High Hamstring Tendinopathy Exercises [Ep37]

High hamstring tendinopathy can be a frustrating injury to overcome, causing buttock pain and pain around the top of the hamstrings.

In this video, I’m going to show you five exercises we almost always give to runners who present with cases of high hamstring tendinopathy, also known as proximal hamstring tendinopathy.

************************

************************

First, we need to understand the nature of the injury.

The clue’s in the title here; high up at the top end of the hamstring muscles we find their common origin, where their tendons insert onto the ischial tuberosity of the pelvis, that's the bony part towards the bottom of your butt cheek.

Being a tendinopathy we know that it’s this conjoined tendon that currently in disrepair. This is very much one of your typical overuse type running injuries, and in my experience comes as a result of chronic overload of the hamstring tendons, usually with a more acute trigger.

What do I mean by overload?

Well, if there’s one thing that tendons don’t particularly enjoy it’s the combination of being compressed while under high tensile loads. They are great at dealing with tension when in an optimal position, but when you add compression, it’s a simple trigger for tendon problems.

Now, because of the specific way in which the tendon attaches to the rear part of the ischial tuberosity near your butt crease, loading the hamstrings in increased amounts of hip flexion will begin to compress the hamstring tendon against the bone. Repeat this excessively and you’re on a fast track to high hamstring tendinopathy.

So what kinds of exercises load the hamstrings in this high hip flexed position?

Well, anything that’s going to force an increased stride length, such as speed work and hill reps. These are also often the aggravating factors that trigger symptoms when runners are trying to train through cases of high hamstring tendinopathy.

Now, when it comes to fixing the injury, it’s important we take this understanding of the injury and it’s anatomy into account. As with most tendinopathies, we need to load the hamstring tendons to stimulate healing and repair, and to build strength in the hamstring muscles themselves - muscular weakness is also a risk factor to tendon problems, don’t forget!

We need to ensure however that we load the hamstrings and their tendons in such a way that doesn’t create this combination of tendon compression under tension. In other words, while initially rehabbing the injury we need to look for hamstring exercises that avoid working into too much hip flexion.

To begin with we focus on isometric exercises such as a simple double leg bridging exercise to help engage the glutes and hamstrings, and load the hamstring origin tendon without flexing the hip.

A simple progression is to incorporate a single leg variety of this isometric hold exercise. The single leg bridge. Most runners find this much tougher than the standard double leg version!

When these become easier, you can progress to working the hamstrings through range of motion at the knee, while still avoiding loaded hip flexion. To begin with, we can use an unloaded exercise such as prone hamstring curls, then add resistance from the other leg to increase eccentric demand on the hamstring muscles and tendon.

************************

************************

ABOUT ME: I'm a runner, sports rehabilitation specialist and coach based in the UK (Norwich and London).

Since 2007 I've been working with athletes focusing specifically on helping distance runners and triathletes overcome injury and improve performance through developing their individual running technique.

Running biomechanics has become a geeky little passion of mine!

************************

[JamesDunne]

*Check out this video next to discover which exercises you MUST AVOID to recover from high hamstring tendinopathy:*

[owkelly]

Thanks for this video James.
I had HHT but it is much better now, nearly 99%lets say.
If it helps anyone reading, it took about a year for it to go. That might be age as I'm over 40. PT like what James shows was the mainstay, single leg curls on a Swiss ball, every day, sometimes 3 times a day. It's tough. I continued to run, even completing marathons but avoided hill work, stretching and speed work. Prone Leg curls at the gym also, heavy resistance, low #of reps. Also added some lifestyle changes around reducing time at a desk sitting and avoiding hard surfaces.

All of the above got me to about 90% in about 3 months which wasn't bad. I struggled to improve after that and sort of plateaued. After 9 months then had 3 sessions of shock wave, 5mins 1 a week for 3 weeks. It helped, about 3 weeks after the last session slowly the pain decreased. Also again the PT was always being done, so it's always needed. I know the science on shock wave isn't great, and I trust science add not gads, but it was a small gamble with no downside. I'm so pleased I did it. I'm certain it wouldn't work on its own.

I hope this helps, it was a really tough one to shake so you have my sympathies if you have it as its very irritating when sitting.

Right now I can sit with no pain run with no pain. My stretch and flexibility on that leg is not great, I'm very slowly building it back.

[effthegop]

Thanks for the information. I'm not a runner but at 71, I am still active in construction work. My flexibility has always been horrible and my adherence to stretching non existent. I stopped playing softball a few years ago in order to avoid potential injury in my old age and I have been strong enough to enjoy my life and work hard. I made the mistake of jumping back into softball at a moments notice and I am paying the price. I told myself, "just jog" but instinct took over and I went down hard. I have only been unable to walk for one full day and it looks like it will be quite a few more before I can walk unassisted.

GAH! I am 100% comfortable in the right position and 100% in sharp pain in the wrong one :) I'm getting around the house with a walker while supporting one foot on the wheel. Im just looking for exercises to do that wont aggravate it. Thanks for the tips. I'l be lucky if I can limp in a week. Thankfully I can sleep well.

[SarahArnoldTheAccidentalArtist]

Very common for ballet dancers as well
~ I appreciate the exercises! Thank you :)

[hemetech]

Timely for me also! I've had this for a long time! Embarrassed to say how long. I do bridges as part of my ab routine, but I have found that foam rolling has helped the best! DON"T roll on the tendon directly, just roll the belly of the muscle only for a couple to a few weeks before trying to go higher toward the butt!

[nikosatsaves]

Thankyouu. I ve pointing my finger at the glutes for so long!!

[bluetickbeagles]

I just got a case of assinitis Lol. Going to utilize your exercises. Training for Spartan Races and need to stay consistent. 💪⚡️

[MaryZeti]

Super helpful...just what I need right now.

[bobbrown]

Thank you for the information. I have stopped the activities that caused the PHT but can I still do spinning at home or other exercises besides those that strengthen the hamstrings and supporting muscles?

[chrism]

How often should these exercises be done?

I am sure I have seen on another video that every second day then check for reaction on 'day off' ?

[h.]

With all the hamstring strength exercises, I know I will have to do hamstring stretches, but can’t with the leg with the HHT. How can I loosen and release the hamstring?

[peggikonvicka]

I have been suffering with this since June 2022 but was in the middle of training for the Dopey challenge in Disney world so worked with a PT until Dec. Dud my races and was told then to take 2 months off from running. In this time I have down spin biking, walking, stair climbing and elliptical. Seems like it got aggravated by the bike, and today the elliptical made it mad. I feel like I can’t win. I’ve read conflicting info on just running here and there and how it’s good for healing. I cannot seem to get better and I don’t know what to do.

[shannainalabama]

I’ve got HHT & have been doing the stability ball & also the glute bridge. I’ve been squeezing my bum when I lift up but when I do the single-legged glute bridge, do I need to squeeze both my left & right glute @ the same time?

[SpidY-TD]

when you got the high hamstring injury (cyclist), is it good to use the foam roller on the hamstrings?or do i need to take some rest untill it heals?

[Sophiemanning]

Can hamstring tendinopathy cause burning sensations in your legs when you are active especially while running or on a stationary bike?

[klporter]

Oops. Last message should read: by the last 20 minutes instead of 0, and trying to get home, instead of yo.

[joedagg]

What about low hamstring tendinopathy?

[JillyBean]

Ughh I’m living this right now. So painful and uncomfortable. 😩