Early Signs of Proximal Hamstring Tendinopathy (PHT)
- Tanner Nyholm
- 3 days ago
- 3 min read
Proximal Hamstring Tendinopathy PHT
- an accumulative overload injury
Like other tendon injuries, proximal hamstring tendinopathy (PHT) doesn’t usually happen from one sudden strain or pop. It’s an accumulative overload, a gradual build-up of small stresses over time that the tendon isn’t able to recover from.
The proximal hamstring tendon attaches high up under the glute, at a bony point called the ischial tuberosity. When irritated, it creates a deep, localised ache just below the gluteal fold.
Symptoms typically build gradually, becoming worse
At the end of training sessions
The day after activity
Or during prolonged sitting, especially on firm chairs or in cars - bucket seats are the worst!
Common Causes & Contributing Factors of PHT
Sudden load increases
Rapid spikes in running distance, hill training, or total time on feet
Adding speed work, plyometrics, or heavier strength loads too quickly
Poor recovery and not listening to your body.
Prolonged sitting
Sitting can place a compressive load directly on the ischial tuberosity and exacerbate symptoms
Long periods in chairs, cars, or office settings can irritate the tendon further after initial increase in load.
Super stiff back can move load to PHT which may get grumpy
Repetitive stretch and tension
Sports or movements involving deep hip flexion and forceful extension such as hurdling, sprinting, kicking, jumping, bounding, or dancing place repetitive stress on the tendon.
Running biomechanics can affect a person's hamstring length with mild hip deviation lengthen causing an ineffective pattern that stretches the tendon as well as reduced hip control.
Relationship between lower back and neural integrity
The lower back can play a major factor with PHT, often those that present with symptoms will have a sore / tight lower back and increased neural sensitivity on the affected side. E.g. SLR
Who’s at Risk?
Long-distance runners (especially hill or trail runners)
Sprinters, hurdlers, and jumpers
Field and court athletes (AFL, soccer, hockey) that involve repeated acceleration and direction change
Dancers and martial artists with frequent hip extension
Cyclist with a poor bike set up
Desk-based workers or anyone spending long hours sitting in the car.
How to test yourself for this inconsistent pain?
Deep, pinpoint pain under the glute, especially when sitting or driving
Tightness or discomfort at the start of a run that eases, then returns later or the next morning.
Pulling or aching when bending forward or stretching the hamstring
Tenderness when pressing just below the gluteal fold
Dragging your foot on the carpet like your trying to remove chewy off your shoes
Feeling sore the next morning after an intense workout or long run.
Treatment
PHT resolves through the typical process of tendon healing, with monitoring of load and pain.
At Move we will educate you on the traffic light system, so you know when you have pushed it too far or what is okay. This is crucial to ensure the tendon is getting enough load, yet not exacerbating symptoms.
Recovery may also include a detailed exercise program, including; isometric strength, dynamic strength and plyometric training. As well as sports-specific exercises and running programs, if necessary.
There is also evidence that suggests NSAID's, shockwave therapy and neural glides can provide additional support alongside appropriate exercise prescription.
Book your FREE physio phone consult – no obligations, just honest advice to help you find the right fit.
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