What Is Hamstring Tendinopathy?
Hamstring tendinopathy is a degenerative condition affecting the proximal hamstring tendons where they attach to the ischial tuberosity (commonly known as the sitting bone).
It differs from a hamstring strain or tear. Tendinopathy is a gradual breakdown of the tendon’s structure over time — often without a specific injury event.
Common symptoms include:
- Deep buttock pain when sitting, lunging, or sprinting
- Discomfort when running uphill or decelerating
- Morning stiffness or aching during prolonged sitting
- Tenderness at the upper hamstring near the sit bone
Why Is It So Hard to Treat?
- The proximal hamstring experiences high tensile and compressive forces, especially during sitting and hip flexion
- Tendon healing is slow due to limited blood supply
- Rest alone often leads to further weakness and delayed recovery
- Passive treatments like massage or stretching may offer short-term relief, but not long-term change without specific loading
How Shockwave Therapy Helps
Extracorporeal Shockwave Therapy (ESWT) stimulates tendon healing by delivering focused acoustic energy into the tissue. For proximal hamstring tendinopathy, it may:
- Create controlled microtrauma that encourages new collagen formation
- Stimulate neovascularisation (new blood vessel growth) at the tendon insertion
- Reduce chronic inflammatory markers and pain sensitivity
- Improve the tendon’s ability to tolerate load and resume function
When combined with the right strength program, shockwave therapy helps restart the tendon’s stalled healing process.
What Does the Research Say?
Rompe et al. (2009, Am J Sports Med)
Randomised controlled trial on chronic proximal hamstring tendinopathy.
→ Results: Patients treated with ESWT showed greater improvements in pain and function compared to exercise-only treatment at 6-month follow-up.
Cacchio et al. (2011, Am J Sports Med)
Focused high-energy ESWT produced excellent outcomes in patients with chronic, treatment-resistant proximal hamstring tendinopathy after 3–5 sessions.
Mani-Babu et al. (2015, Br J Sports Med)
Systematic review concluded that shockwave therapy is effective for chronic tendinopathies, especially when combined with graded strengthening exercises.
Sydney Chiro’s Clinical Perspective
At Tensegrity Sports Clinics, leading chiropractors in Sydney, we recommend shockwave therapy for patients who:
- Have had persistent hamstring origin pain for over 6–8 weeks
- Experience deep tenderness at the ischial tuberosity
- Find their symptoms worsen with sitting, lunging, running, or squatting
- Want to treat the underlying tendon dysfunction, not just mask pain
- Are ready to commit to a tailored rehab program
Our treatment approach combines ESWT with:
- Isometric hamstring loading to reduce pain and gradually reintroduce force
- Progressive eccentric strengthening, including exercises like Nordic curls and Romanian deadlifts
- Pelvic stability and glute strength training to improve movement patterns
- Running gait retraining where poor mechanics are contributing to overload
Treatment Schedule & What to Expect
| Phase | Details |
| Sessions | 1 per week for 4–6 weeks |
| Per Session | 10–15 minutes of shockwave + supervised rehab |
| Early Results | Less sitting pain and stiffness after 2–4 sessions |
| 8–12 Weeks | Return to jogging and controlled strength work |
| Full Program | Typically 6 sessions with progressive loading plan |
Recovery Timeline
- 2–4 weeks: Reduced pain when sitting or walking
- 6–8 weeks: Ability to jog or run at light intensity
- 3–6 months: Return to sprinting, jumping, or sport, depending on severity
Full tendon recovery takes time. Athletes with chronic or high-grade tendinopathy may require up to 6 months for full return to peak performance.
When to Consider Shockwave Therapy
Shockwave therapy could be right for you if:
- You have deep upper hamstring pain with no clear tear on imaging
- You’ve tried massage, stretching, cortisone, or dry needling without long-term results
- You’re ready to stimulate real tendon healing, not just manage symptoms
- You’re committed to a structured loading program
Sydney Chiro’s Final Thoughts
Proximal hamstring tendinopathy can be one of the most frustrating injuries for runners, athletes, and active individuals. Shockwave therapy offers a proven, non-invasive treatment to regenerate tendon tissue and support your return to sport — safely and sustainably.
Book Your Shockwave Consultation
Ready to kick chronic hamstring pain for good?
Call Tensegrity Sports Clinics or book online at www.tensegrity.com.au
Get stronger. Move smarter. Leave pain behind.