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Low Hamstring Tendonitis | FAQs

Minute Read


Posted 9 months ago


Last updated: 21/05/2023


by James McCormack

What is Low Hamstring Tendonitis?

Low Hamstring tendonitis, also known as distal hamstring tendinopathy, is a painful condition that affects the hamstring tendons. There are 3 hamstring tendons; the Semitendinosus, Semimembranosus, and Bicep Femoris.

The proximal (high) tendons attach to the ischial tuberosity of the pelvis, and the distal (low) tendons attach below the knee. Tendonitis at the distal tendons is often called low hamstring tendonitis; at the ischial tuberosity, it is called high hamstring tendonitis or proximal hamstring tendonitis.

Hamstring Tendonitis is a degenerative condition resulting from a sudden overload or progressive tendon overuse. The symptoms of distal hamstring tendinopathy are stiffness first thing in the morning and pain at the back of the knee at the start of exercise, such as running, which improves as the tendon warms up.

The best form of treatment for low hamstring tendonitis requires a supervised strengthening programme over a period of 8-12 weeks that a Physical Therapist supervises.

Photo of man with hamstring pain

How do you know if you have hamstring tendonitis?

Low hamstring tendonitis will present as pain and possible stiffness at the back of the knee, with pain on palpation or squeezing the hamstring tendons on the back of the knee.

Sometimes, the tendons may feel thicker than those on the opposite leg. In most cases, tendonitis starts after an increase in activity, which might be an increase in volume or intensity or taking up a new sport.

You should see a physical therapist or sports doctor to confirm your suspected diagnosis. They will perform a physical examination and may wish to get additional confirmation from diagnostic imaging.

How to relieve hamstring tendonitis?

Treatment to reduce pain from hamstring tendonitis varies depending on the severity of your symptoms and how long you have had the symptoms.

Complete rest and ice are needed for some acute cases to reduce pain intensity.

For other, more chronic cases, some targeted activation of the hamstring muscles in the form of isometric contraction (a static hold) can reduce pain (Rio et al, 2015). This is progressed to an isotonic loading programme that includes exercises such as a prone hamstring curl, single leg deadlift and long lever bridges.


How long does hamstring tendonitis last?

In our experience, Hamstring tendonitis lasts 6-12 weeks. 

If the symptoms of Hamstring tendonitis are quickly identified and the correct treatment quickly begins, it can take 6 weeks to recover. 

If a patient has long-standing hamstring tendonitis, it can take up to 12 weeks to recover under the guidance of a Physical therapist.

The general health of the individual will affect healing time as well as specific lifestyle factors; drinking alcohol and smoking will both increase recovery time.

Man waiting with hour glass

How do you strengthen hamstring tendonitis?

Strengthening for hamstring tendonitis can be done in many ways, and depending on what phase of recovery you are in, it will affect your selection of strengthening style.

Early hamstring tendonitis strengthening may be in the form of static resistance, also called isometric holds, such as a bridge position hold. Later stages may use slow movements through the inner range of the muscle (the short position of the muscle), such as a hamstring curl. Then building up to movements through the full range, including the outer range (lengthened position), such as a straight leg deadlift.

The final stages may work on faster movements, more powerful contractions, and functional movements. You should follow the guidance of an experienced physical therapist to ensure you get the most out of your time and effort rehabilitating. 

Bridge Exercise

A bridge exercise with your knees at 90º is a great way to work your hamstrings and glute muscles. It can strengthen the hamstring while keeping it is a short position and is unlikely to irritate the tendon.

Photo of man doing a double leg bridge

Long Lever Bridge

A long lever bridge is a great progression, still keeping the hamstrings in a relatively short position, so it is unlikely to irritate the tendons. But with more load as the knee is at a smaller angle of flexion.

Pictuer of James McCormack doing a Long Lever Bridge exercise

Why is it taking so long for my hamstring to heal?

If it is taking longer than expected to heal, then firstly check that your expectations are correct. Tendons are slow to fully heal. While it might only be a few weeks for an acute injury on a health strong body, it can take much longer for a chronic injury on an older and/or weaker body. 

Factors that will increase the healing time of a hamstring tendon include: general health of the individual, the tendon health prior to injury, the duration of symptoms, severity of symptoms, consumption of alcohol, smoking status and, quality and duration of sleep. That is, along with the physical loading of the tendon and the relative rest of the tendon. In many cases, the balance between loading and rest is not there, and this is the prime reason for the recovery taking longer than hoped.

Can massage help hamstring tendonitis?

Massage can help hamstring tendonitis by reducing spasm and relaxing muscles. Massage is often used for these benefits with musculoskeletal injuries, to improve healing and speed up recovery time.

Deep tissue massage is effective for relaxation and reducing tone. Deep transverse friction massage can be helpful for short-term pain relief. 

Does foam rolling help hamstring tendonitis?

Foam rolling has benefits similar to massage, but the bonus that it is possible to do at home, more frequently, and at a fraction of the cost.

Deep pressure moving through the muscle or held on tight points along the muscle can help to reduce tendon and tone. This can help tendonitis be reducing the load on the tendon at rest.

picture of two people Running w

Can you run through hamstring tendonitis?

Yes, in the majority of cases, you can continue to run with hamstring tendonitis.

We rarely recommend patients to stop running with Hamstring tendonitis as it can lead to deconditioning of the tendon, but it is important to modify your running.

Consider avoiding uphill running and avoid high-end pace running or intervals. Increase the rest period between runs and replace them with non-impact activities.

If you plan to continue running with your injury, you should consult your physical therapist to check if this is sensible. They can assess your running style and ensure this does not negatively impact your recovery time.

Essentially, it depends on how running affects your symptoms. Here are 3 good rules to follow:

  • Pain less than 4/10 during your run
  • Pain settles within 2 hours of finishing run
  • No more stiffness or pain the next day

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments weekly.

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