Proximal Hamstring Tendinopathy and Tendon Tears

Proximal hamstring tendinopathy is under-recognized and affects athletes and non-athletes, with one study putting it at about 12% of distance runners. Compression aggravates it: sitting, stretching, deadlifts, deep squats, lunges and running. Palpation along the ischial tuberosity can help, but a negative finding does not rule it out. The speaker demonstrates loading tests: double- and single-leg hinges at increasing speed, squats, a shoe-removal test, the Puranen-Orava test, the modified bent knee stretch test, a measured hip flexion and knee extension angle, and active knee flexion at 30 and 90 degrees. If one test is positive, the rest are not needed. Management covers education that recovery can take up to 12 months, pain up to 4 or 5 out of 10 during activity, less sitting, load management, progressive hamstring and hip strengthening, and running gait changes. Shockwave may help, but the tendon should not be frictioned. A tear has a sudden onset, often with a pop, bruising and clear weakness. On MRI, separation over 2 cm indicates surgery; under 2 cm can be managed conservatively.