Hamstring tendinopathy

Hamstring tendinopathy occurs when the tendons connecting your hamstring muscles to your pelvis or lower leg become irritated or damaged. Because these tendons are essential for walking, running and maintaining balance, this condition can make everyday activities like sitting, walking or exercising uncomfortable and frustrating. With the right care, most people recover well and return to the activities they enjoy.

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A detailed diagram of human leg muscles with labels: Gluteus maximus, Adductor magnus, Semimembranosus, Biceps femoris, Gracilis, Semitendinosus.

Anatomy of the thigh

The hamstrings are a group of three muscles, the biceps femoris, semitendinosus and semimembranosus, located along the back of your thigh. These muscles originate from a bony area in the lower pelvis called the ischial tuberosity, often referred to as the sit bone, and attach to the bones of the lower leg.

Together, the hamstrings allow you to bend your knee and move your leg backward. Because they're active during nearly every step you take, these muscles and tendons are under constant demand. When the tendons become inflamed or begin to degenerate, pain often develops near the sit bone or behind the knee and may take time to heal without proper treatment.

Overview

Symptoms

You may be experiencing hamstring tendinopathy if you notice:

A deep, aching or sharp pain in the buttock or upper thigh
Pain that worsens with running, climbing hills or sitting for long periods
Tenderness near the bone or behind the knee
Stiffness or tightness in the back of the thigh, especially in the morning
Weakness or discomfort when bending the knee or extending the hip

Symptoms often begin gradually and may fluctuate with activity before becoming more persistent.

Causes

Hamstring tendinopathy may develop gradually from repetitive strain (see overuse injuries) or occur after a specific injury. Common contributing factors include:

Repetitive activities such as running, cycling or prolonged sitting
Sudden overload, sprinting or overstretching injuries
Inadequate warm-up or poor flexibility before exercise
Muscle imbalances between the hamstrings and quadriceps
Weak core or hip muscles that alter body mechanics
Age-related tendon changes or previous hamstring injuries that didn't fully heal

Understanding what led to your injury helps our specialists recommend the most effective treatment plan.

Risk factors

Certain factors can make you more likely to develop hamstring tendinopathy, though having one or more of these does not mean you'll experience this condition:

Participating in running, cycling or other repetitive lower-body activities
Sitting for long periods throughout the day
Poor flexibility or inadequate warm-up before exercise
Muscle imbalances between the hamstrings and quadriceps
Weak core or hip muscles
A previous hamstring injury that didn't fully heal
Increasing age

Knowing your risk factors can help you and your care team take steps to protect your hamstring tendons.

Diagnosis

Our orthopedic specialists take a thorough, patient-centered approach to diagnosis. Your evaluation may include a detailed medical history and discussion of your activity level, a physical examination to assess tenderness, strength and flexibility, and range-of-motion and muscle balance testing. Imaging studies, such as MRI or ultrasound, may also be used to confirm tendon involvement and rule out other conditions — see sports injury evaluation and imaging. We explain your results clearly, so you understand your diagnosis and next steps.

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We offer leading-edge treatments for most sports medicine conditions, treating many with medications, bracing, injections and therapy.

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