Proximal hamstring tendinopathy




Pain lower gluteal region


Worsened by

- sprinting

- prolonged sitting




Tender lateral ischial tuberosity

Pain with resisted knee flexion




Peritendinous edema / low grade partial tears






High grade partial tears


high grade PTHigh grade PT


High grade PTHigh grade PT




Ischiofemoral impingement

Piriformis syndome

Lower back pain / SIJ pain






Eccentric exercises


Shockwave therapy


Cacchio et al AJSM 2011

- 40 patient RCT

- shockwave versus physiotherapy

- 50% reduction in pain in 85% of shock wave group

- 50% reduction in pain in 10% of therapy group




Nicholson et al Orthop J Sports Med 2014

- 18 athletes treated with guided cortisone

- at mean of 21 months, sporting activity increased from 30% to 70%




Auriemma et al Regen Med 2020

- 22 patients treated with leucocyte rich PRP

- 68% had < 50% reduction in pain




Debridement, semimembranosus release, and sciatic nerve neurolysis


Bernazzo et al J Orthop Traumatol 2013

- 17 high level athletes treated surgically

- returned to sport at 4.4 months post surgery

- excellent results in 88%, good results in 12%


Lempainen et al AJSM 2009

- 103 cases with sciatic nerve release, semimembranosus release (+ suture to conjoint)

- 80/90 (89%) returned to pre-sporting activity level


Repair high grade partial tears



Ischial tuberosityIschial tuberosity

Elevate high grade tear with Cobb, exposing bare ischial tuberosity (*)



Post suture repairProximal hamstring xray

Post suture anchor repair


Kayani et al AJSM 2020

- 41 patients with chronic incomplete proximal hamstring injuries

- failure 6 months nonoperative care

- 95% satisfaction

- improvement in strength, function and pain