • Brodie navigates through tendinitis, tendinosis, and tendinopathy, favoring the latter term in physiotherapy.
  • Jill Cook and Ebony Rio’s tendonopathy continuum model is spotlighted, emphasizing stages of tendon irritation throughout its lifecycle.
  1. Why Tendinopathies Occur:
  • Overload: Brodie discusses the impact of excessive load, citing spikes in training, terrain changes, and inadequate recovery.
  • Compression: Insights into how tendon compression, whether from sitting or altered biomechanics, contributes to tendinopathies.
  • Lack of Recovery: The importance of factors like sleep, diet, stress, and certain vitamins in maintaining tendon load tolerance.
  1. Risk Factors:
  • Age, BMI, high cholesterol, hypertension, diabetes, and medication usage emerge as potential risk factors for tendinopathies.
  1. Biomechanics vs. Load Management:
  • Brodie stresses that while biomechanics play a role, they are less significant compared to overload, compression, and recovery factors.

Understanding Proximal Hamstring Tendinopathy: The Basics

1. Anatomy

To understand proximal hamstring tendinopathy, let’s start with the anatomy. The hamstring muscles transition into tendons, attaching to the ischial tuberosity, also known as the sitting bone. The location of tendon pathology can vary, and studies show considerable variability among individuals.

2. Causes

Proximal hamstring tendinopathy is often triggered by factors like compression and tensile load. Tensile factors, such as increased speed in activities like running, can elevate the demand on the tendon. Compression factors, like hip flexion during activities such as running uphill or cycling, also contribute to the condition.

3. Symptoms

Symptoms typically manifest as deep, localized pain around the sitting bones and worsen after activities like running, squatting, or sitting. The characteristic warm-up effect, where symptoms lessen as the tendon warms up during activity, is common in the early stages.

Tests and Differential Diagnoses

1. Show Off Test

One at-home test involves standing, wearing shoes, and bringing the heel to the front of the other foot, simulating a scraping motion. If this triggers pain in the high buttock area, proximal hamstring tendinopathy may be implicated.

2. Wall Test

Stand close to a wall, back against it, and lift the symptomatic leg, attempting to press the heel into the wall. Pain during this test could indicate proximal hamstring tendinopathy.

3. Differential Diagnoses

If symptoms become diffuse or spread to other areas, it might suggest involvement of the lumbar spine, hip, sacroiliac joint, or nerve-related issues. Seeking professional assessment is crucial for an accurate diagnosis.

Risk Factors

Excessive static stretching, as in certain yoga or Pilates postures, is suggested as a potential risk factor. Awareness of these risk factors can aid in preventing flare-ups and managing the condition effectively.


Understanding proximal hamstring tendinopathy involves grasping the anatomy, recognizing causative factors, and being aware of symptoms and risk factors. Stay tuned for the next episode, where we’ll explore tendon rehab and prevention strategies. Remember, knowledge is power in taking control of your rehabilitation journey.