Shockwave therapy for hamstring tendinopathy
Deep pain under the sit bone that bites on sitting and on running uphill is usually proximal hamstring tendinopathy. It is the one condition on this site with no NICE assessment of shockwave behind it, and that is the most useful thing to know before paying for a course.
What you're seeing
Understanding proximal hamstring tendinopathy
Proximal hamstring tendinopathy is pain at the ischial tuberosity, the sit bone, where the hamstring tendons attach. It is localised, deep, and reliably provoked by two things: sitting on a hard surface, and running uphill or accelerating. Runners, rowers and people whose training includes sprinting see it most, and it is frequently mistaken for a persistent hamstring strain or for referred pain from the lower back.
Like the gluteal tendons on the outside of the hip, this attachment is compression-sensitive. Deep hip flexion presses the tendon against the sit bone, which is why sitting hurts, why a deep stretch into hip flexion tends to aggravate rather than help, and why the early management is about removing compression before load is added.
There is no NICE interventional procedures guidance on shockwave therapy for hamstring tendinopathy. NICE has assessed the procedure for refractory plantar fasciitis, for Achilles tendinopathy, for refractory tennis elbow, for refractory greater trochanteric pain syndrome and for calcific tendinopathy of the shoulder. This condition is not on that list, and conclusions reached about the heel or the elbow do not transfer to it.
What that means in practice is that a course here rests on a clinician reasoning by analogy from other tendons rather than on assessed evidence for this one, and you are entitled to have that said to you plainly before you pay. Progressive loading remains the treatment with the strongest support. Extracorporeal shockwave therapy covers how a course is delivered, and shockwave therapy for gluteal tendinopathy covers the neighbouring attachment, which does have guidance behind it.
Why it happens
What causes hamstring tendinopathy?
- A rise in sprinting, hill running or acceleration work that the tendon had not adapted to
- Long periods sitting on hard surfaces, which compress the tendon against the sit bone
- Deep stretching into hip flexion, which loads the attachment in compression
- Reduced hamstring and gluteal strength, particularly at longer muscle lengths
- A rapid return to running after a quiet period
- A previous hamstring injury that settled before capacity was rebuilt
Treatment approach
Where shockwave therapy fits for hamstring tendinopathy
FAQ
Shockwave therapy for hamstring tendinopathy
questions people ask
Is there NICE guidance on shockwave for hamstring tendinopathy?
No. NICE has published interventional procedures guidance on shockwave for plantar fasciitis, Achilles tendinopathy, tennis elbow, greater trochanteric pain syndrome and calcific shoulder tendinopathy. Hamstring tendinopathy is not among them, so conclusions reached about those conditions do not carry across to this one.
Why does sitting hurt so much with hamstring tendon pain?
Sitting presses the tendon directly against the sit bone, and deep hip flexion increases that compression. Hard chairs, car seats and cycling saddles are the common aggravators. A cushion and shorter stretches of sitting often change day to day symptoms more quickly than any single treatment does.
Should I stretch a painful hamstring tendon?
Deep stretching into hip flexion tends to aggravate this particular problem, because it loads the attachment in compression. That is the opposite of the advice most people are given for a hamstring. Progressive loading through range that avoids end-range compression is the approach with better support.
How do I tell a tendinopathy from a hamstring strain?
A strain usually has a sudden onset during a specific effort and hurts through the muscle belly. A proximal tendinopathy builds gradually, sits deep under the sit bone, and is provoked by sitting and by uphill running. A clinician who examines you can distinguish them and the treatments differ.
What should I ask before paying for shockwave here?
Ask what evidence the recommendation rests on for this specific condition, since there is no NICE assessment of it. Ask how many sessions are included, whether a loading programme comes with the course, and what the plan is if the pain has not shifted at the review.
Get Started
Describe the problem and what has been tried.
UNTIL Health Concierge arranges the examination.
London Shockwave Therapy • UNTIL, 280 Bishopsgate, London EC2M 4RB
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