Proximal Hamstring Tendinopathy

Explanation of Diagnosis

Proximal hamstring tendinopathy is irritation and degeneration of the hamstring tendon where it attaches near the sit bone in the back of the pelvis. It often develops after repeated overuse such as sprinting, hills, sudden acceleration, heavy lifting, or prolonged sitting that loads the tendon. Common symptoms include pain and stiffness at the sit bone, soreness with running or bending at the hips, and discomfort when pushing off or rising from a seated position. Symptoms usually fluctuate, and they may feel worse the day after activities.

Specific Work Modifications

• Take brief standing or walking breaks every 20 to 30 minutes if your job involves sitting.
• Use a supportive chair and consider a footrest to reduce constant hip bending.
• Avoid long periods of leaning forward; try to keep your torso more upright when possible.
• When lifting, use a hip hinge with a neutral spine rather than bending deeply at the waist.
• Limit stair climbing, ladders, kneeling, and squatting on days symptoms flare.
• If you drive or commute, adjust the seat so your hips are not forced into deep flexion for long stretches.

Specific Activity Modifications

• Reduce or pause running, sprinting, and hill work until pain is calming and you can tolerate normal daily movement.
• Temporarily avoid deep hamstring stretching and aggressive range of motion that reproduces the sit bone pain.
• Modify strength training by stopping hamstring curls, heavy deadlifts, and high-resistance hip hinges that cause tendon pain.
• For cardio, switch to lower-load options like flat walking, swimming, or easy cycling with low resistance.
• Choose activities that keep a comfortable hip position and avoid sudden acceleration, jumping, or twisting.
• Use a gradual return: resume only the activities that stay at mild symptom levels during and after.

Recommended Supplements

• Omega-3 fish oil 1 to 2 grams combined EPA and DHA daily may help support a healthier inflammatory balance in soft tissue.
• Curcumin 500 to 1000 mg daily may help reduce discomfort for some people with musculoskeletal overuse.
• Collagen peptides 10 grams daily may support tendon and connective tissue nutrition when paired with loading and rehab.

Recommended Nutrition and Hydration

Diet Recommendations

• Aim for adequate protein with each meal to support tissue repair, especially from foods like eggs, fish, poultry, beans, and Greek yogurt.
• Include colorful fruits and vegetables daily to supply antioxidants that support overall recovery.
• Choose healthy fats such as olive oil, nuts, and fatty fish rather than frequent highly processed foods.
• Stay consistent with meals and avoid frequent crash dieting, which can slow recovery.
• Limit alcohol if you notice it worsens pain or sleep.

Hydration Tips

• Drink enough fluids so your urine is pale yellow, especially on training and work days.
• Use water regularly throughout the day rather than trying to catch up all at once.

Home Exercise Prescription

Do these exercises 4 to 5 days per week, and keep symptoms at a mild level while you work through them.

1. Hamstring Isometric Press - Sit or lie with your knee at a comfortable angle, then gently press the heel into a firm surface or strap without moving the joint, hold steady and controlled - 5 holds of 30 seconds, with 60 to 90 seconds rest between holds.
2. Glute Bridge - Lie on your back with knees bent, tighten your glutes and lift your hips until you are in a straight line from shoulders to knees, then slowly lower - 3 sets of 8 to 12 reps.
3. Supported Hip Hinge Practice - Hold a counter or wall for balance, shift your hips back as if closing a car door, keep a neutral spine, then return upright - 2 to 3 sets of 8 reps.
4. Clamshells - Lie on your side with knees bent, keep your feet together and open your top knee without rolling your hips, then close slowly - 2 to 3 sets of 10 to 15 reps per side.
5. Gentle Hip Flexor Stretch - Kneel with one knee down or use a supported lunge position, gently tuck your pelvis and move into a mild stretch at the front of the hip, not the hamstring attachment - 2 holds of 30 seconds per side.

Stop any exercise that causes sharp pain, new numbness, or rapidly worsening symptoms.

Helpful Books

• "Explain Pain" written by David Butler and Lorimer Moseley
• "The Way Out" written by Alan Gordon
• "Back Mechanic" written by Stuart McGill