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. 2025 Jun 2;20(6):892-910.
doi: 10.26603/001c.138308. eCollection 2025.

Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary

Aidan Rich  1   2 , Jillianne Cook  1 , Andrew Hahne  1 , Jon Ford  1   3
Affiliations

Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary

Aidan Rich et al. Int J Sports Phys Ther. .

Abstract

Proximal hamstring tendinopathy (PHT) can occur in active and sedentary people and presents clinically as localised lower buttock pain with activities including prolonged sitting, squatting, and walking uphill or running. A recent systematic review of interventions for PHT reported insufficient evidence to recommend one intervention over another. The most commonly recommended treatment for PHT by experts is education and exercise. Exercise for PHT aims to restore kinetic chain function and loading capacity of the hamstring complex. The purpose of this commentary is to outline an education and exercise program developed for treating PHT utilizing principles successful in clinical trials for other tendinopathies adapted to the specific anatomical and biomechanical considerations of the proximal hamstring complex.

Level of evidence: 5.

Keywords: physiotherapy; proximal hamstring tendinopathy; rehabilitation; shockwave; tendinopathy.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

A diagram of a flowchart Description automatically generated
Figure 1.. Progression through the physiotherapy exercise stages
Diagram Description automatically generated
Figure 2.. Stage 1-Isometric
Legend: * = other exercise options available
Figure 3.
Figure 3.. Single leg hamstring bridge. Exercise can be performed isometrically for Stage 1, or isotonically for Stage 2. (a) starting position, (b) position held in isometric exercise, (c) and (d) show a progression of the exercise with reduced leg support.
Figure 4.
Figure 4.. Stage 2- Isotonic.
Legend: * = other options available, reps = repetitions
Diagram Description automatically generated
Figure 5.. Stage 3- Kinetic Chain.
Legend: conc = concentric, ecc = eccentric, SL = single leg, DL = double leg, reps = repetitions
Figure 6.
Figure 6.. Kinetic chain exercises. Single leg hip thruster to strengthen gluteus maximus and adductors (a) and (b), and standing theraband abduction to retrain lumbopelvic control (c) and (d).
Diagram Description automatically generated
Figure 7.. Stage 4- Compressive loading.
Legend: reps = repetitions, conc = concentric, ecc = eccentric
Figure 8.
Figure 8.. Compression exercises, modified deadlift (a) and modified depth lunge (b)
Diagram Description automatically generated
Figure 9.. Stage 5- Energy Storage and Release.
Legend: NRS = numerical rating scale, reps = repetitions
Diagram Description automatically generated
Figure 10.. Return to running progression
See this image and copyright information in PMC

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