{"id":66094,"date":"2026-10-12T07:24:33","date_gmt":"2026-10-12T12:24:33","guid":{"rendered":"https:\/\/osteomag.ca\/?p=66094"},"modified":"2026-10-12T07:24:33","modified_gmt":"2026-10-12T12:24:33","slug":"proximal-hamstring-tendinopathy-pain-and-return-to-activity","status":"publish","type":"post","link":"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/","title":{"rendered":"Proximal Hamstring Tendinopathy: Pain and Return to Activity"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_89 counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #000000;color:#000000\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #000000;color:#000000\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 eztoc-toggle-hide-by-default' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Understanding_pain_below_the_buttock_and_rebuilding_capacity\" >Understanding pain below the buttock and rebuilding capacity<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Hamstring_attachments_near_the_ischium\" >Hamstring attachments near the ischium<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Load_recovery_and_tendon_sensitivity\" >Load, recovery and tendon sensitivity<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Why_sitting_or_hip_flexion_may_be_uncomfortable\" >Why sitting or hip flexion may be uncomfortable<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Distinguishing_nearby_sources_of_pain\" >Distinguishing nearby sources of pain<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Acute_injury_and_tendinopathy_follow_different_pathways\" >Acute injury and tendinopathy follow different pathways<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#An_examination_connecting_symptoms_to_tasks\" >An examination connecting symptoms to tasks<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#When_imaging_becomes_useful\" >When imaging becomes useful<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Reducing_irritating_loads_without_stopping_every_activity\" >Reducing irritating loads without stopping every activity<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Gradually_rebuilding_strength_and_range\" >Gradually rebuilding strength and range<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Stretching_and_shockwave_therapy_avoiding_automatic_prescriptions\" >Stretching and shockwave therapy: avoiding automatic prescriptions<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#Returning_to_running_and_sporting_demands\" >Returning to running and sporting demands<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/osteomag.ca\/en\/proximal-hamstring-tendinopathy-pain-and-return-to-activity\/#The_complementary_role_of_osteopathy\" >The complementary role of osteopathy<\/a><\/li><\/ul><\/nav><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Understanding_pain_below_the_buttock_and_rebuilding_capacity\"><\/span>Understanding pain below the buttock and rebuilding capacity<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Deep pain below the buttock can appear during running, acceleration or after prolonged sitting. When it is near the bone we sit on and responds to hamstring loading, proximal tendinopathy may be considered. However, location alone is insufficient for diagnosis: the lower back, hip, a nerve or an acute injury can produce similar discomfort [<a style=\"color:#076bb5\" href=\"#reference-1\">1<\/a>].<\/p>\n<p>The aim is to connect the history, symptoms and function. An MRI abnormality does not automatically identify the pain source. Nor does a feeling of tension require intense stretching. A coherent assessment helps adjust loads and rebuild the capabilities needed to work, sit and participate in sport.<\/p>\n<aside>\n<p><strong>After an accident or with unusual signs<\/strong><\/p>\n<p>A sudden pop with bruising, abrupt loss of strength or substantial difficulty walking requires prompt assessment. Progressive weakness, marked numbness, fever or unusual constant pain also warrants consultation.<\/p>\n<\/aside>\n<h2><span class=\"ez-toc-section\" id=\"Hamstring_attachments_near_the_ischium\"><\/span>Hamstring attachments near the ischium<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The hamstrings lie at the back of the thigh. Semitendinosus, semimembranosus and the long head of biceps femoris attach proximally to the ischial tuberosity, beneath the buttock. The short head of biceps femoris originates on the femur and does not share this upper attachment. This distinction matters when discussing the proximal tendons rather than every pain at the back of the thigh [<a style=\"color:#076bb5\" href=\"#reference-6\">6<\/a>].<\/p>\n<p>The hamstrings contribute to hip extension and knee flexion. They work during brisk walking, running and changes of speed. Knee and hip position influences loading. The sciatic nerve passes near their origin, making attention to neurological symptoms essential [<a style=\"color:#076bb5\" href=\"#reference-5\">5<\/a>].<\/p>\n<p>Tendinopathy describes persistent tendon pain and reduced function related to mechanical loading. The term does not mean that a tendon is simply worn out or necessarily inflamed. Structural changes, symptoms and tolerance of effort do not match perfectly [<a style=\"color:#076bb5\" href=\"#reference-2\">2<\/a>].<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Load_recovery_and_tendon_sensitivity\"><\/span>Load, recovery and tendon sensitivity<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Increasing running distance, adding hills or sprints, or returning to strength training can precede symptoms. A previously well-tolerated load can also become difficult after a less active period. This information contributes to clinical reasoning without establishing that a single session caused the entire tendinopathy.<\/p>\n<p>The tendon continuum model describes different responses to load and different tissue changes. It offers a way to think about adaptation, but cannot precisely classify every tendon from pain or palpation. Return to activity depends on current capacity, demands and the response to the programme [<a style=\"color:#076bb5\" href=\"#reference-3\">3<\/a>, <a style=\"color:#076bb5\" href=\"#reference-4\">4<\/a>].<\/p>\n<p>Age influences tissues without determining their functional limits. An older person can regain useful capabilities with an adapted programme. Sleep, recovery and the time available for training are part of the context. They are discussed to make the plan feasible, rather than to attribute pain to a single cause.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Why_sitting_or_hip_flexion_may_be_uncomfortable\"><\/span>Why sitting or hip flexion may be uncomfortable<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Sitting pressure and some hip positions can load the attachment region. Tendon compression near the ischium is a useful explanatory model. Greater hip flexion can also increase local loads. This helps explain why a hard chair, deep lunge or forceful stretch is sometimes poorly tolerated [<a style=\"color:#076bb5\" href=\"#reference-1\">1<\/a>, <a style=\"color:#076bb5\" href=\"#reference-16\">16<\/a>].<\/p>\n<p>Responses differ between people. Some mainly need to adjust sitting duration; others tolerate a chair but experience pain during acceleration. A cushion, different position or breaks may improve comfort. The long-term aim is to reintroduce necessary situations rather than avoid them permanently.<\/p>\n<p>Discomfort while sitting therefore does not prove that the tendon is being damaged every minute. Observing tolerated duration, the sitting surface and recovery after standing provides more useful guidance than continuously monitoring posture.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Distinguishing_nearby_sources_of_pain\"><\/span>Distinguishing nearby sources of pain<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Tendinopathy often produces localised pain below the buttock, sometimes extending down the back of the thigh. Electric shock sensations, tingling, altered sensation or weakness suggest possible nerve involvement. Low back pain may coexist, but the presentation must be considered as a whole [<a style=\"color:#076bb5\" href=\"#reference-6\">6<\/a>].<\/p>\n<table>\n<thead>\n<tr>\n<th>Symptom pattern<\/th>\n<th>Possibility to assess<\/th>\n<th>Important consideration<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>Gradual pain below the buttock with running or sitting<\/td>\n<td>Proximal tendinopathy<\/td>\n<td>Check agreement between history, load and examination.<\/td>\n<\/tr>\n<tr>\n<td>Pain with tingling, numbness or weakness<\/td>\n<td>Nerve or lumbar involvement<\/td>\n<td>Neurological assessment according to symptoms.<\/td>\n<\/tr>\n<tr>\n<td>Sudden pop, bruising and loss of strength<\/td>\n<td>Tear or avulsion<\/td>\n<td>Prompt assessment and appropriate imaging.<\/td>\n<\/tr>\n<tr>\n<td>Acute pain near the ischium in an adolescent<\/td>\n<td>Possible apophyseal avulsion<\/td>\n<td>Consider skeletal growth.<\/td>\n<\/tr>\n<tr>\n<td>Unusual persistent pain, fever or a mass<\/td>\n<td>Another cause to investigate<\/td>\n<td>Reassessment before beginning an exercise programme.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><small>Location alone is insufficient for diagnosis.<\/small><\/p>\n<figure class=\"wp-block-image aligncenter size-full\"><img decoding=\"async\" src=\"https:\/\/osteomag.ca\/wp-content\/uploads\/2026\/10\/proximal-hamstring-load-rehabilitation-en.webp\" width=\"1200\" height=\"675\" alt=\"Four scenes: comfortable sitting, discussion of load, a supervised bilateral bridge and easy running on level ground.\"\/><figcaption>Adjust loading, then rebuild the capabilities needed for sitting and sport. An educational illustration, not a universal exercise prescription.<\/figcaption><\/figure>\n<p>A sensitive ischial bursa, deep gluteal syndrome, a hip condition or a bone injury may also be considered in the differential diagnosis. Not every possibility needs investigation in everyone. The mechanism, associated signs and course guide the choice of appropriate tests [<a style=\"color:#076bb5\" href=\"#reference-5\">5<\/a>].<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Acute_injury_and_tendinopathy_follow_different_pathways\"><\/span>Acute injury and tendinopathy follow different pathways<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Severe pain during a sprint or slip, with the hip flexed and knee extended, may represent a rupture or avulsion. In an adolescent, the tendon can pull on an immature bony attachment. These situations require suitable assessment: a programme designed for gradually developing pain does not necessarily address the injuries present [<a style=\"color:#076bb5\" href=\"#reference-9\">9<\/a>].<\/p>\n<p>An avulsion does not automatically mean surgery. A 2024 randomised trial in adults aged 30 to 70 found nonoperative care noninferior to surgery for function at two years in the studied population. The result does not apply to every age, sporting goal or injury pattern [<a style=\"color:#076bb5\" href=\"#reference-15\">15<\/a>].<\/p>\n<p>New bladder or bowel problems, loss of perineal sensation or substantial leg weakness requires urgent assessment. These signs are not explained by a simple tendinopathy. The priority is to investigate a neurological condition that may need rapid treatment [<a style=\"color:#076bb5\" href=\"#reference-10\">10<\/a>].<\/p>\n<h2><span class=\"ez-toc-section\" id=\"An_examination_connecting_symptoms_to_tasks\"><\/span>An examination connecting symptoms to tasks<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The professional clarifies pain onset, activity changes and the response to exertion. Examination then assesses strength, local sensitivity and useful movements. The hip, back and neurological system are examined when the history indicates a need. The purpose is not to provoke the greatest possible pain.<\/p>\n<p>The Puranen\u2013Orava and bent-knee stretch tests have been studied in chronic proximal hamstring tendinopathy. They add information to the clinical picture. A study&#8217;s findings do not make a single test absolute proof, particularly when other causes or a recent injury are possible [<a style=\"color:#076bb5\" href=\"#reference-7\">7<\/a>].<\/p>\n<p>Describing a specific task often adds useful information: comfortable driving time, a run that has become difficult or an exercise that provokes pain. These measures also allow progress to be compared over several weeks without constantly repeating sensitive tests.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"When_imaging_becomes_useful\"><\/span>When imaging becomes useful<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>MRI can help when the diagnosis remains uncertain, symptoms persist or a rupture is suspected. Ultrasound can also examine tendons in some situations. The value of each investigation depends on the question being asked and how the result would change care.<\/p>\n<p>An MRI study found some changes more frequently associated with symptomatic tendinopathy, but also present in people without corresponding symptoms. An image therefore does not summarise a tendon&#8217;s functional state. Follow-up relies mainly on activities, strength and load tolerance [<a style=\"color:#076bb5\" href=\"#reference-8\">8<\/a>].<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Reducing_irritating_loads_without_stopping_every_activity\"><\/span>Reducing irritating loads without stopping every activity<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>When tendinopathy is likely, temporarily reducing the least-tolerated demands may allow rehabilitation to begin. This can involve fewer sprints, hills, long runs or certain hip ranges. Comfortable activities can be maintained according to the assessment and advice received [<a style=\"color:#076bb5\" href=\"#reference-16\">16<\/a>].<\/p>\n<p>The load of one session differs from cumulative load. A day of driving followed by training may be harder than either activity separately. Adjusting tasks helps identify a tolerable dose. This does not mean avoiding every sensation during every activity.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Gradually_rebuilding_strength_and_range\"><\/span>Gradually rebuilding strength and range<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Systematic reviews support progressive rehabilitation while highlighting limitations in the condition-specific evidence. Resistance, range and demands are adjusted to the individual. A programme should not be presented as a mandatory sequence of identical movements for every tendon [<a style=\"color:#076bb5\" href=\"#reference-11\">11<\/a>, <a style=\"color:#076bb5\" href=\"#reference-12\">12<\/a>].<\/p>\n<p>Sustained contractions, bridges and resisted knee flexion may form part of a progression. Greater hip ranges and faster tasks are subsequently reintroduced according to tolerance. A 2025 clinical commentary describes an individualised framework; it offers practical principles rather than a guarantee of results [<a style=\"color:#076bb5\" href=\"#reference-13\">13<\/a>].<\/p>\n<p>Training the trunk and other muscles may address sporting demands or reduced capacity. It does not imply that an \u201cunbalanced\u201d pelvis necessarily caused the problem. The choice should remain connected to a useful task, an observed difficulty and a progression goal.<\/p>\n<p>The following day provides important information. Clearly worse sitting pain after every session may indicate a need to adjust the dose. Mild, temporary discomfort does not automatically demonstrate a new injury. The trend across sessions is more informative than an isolated fluctuation.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Stretching_and_shockwave_therapy_avoiding_automatic_prescriptions\"><\/span>Stretching and shockwave therapy: avoiding automatic prescriptions<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>A feeling of tension does not necessarily justify forceful hamstring stretching. If hip flexion reproduces pain, intense stretching may be poorly tolerated. Range is reintroduced when it serves the person&#8217;s activities and becomes tolerable. Maximum flexibility is not a universal goal.<\/p>\n<p>Rich and colleagues&#8217; randomised trial compared individualised physiotherapy and shockwave therapy in 100 people. Both groups also received education. There was no significant difference in the main functional and global-effect outcomes. Some secondary measures favoured shockwave therapy: the findings do not establish one method as superior on every outcome [<a style=\"color:#076bb5\" href=\"#reference-14\">14<\/a>].<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Returning_to_running_and_sporting_demands\"><\/span>Returning to running and sporting demands<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Return can begin with an easy, regular activity, sometimes alternating walking and running on level ground. Duration is then adapted, followed by speed or elevation demands. Changing few variables at a time makes it easier to understand what is tolerated.<\/p>\n<p>An explosive sport requires more than a painless bridge. Accelerations, changes of direction and sport-specific movements need gradual preparation. Return also depends on recovery between sessions, confidence and the ability to maintain regular training.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"The_complementary_role_of_osteopathy\"><\/span>The complementary role of osteopathy<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The relationship between structure and function invites us to examine the tendon during real activities. Osteopathic support may help clarify loads, support comfort and coordinate progression with the relevant professionals. Immediate pain relief does not mean that the tendon is ready for a maximal sprint.<\/p>\n<p>The evidence presented does not establish that osteopathic treatment directly repairs the tendon or prevents recurrence. Complementary care must respect the medical diagnosis and active programme. Its value is assessed against practical goals, such as better sitting tolerance and returning to a chosen activity.<\/p>\n<aside>\n<p><strong>Key points<\/strong><\/p>\n<p>Pain below the buttock may arise from the proximal tendons, but other causes sometimes need investigation. Recovery combines temporary load adjustment with gradual rebuilding of capacity. Function, the delayed response and sporting demands guide the stages.<\/p>\n<\/aside>\n<ul style=\"list-style:none;padding-left:0\">\n<li id=\"reference-1\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27084841\/\" target=\"_blank\" rel=\"noopener\">[1]<\/a> Goom et al. (2016). Proximal Hamstring Tendinopathy: assessment and management.<\/li>\n<li id=\"reference-2\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31399426\/\" target=\"_blank\" rel=\"noopener\">[2]<\/a> Scott et al. (2020). ICON 2019 consensus: terminology for tendinopathies.<\/li>\n<li id=\"reference-3\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18812414\/\" target=\"_blank\" rel=\"noopener\">[3]<\/a> Cook and Purdam (2009). Tendinopathy continuum model.<\/li>\n<li id=\"reference-4\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27127294\/\" target=\"_blank\" rel=\"noopener\">[4]<\/a> Cook et al. (2016). Revisiting the tendon continuum model.<\/li>\n<li id=\"reference-5\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25878983\/\" target=\"_blank\" rel=\"noopener\">[5]<\/a> Lempainen et al. (2015). Diagnosis and treatment: expert opinion.<\/li>\n<li id=\"reference-6\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37348536\/\" target=\"_blank\" rel=\"noopener\">[6]<\/a> Pathogenesis and Diagnosis of Proximal Hamstring Tendinopathies (2023).<\/li>\n<li id=\"reference-7\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22219215\/\" target=\"_blank\" rel=\"noopener\">[7]<\/a> Cacchio et al. (2012). Validity of three pain-provocation tests.<\/li>\n<li id=\"reference-8\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22268187\/\" target=\"_blank\" rel=\"noopener\">[8]<\/a> De Smet et al. (2012). MRI findings in symptomatic and asymptomatic proximal hamstring tendinopathy.<\/li>\n<li id=\"reference-9\"><a style=\"color:#076bb5\" href=\"https:\/\/www.orthoinfo.org\/en\/diseases--conditions\/hamstring-muscle-injuries\" target=\"_blank\" rel=\"noopener\">[9]<\/a> AAOS. Hamstring Muscle Injuries.<\/li>\n<li id=\"reference-10\"><a style=\"color:#076bb5\" href=\"https:\/\/www.ouh.nhs.uk\/media\/clzbjpyx\/114862cauda.pdf\" target=\"_blank\" rel=\"noopener\">[10]<\/a> Oxford University Hospitals. Cauda Equina Syndrome Awareness.<\/li>\n<li id=\"reference-11\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33842025\/\" target=\"_blank\" rel=\"noopener\">[11]<\/a> Nasser et al. (2021). Proximal Hamstring Tendinopathy: a systematic review of interventions.<\/li>\n<li id=\"reference-12\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/36976939\/\" target=\"_blank\" rel=\"noopener\">[12]<\/a> Dizon et al. (2023). Conservative interventions and rehabilitation recommendations.<\/li>\n<li id=\"reference-13\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40469642\/\" target=\"_blank\" rel=\"noopener\">[13]<\/a> Rich et al. (2025). Individualised physiotherapy: clinical commentary.<\/li>\n<li id=\"reference-14\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/41243328\/\" target=\"_blank\" rel=\"noopener\">[14]<\/a> Rich et al. (2025). Physiotherapy compared with shockwave therapy: a randomised trial.<\/li>\n<li id=\"reference-15\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/39023393\/\" target=\"_blank\" rel=\"noopener\">[15]<\/a> Pihl et al. (2024). Operative or nonoperative treatment of proximal hamstring avulsions.<\/li>\n<li id=\"reference-16\"><a style=\"color:#076bb5\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33378733\/\" target=\"_blank\" rel=\"noopener\">[16]<\/a> Proximal hamstring tendinopathy: perspectives of expert physiotherapists (2021).<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Pain below the buttock during sitting or running may involve the proximal hamstring tendons. Explore assessment, alternative causes, imaging indications and warning signs, together with practical principles for adjusting load, rebuilding strength and returning progressively to activity.<\/p>\n","protected":false},"author":1,"featured_media":62937,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"tdm_status":"","tdm_grid_status":"","footnotes":""},"categories":[498,330],"tags":[],"class_list":["post-66094","post","type-post","status-publish","format-standard","has-post-thumbnail","category-tendinopathy","category-cuisse"],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/posts\/66094","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/comments?post=66094"}],"version-history":[{"count":2,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/posts\/66094\/revisions"}],"predecessor-version":[{"id":66100,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/posts\/66094\/revisions\/66100"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/media\/62937"}],"wp:attachment":[{"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/media?parent=66094"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/categories?post=66094"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/osteomag.ca\/en\/wp-json\/wp\/v2\/tags?post=66094"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}