Proximal Hamstring Tendinopathy: An Evidence-Based Guide for Physical Therapists
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In today's video we go over, Proximal Hamstring Tendinopathy: An Evidence-Based Guide for Physical Therapists - FPF Show Episode 189:
- 00:00 What PTs Need to Know About Proximal Hamstring Tendinopathy
- 00:00:31 What Actually Defines Tendinopathy (Pain vs Imaging)
- 00:01:17 Tendon Loading 101: Tensile vs Shear vs Compression
- 00:02:56 Why Hip Flexion = More Compressive Load at the Ischial Tuberosity
- 00:03:28 Free PHT Cheat Sheet (Ad Break)
- 00:04:30 Exercise Selection: Neutral Hip vs Flexed Hip Loading
- 00:05:13 Prevalence & Imaging Reality Check (MRI ≠ Symptoms)
- 00:08:27 Relevant Anatomy: Semimembranosus vs Conjoint Tendon
- 00:11:00 Perimenopausal Considerations & Hormonal Influence
- 00:11:47 Running Biomechanics: Late Swing & Early Stance Demands
- 00:13:01 Coaching Runners: Pelvic Tilt, Trunk Lean & Overstriding
- 00:14:47 End-Stage Rehab for Athletes: Eccentrics, B-Skips & Sprint Prep
- 00:16:23 Mechanism of Injury: Training Errors & Load Spikes
- 00:17:31 Excessive Stretching as a Risk Factor (Yoga/Pilates Trap)
- 00:18:47 Intrinsic Risk Factors: Age, BMI, Hormones, Medications
- 00:19:54 Insiders Academy Promo (Ad Break)
- 00:22:19 Fluoroquinolones & Tendon Rupture Risk
- 00:23:00 Hormone Replacement Therapy & Tendon Pain
- 00:24:01 Compression Debate: When to Unload vs Reload
- 00:26:22 Pathogenesis: What’s Happening Inside the Tendon
- 00:28:29 Clinical Presentation: “Sit Bone” Pain Patterns
- 00:29:54 Warm-Up Effect & 24-Hour Pain Monitoring Model
- 00:31:13 Squatting & Compressive Load Considerations
- 00:31:35 Objective Testing: Max Hip Flexion + Active Knee Extension
- 00:32:20 Strength Testing: Dynamometry & Length-Specific Testing
- 00:32:55 Functional Testing: Jumps, Sprinting & Return-to-Run
- 00:37:34 Clinical Test Cluster for Diagnosis (Arabesque, Bridge, Sitting)
- 00:38:53 Imaging: MRI vs Ultrasound — What Matters?
- 00:41:00 Imaging Doesn’t Always Match Pain
- 00:43:19 Differential Diagnosis: Sciatic, Stress Fracture, Avulsion & Lumbar Referral
- 00:45:00 When It’s Hard to Tell: Radicular vs Tendon Presentation
- 00:45:48 Final Thoughts + Insiders Academy + Hamstring Strain Video
Hamstring tendons are the best...
- Dan Pope DPT,OCS,CSCS
Show Notes / Relevant Articles:
- FPF Mini Course - 7 Reasons Why Injuries Happen in the Gym and What to do About it
- What Physical Therapists NEED to Know About Hamstring Strain Injuries
- Patellofemoral Pain MASTER Class
- What Physical Therapists Need to Know About Adult Hip Dysplasia
- What Physical Therapists Need to Know About Femoral Acetabular Impingement Syndrome
- Femoral Acetabular Impingement Treatment WITHOUT Surgery! [Physical Therapist's Guide]
Want to earn some CEUs for physical therapists, physical therapy assistants & ATCs for watching this content? Click HERE to sign up for FPF "Insiders Academy" for just a dollar. You can earn CEUs for watching this content. Plus, you'll gain access to over 14 MASTER courses, 50+ cheat sheets, 100+ webinars, e-books and complete guides. You'll also get private access to the "Insiders Academy" community where you can have all of your questions answered by me.
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Thank you!
Dan Pope DPT, OCS, CSCS
References:
Millar NL, Silbernagel KG, Thorborg K, Kirwan PD, Galatz LM, Abrams GD, Murrell GAC, McInnes IB, Rodeo SA. Tendinopathy. Nat Rev Dis Primers. 2021 Jan 7;7(1):1. doi: 10.1038/s41572-020-00234-1. Erratum in: Nat Rev Dis Primers. 2021 Feb 3;7(1):10. doi: 10.1038/s41572-021-00251-8. PMID: 33414454.
Cardoso TB, Pizzari T, Kinsella R, Hope D, Cook JL. Current trends in tendinopathy management. Best Pract Res Clin Rheumatol. 2019 Feb;33(1):122-140. doi: 10.1016/j.berh.2019.02.001. Epub 2019 Mar 8. PMID: 31431267.
Goom TS, Malliaras P, Reiman MP, Purdam CR. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management. J Orthop Sports Phys Ther. 2016 Jun;46(6):483-93. doi: 10.2519/jospt.2016.5986. Epub 2016 Apr 15. PMID: 27084841.
Rich A, Cook J, Hahne A, Ford J. Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary. Int J Sports Phys Ther. 2025 Jun 2;20(6):892-910. doi: 10.26603/001c.138308. PMID: 40469642; PMCID: PMC12129629.
De Smet AA, Blankenbaker DG, Alsheik NH, Lindstrom MJ. MRI appearance of the proximal hamstring tendons in patients with and without symptomatic proximal hamstring tendinopathy. AJR Am J Roentgenol. 2012 Feb;198(2):418-22. doi: 10.2214/AJR.11.6590. PMID: 22268187.
Load, Overload, and Recovery in the Athlete: Select Issues for the Team Physician—A Consensus Statement. Medicine & Science in Sports & Exercise 51(4):p 821-828, April 2019. | DOI: 10.1249/MSS.0000000000001910
Thompson SM, Fung S, Wood DG. The prevalence of proximal hamstring pathology on MRI in the asymptomatic population. Knee Surg Sports Traumatol Arthrosc. 2017 Jan;25(1):108-111. doi: 10.1007/s00167-016-4253-4. Epub 2016 Aug 4. PMID: 27492382.
Rich ALF, Cook JL, Hahne AJ, Ford JJ. A pilot randomised trial comparing individualised physiotherapy versus shockwave therapy for proximal hamstring tendinopathy: a protocol. J Exp Orthop. 2023 May 25;10(1):55. doi: 10.1186/s40634-023-00615-x. PMID: 37227516; PMCID: PMC10212870.
Crowe LAN, Akbar M, de Vos RJ, Kirwan PD, Kjaer M, Pedret C, McInnes IB, Siebert S, Millar NL. Pathways driving tendinopathy and enthesitis: siblings or distant cousins in musculoskeletal medicine? Lancet Rheumatol. 2023 May;5(5):e293-e304. doi: 10.1016/S2665-9913(23)00074-7. PMID: 38251592.