Hamstring Tendonitis: Signs You Have It and How to Treat It

Pain and tenderness down the backs of your thighs when you’re active can be a telltale sign of hamstring tendonitis (tendinitis). Your hamstrings — which are the large muscles that start at the bottom of your hip and extend down the back of your leg to the bottom of your knees — are integral to all types of movement, from walking to running to lifting things. If they’re sore, it may be hard to do basic activities, like climbing up and down stairs or bending over to tie your shoes.

The good news is that while hamstring tendonitis may be uncomfortable, it’s usually not serious, reassures Alec Martinez, PT, DPT, a physical therapist at Hinge Health. It will usually get better with simple, at-home remedies such as gentle stretching and strengthening leg exercises. It’s also important to keep moving to allow your sore hamstrings to heal. 

Read on to learn more about hamstring tendonitis: what it is, what causes it, and how to treat it with exercises from our Hinge Health physical therapists. 

What Is Hamstring Tendonitis?

Hamstring tendonitis is irritation of one or more of the hamstring tendons that run down the back of your thigh. “There are three hamstring muscles that start at the bottom of your pelvis, cross your knee joint, and end at your lower leg,” explains Dr. Martinez. They join with your hamstring tendons — the tough connective tissue that attaches your hamstring muscles to bones — at points right behind your buttocks, your knees, and near the top of your calves.

While the pain might feel similar, hamstring tendonitis is different from a hamstring strain. A strain occurs when you pull your hamstring muscle, says Dr. Martinez. A strain also tends to come on suddenly due to an increased force on the muscle. Tendonitis, on the other hand, usually develops more gradually over time. “Hamstring tendonitis can affect anyone at any fitness level,” says Dr. Martinez. “We see it in beginner exercisers who start a walking routine, and high-level athletes who have ramped up the intensity of their activity.”

Symptoms of Hamstring Tendonitis

The hallmark sign of hamstring tendonitis is a sharp pulling sensation in the back of your thigh, says Dr. Martinez. Other hamstring tendonitis symptoms include:

• Irritation right where the hamstring tendon attaches to bone. You might notice it most when you try to straighten out your knee, for example, or begin to walk, says Dr. Martinez. “The pain often comes on as soon as you start the activity.” 

• Leg stiffness when you walk or bend your knee.

• Tingling and weakness that runs from the top of your leg down your thigh, like sciatica.

• General thigh muscle tightness. You may notice that it’s harder to do daily activities that involve your hamstrings, like bending forward.

Hamstring Tendonitis Causes

Hamstring tendonitis is a common complaint in both non-athletes and athletes alike, says Dr. Martinez. Here are some reasons you might experience it. 

• Going beyond your body’s movement sweet spot. “Hamstring tendonitis is often your body’s response to a sudden new load or an increase in the existing load that you are simply not ready for,” explains Dr. Martinez. “We see it, for example, when someone quickly increases the mileage of their daily walks, or if a weightlifter attempts to quickly increase the amount they lift.”

• Past hamstring injury. Athletes with a previous hamstring injury are up to six times more likely to suffer a repeat strain or tendonitis, according to a 2020 review published in the British Journal of Sports Medicine. “Oftentimes, people will take enough medication to calm the pain, but don’t work on improving their hamstring strength and flexibility,” says Dr. Martinez. As a result, they’re more likely to experience it again.

• Tight muscles. It’s not just tight hamstring muscles, either. Research shows that tight quadricep muscles (the muscles that run down the front of your thighs) and tight hip flexor muscles raise the risk of hamstring injuries such as tendonitis. Tight hip flexor muscles, in particular, make it more challenging to run and place more load on your hamstrings.

• Muscle imbalances. Research shows that imbalances between the strength of your quadriceps and hamstrings may make you more likely to develop hamstring tendonitis. Here’s why: Your quads are usually stronger than your hamstrings. As a result, when you exercise — especially if you run — your hamstring tendons may bear the brunt of the workout.

• Certain sports. Hamstring tendonitis is more common in sports that involve high-speed running, like track and field, as well as sports that involve stopping quickly, such as soccer and football, according to a 2023 review published in the British Journal of Sports Medicine.

Exercise plays a big role in helping your body heal from hamstring tendonitis. It increases blood flow to the area and improves strength and flexibility to reduce risk of reinjury. The above exercises recommended by Hinge Health physical therapists are a great place to start. 

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Treatment Options for Hamstring Tendonitis

Hamstring tendonitis can be painful, but it shouldn’t stop you from being active and doing the activities you love. In fact, movement is one thing that will help your body heal faster, stresses Dr. Martinez. Here’s what you can do to help treat hamstring tendonitis.

• Physical therapy. A physical therapist can help to identify the activity that’s triggering your hamstring tendonitis, as well as what level of exercise you’re ready for, says Dr. Martinez. “Movement is the real medicine here,” he says. “They can recommend activities to keep you moving, so that your hamstrings can recover faster.” You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

• Modify your activities. You don’t want to rest your hamstrings completely and risk more tightness, but you don’t want to force yourself to hobble through extreme pain, either. “Identify the activities that seem to irritate your hamstring, and then decrease them to the point where they’re not painful, or only cause low levels of pain,” advises Dr. Martinez. (That means on a scale of 0-10, pain should be no more than a three or four, he says.)

• Prioritize strengthening and stretching leg exercises. These are important to build up the strength of your hamstring tendons and increase your range of motion, says Dr. Martinez. They will help your hamstring tendon heal faster and prevent tendonitis from recurring. The exercises listed above are a good starting point.

• Elevate your leg. If your hamstring is swollen, lie down as much as possible and elevate your sore leg with pillows above the level of your heart. This will help excess fluid drain.

• Use a compression sleeve. An over-the-counter compression wrap or sleeve can help manage swelling as well as provide enough support that you can continue to do daily activities, says Dr. Martinez. Just make sure you don’t spend too much time in the sleeve as you want to focus on strengthening your hamstrings. 

• Apply ice or heat. If your hamstring is swollen, you’ll want to ice it for 20 to 30 minutes, a few times a day. But if it’s just painful and stiff, you can use either ice or heat, or rotate between both, advises Dr. Martinez. It’s all about what feels best to you.

• Over-the-counter (OTC) pain relievers. Pain relievers such as ibuprofen (Advil, Motrin), naproxen (Aleve) and acetaminophen (Tylenol) can be helpful for pain due to hamstring tendonitis. It’s important to make sure that you’re safely able to take them, based on your medical history. 

PT Tip: Ease Back Into Exercise

While you want to stay active with hamstring tendonitis, you don’t want to jump back into activity too fast, cautions Dr. Martinez. “Listen to your body, and use pain as your guide,” he says. “Otherwise, you’ll be susceptible to reinjury.”

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program. 

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. 

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Fields, K. B., Copland, S. T., & Tipton, J. S. (2019). Hamstring muscle and tendon injuries. UpToDate. https://www.uptodate.com/contents/hamstring-muscle-and-tendon-injuries

2. Freckleton, G., & Pizzari, T. (2012). Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. British Journal of Sports Medicine, 47(6), 351–358. https://pubmed.ncbi.nlm.nih.gov/22763118/ 

3. Gabbe, B. J. (2005). Risk factors for hamstring injuries in community level Australian football. British Journal of Sports Medicine, 39(2), 106–110. doi:10.1136/bjsm.2003.011197

4. Gabbe, B. J., Bennell, K. L., & Finch, C. F. (2006). Why are older Australian football players at greater risk of hamstring injury? Journal of Science and Medicine in Sport, 9(4), 327–333. doi:10.1016/j.jsams.2006.01.004

5. Green, B., Bourne, M. N., van Dyk, N., & Pizzari, T. (2020). Recalibrating the risk of hamstring strain injury (HSI) - A 2020 systematic review and meta-analysis of risk factors for index and recurrent HSI in sport. British Journal of Sports Medicine, 54(18), bjsports-2019-100983. doi:10.1136/bjsports-2019-100983

6. Maniar, N., Carmichael, D. S., Hickey, J. T., Timmins, R. G., San Jose, A. J., Dickson, J., & Opar, D. (2022). Incidence and prevalence of hamstring injuries in field-based team sports: a systematic review and meta-analysis of 5952 injuries from over 7 million exposure hours. British Journal of Sports Medicine, 57(2), bjsports-2021-104936. doi:10.1136/bjsports-2021-104936