Hamstring Tendonitis Overview

Hamstring tendonitis is a common condition experienced by athletes, regular gym-goers, and older adults alike. The term hamstring tendonitis is often used interchangeably with hamstring tendinopathy, or even a hamstring tear on occasion, however,  tendonitis refers to inflammation of a tendon while tendinopathy is degeneration of specific tissues within the tendon called collagen. If left untreated or severe, both can lead to a tendon tear. Keep reading to learn more about hamstring tendonitis.

Regardless of what it’s called or where it is located, one thing is for certain—hamstring tendonitis hurts!

Read on to discover more about hamstring tendonitis, plus its causes, symptoms, and the many treatments available for this painful and sometimes debilitating condition.

What is Hamstring Tendonitis?

Hamstring tendonitis is essentially inflammation in one or more of the hamstring tendons.

These tendons are the soft tissues that connect the hamstring muscle to local bones essential for effective muscle function. There are three primary bony attachments:

• The middle part of the knee
• The top of the fibula (the small bone on the outside of the knee joint) 
• The Ischial tuberosity (known as the butt bone or sits bones).

These tendons assist the hamstring muscles in generating force for bending the knee, stabilizing the knee and pelvis,  and extending the hip; all essential for daily activities like walking, running, jumping, and kicking.

Both the hamstring muscles and their associated tendons are vital to our everyday activities. Protecting them from strain or injury is important.

Symptoms of Hamstring Tendonitis

It’s typically possible to diagnose hamstring tendonitis based on symptoms alone. In fact, your doctor will ask for a detailed description of your symptoms. Here are the main signs and symptoms of hamstring tendonitis.

• Upper hamstring pain when sitting for long periods
• Sudden, sharp pain in the back of the thigh or back of the knee during physical activity
• Pain that gets gradually worse during physical activity
• Swelling or bruising on the back of the leg
• Persistent weakness in the hamstring
• A dull ache or stiffness when waking

In severe cases, pain and swelling in the thigh and calf.

Hamstring Tendonitis Causes and Risk Factors

You may have hamstring tendonitis for many reasons, ranging from lack of stretching to overuse. Common causes of hamstring tendonitis include:

Overworked Tendon

The number one cause of hamstring tendonitis is working the muscles and tendons too hard, such as carrying heavy loads or repetitive motions.

Overworked tendons and muscles are a common complaint among athletes and people who work out excessively. Additionally, being out of shape and starting a new workout too quickly, or increasing the intensity too quickly, can also lead to hamstring troubles. Fatigued muscles reduce energy-absorbing abilities, which naturally affects the nearby tendons and puts them at a higher risk for injury.

Tight Muscles

If you don’t stretch your muscles regularly (especially before and after exercising) or are genetically predisposed to inflexibility, you likely have tight muscles. This causes increased stress on the hamstring tendons, leading to tendon strain and injury.

Weak or Imbalanced Muscles

We’re not composed of isolated muscles and tendons—all our body parts work together to help us function. If there is an imbalance in one group of muscles, the others have to pick up the slack, putting themselves and their nearby tendons at risk for strain. For example, poor gluteal strength is a common issue with hamstring strains. Strengthening all your muscle groups adequately helps the body cope with physical activity and reduces the risk of injury.

Type of Activity

The risk of hamstring tendonitis is highest among:

• Older adults whose main physical activity is walking
• People who play football, soccer, or basketball
• Runners
• Dancers
• Any activity that involves jumping or kicking

Diagnosing Hamstring Tendonitis

Diagnosis of hamstring tendonitis can often be carried out at home by evaluating your symptoms and using simple flexibility tests. For a more formal diagnosis and treatment plan, it is recommended to see your doctor or physical therapist for a physical exam and imaging to rule out other issues (for example; an x-ray or MRI if needed).

DIY Tests for Hamstring Tendonitis

A 2012 paper outlined three tests to check for the presence of hamstring tendonitis. In the study, the tests showed between 76 and 89% accuracy in diagnosis.

While you can carry out these tests at home, you should follow up with a doctor for a formal diagnosis.

Pain during any of the following tests suggests you have hamstring tendonitis.

• Test 1: Standing Hamstring Stretch

  Simply prop your heel on the seat of a chair. Flex your foot until you feel a stretch in your hamstring. You may need to bend forward slightly at the hips to increase the stretch.

• Test 2: Assisted Hamstring Stretch

  Lie on your back on a mat. Flex your hip and knee, and have another person gently and slowly straighten your knee to stretch out your hamstring.

• Test 3: Fast Assisted Hamstring Stretch

  In the same position as the second test, flex your hip and knee. Straighten your knee quickly, rather than slowly.

Professional Diagnosis of Hamstring Tendonitis

Your doctor will diagnose your hamstring tendonitis primarily based on a physical exam, but imaging techniques may also be used. As part of the physical exam, the doctor will take a full medical history and inquire about your symptoms. They may also apply pressure to the back of your thigh to check for pain or inflammation in addition to testing your overall strength, flexibility, and lower leg coordination.

If the doctor does not have enough information from the physical exam, or if your symptoms are severe, they may order imaging techniques, such as an X-ray or an MRI scan. These scans also help rule out complications. An X-ray can highlight a hamstring tendon avulsion—when the tendon separates from the bone. MRI scans are used to indicate other kinds of damage to the hamstring muscles, tendons, and other soft tissues.

Hamstring Tendonitis Recovery Time

After hamstring tendon injuries, a common question is, “Does hamstring tendonitis go away?” And, “what are my treatment options?” Hamstring tendonitis recovery time varies depending on the severity of your injury and on your overall fitness level. One thing is for sure—early intervention is key to a speedy recovery.

• The vast majority of people fully recover from hamstring tendonitis.

• Most people using non-invasive treatments can expect the recovery period to last three to six months.

• Surgery is typically not recommended for this type of injury, unless it has become severe enough to cause a tear or avulsion. Surgery will require a longer period of rest and take additional time to fully recover and return to previous activities.

Learn more about using the RICE protocol (rest, ice, compression, and elevation), taking anti-inflammatory medications like ibuprofen, and participating in hamstring exercises or physical therapy tend to enjoy better and quicker results.

Research suggests that the risk of re-injury is a major problem in cases of hamstring tendonitis. Once you’re fully healed, take all the necessary steps to prevent recurrence with a balanced program that emphasizes adequate flexibility and strengthening exercises. Otherwise, you risk permanent damage and a chronic hamstring condition.

Prevent Hamstring Tendonitis

All three muscles comprise the hamstrings (the semimembranosus, semitendinosus, and biceps femoris) and play a vital role in our physical functioning. Taking care of our hamstring tendons and muscles is imperative to our overall health and wellbeing. If you're experiencing hamstring pain, consult with your sports medicine doctor to find the best recovery regimen for you; the sooner the better to prevent unnecessary complications.

By respecting our muscles and tendons and the work they do, and by providing them with adequate rest and support, we can avoid hamstring tendinitis and enjoy a full range of mobility and flexibility, now and for years to come!