Distal Hamstring Tendinopathy

Do you have pain on the back side of the knee? This pain could be coming from distal (low) hamstring tendinopathy, which is a chronic tendon injury and cause of chronic knee pain.



What are the causes of hamstring tendinopathy?

Hamstring overuse and poor load management, causing a failed healing response of the tendon, resulting in inflammation and degeneration of the tendon.


Distal hamstring tendinopathy can also quite often arise as a result from other previous or current conditions. These include; meniscal tears, osteoarthritis, tendinopathy or bursitis of the pes anserine, popliteal (baker’s) cysts, strain of the medial/lateral head of the gastroc, popliteus muscle strain, medial/lateral collateral ligament sprain, pelvic instability and more.


How can you treat distal (low) hamstring tendinopathy?


Generally speaking, where we find other practitioners may have failed, is their ability to specifically isolate the distal portion of the hamstrings, as well as appropriately and progressively load up the tendon, according to the individuals symptoms and recovery rate.


These are two of the biggest keys in successful distal hamstring tendinopathy rehabilitation.


For example, although for some minor cases, generalised hamstring strengthening may help... for the vast majority though, this tends to lead to plateau's or failed return to sport/activity. This is because there are certain hamstring exercises that will target the distal tendons and portion of the muscle belly more than others.


We quite often find when patients come in after failed rehabilitation elsewhere, that their strength and flexibility at the site of their tendinopathy is still quite limited, and their tendons health & structure has not been fully restored.


Generally speaking, the distal portion of your hamstrings are most targeted during longer lever positions, i.e., exercises containing minimal angles of knee & hip flexion.


Shockwave therapy can also be used as a useful tool for stimulating tendon healing, particularly when improvements in symptoms have plateaued.


What successful distal hamstring tendinopathy rehab looks like


Give to you a visual understanding of this, check out our Instagram post showcasing examples of distal hamstring tendinopathy rehab!


For this condition, we prefer to thoroughly build up isometric loading for the tendon first, in order to decrease pain sensitivity and stimulate collage reformation. For example, building up long lever hamstring bridge holds for up to a 2-3 minutes in duration.


In conjunction with this, we will then transition to non-weightbearing eccentric loading, then weight-bearing eccentric loading, then advanced strengthening. For example, hamstring bridge sliders into bodyweight single leg Romanian deadlifts, into barbell Romanian deadlifts.


Depending upon what sport or activity you wish to return to, rehabilitation will also need to include muscular endurance (high reps), as well as power/plyometric training in order to improve tendon energy storage (e.g., hopping, jumping, running).


Neural and hamstring mobility exercises may be beneficial too, particularly for those who have had this condition for several months and/or sit down for prolonged periods of time.


Manual Therapy can also be used (particularly in early stages) in order to help decrease hamstring muscle tightness, promote blood flow and stimulate further healing of the tendon.


Who is the best person to see for this condition?


If you are currently in pain and are yet to see an appropriate health professional for diagnosis, the best person to see is a sports physiotherapist. Click below to learn more!





If however, you have been suffering from this condition for a while and are frustrated with your results, the best person to see is an exercise physiologist. Click below to learn more!





Struggling with this injury and in need of some help? We have 4 clinics in Sydney conveniently located for you to choose from - Sydney CBD, North Sydney, Chatswood & Mosman.


Alternatively, if you’re not from our area we have an online rehab platform available, suitable for anyone based anywhere in the world. Click the button below to check out our page!





Hope you enjoyed the read!


Kind regards,

Infinite Health Team


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