Why your hamstring tendinopathy isn’t getting better with Maryke Louw

Title: Proximal Hamstring Tendinopathy: 5 Key Insights for Effective Treatment


Proximal Hamstring Tendinopathy (PHT) can be a debilitating condition for athletes and non-athletes alike. In this podcast episode transcript, we discuss five crucial insights with Mareika Lowe, an online physiotherapist and creator of the Run Smarter series. Whether you’re battling PHT or seeking to prevent it, Mareika’s expertise can guide you in the right direction.

  1. Addressing Compression

Compression plays a significant role in PHT, and understanding how to manage it is the first step. Sitting for extended periods or sitting in uncomfortable positions can aggravate the tendon around the sit bone. To combat this, consider investing in a sit-stand desk, allowing you to alternate between sitting and standing. Remember that sitting capacity is different from running capacity, and gradual progression is key. Avoid hamstring stretches and exercises that increase compression on the tendon, as these can exacerbate the condition. It’s not only about avoiding compression; you must also build the tendon’s capacity to handle compression loads again.

  1. Exercise Choice

Exercise selection is critical in PHT rehabilitation. Many individuals jump into high-load training, such as squats and deadlifts, without considering their tendon’s sensitivity. Start with isometric exercises and movements that don’t compress the tendon. Test how your tendon responds to exercises like squats and deadlifts without weights before gradually adding weight. It’s essential to match the weight to the tendon’s capacity, not just your muscle strength. Tailor your exercise program to your specific needs, and don’t rush into heavy lifting.

  1. Dosage Matters

The dosage of exercises and training sessions is a crucial factor in managing PHT. No two individuals are the same, and recovery rates can vary based on age, gender, and other factors. Tendons take longer to recover than muscles, so it’s vital to consider when you schedule strength training in relation to running. Overloading the tendon can lead to cumulative stress. Dosages must be personalized, and you should pay attention to your body’s response, adjusting your training accordingly. Severity and individual differences should guide your choices.

  1. Fear of Sitting

Overcoming the fear of sitting is a psychological aspect of PHT treatment. Many patients who experience PHT pain develop a fear of sitting due to the discomfort it causes. Mareika Lowe highlights the importance of making the tendon accustomed to compression again, emphasizing that compression is necessary for healthy tendons. This psychological component of PHT management should not be overlooked.

  1. Patience and Progression

Patience is key in PHT rehabilitation. Trust the process and don’t rush. Building strength and tolerance in a tendon takes time, often several months. Remember that PHT is a spectrum of conditions, and the dosage and progression depend on your individual situation. Clinical reasoning and experience play a crucial role in tailoring your treatment.

Understanding Proximal Hamstring Tendinopathy

Before delving into the insights offered by Marika Hart, let’s take a moment to understand what proximal hamstring tendinopathy is. This condition primarily affects the tendons connecting the hamstring muscles to the pelvis, specifically near the sitting bones. It can be a nagging and persistent issue, causing pain, discomfort, and a range of symptoms that may impact daily life and physical activity.

Expert Insights on Proximal Hamstring Tendinopathy

Marika Hart, an experienced sports injury physiotherapist, has shared her valuable insights on managing proximal hamstring tendinopathy. Here are some of the key takeaways from her discussion:

1. Clinical Reasoning and Individualized Care

One of the significant challenges in managing proximal hamstring tendinopathy is that each patient is unique. Marika emphasizes the importance of clinical reasoning and individualized care. As a physiotherapist, understanding why you recommend certain exercises or interventions is crucial. It’s not just about what you do but why you do it, taking into account the patient’s specific needs and condition.

2. Continuous Communication and Symptom Monitoring

Proximal hamstring tendinopathy isn’t a one-size-fits-all condition. Marika stresses the importance of open communication and continuous monitoring of symptoms. Patients need to be aware of how their body responds to treatment and exercise. Adjustments might be necessary to find the right balance between load and recovery. For online clients, timely communication is essential to address any flare-ups promptly.

3. The Role of Exercise Speed and Dosage

The speed at which exercises are performed can have a significant impact on managing proximal hamstring tendinopathy. Marika advocates a gradual approach, favoring slow and controlled movements, especially in the initial phases of rehabilitation. As patients progress and return to running or more dynamic activities, speed can be gradually introduced. The key is to strike the right balance between building strength and avoiding overloading the tendon.

4. Realistic Expectations for Recovery

Patience is crucial when dealing with proximal hamstring tendinopathy. Marika emphasizes the need for realistic expectations. Recovery is not a linear process, and there may be days when symptoms worsen without apparent reason. It’s essential for patients to understand that tendons take time to adapt and strengthen. A long-term perspective is vital, and tracking progress can help reassure patients that they are on the right path.

5. Addressing Beliefs and Fear Avoidance

Beliefs play a significant role in the management of proximal hamstring tendinopathy. Patients may encounter conflicting information online or develop fear avoidance behaviors. Marika highlights the importance of addressing these beliefs. It’s essential to understand that pain perception can be influenced by beliefs, and gradually rebuilding confidence in movement and exercise can be a powerful tool in managing this condition.


Proximal Hamstring Tendinopathy can be a persistent and challenging condition, but with the right knowledge and approach, you can take steps towards recovery. Understanding the importance of managing compression, choosing the right exercises, dosing appropriately, and addressing psychological factors are all essential components of effective PHT treatment. Remember to be patient, trust the process, and seek personalized guidance for your unique situation.

Proximal hamstring tendinopathy can be a challenging condition to manage, but with the right knowledge and guidance, patients can find relief and regain their quality of life. Marika Hart’s expert insights offer a valuable roadmap for physiotherapists and individuals dealing with this condition. By emphasizing individualized care, continuous communication, and realistic expectations, and addressing beliefs and fear avoidance, it’s possible to make significant progress in the management of proximal hamstring tendinopathy. Remember, knowledge is power, and with the right approach, a pain-free future is within reach.