Hamstring Tendinitis Tendinopathy Information

Hamstring Tendinitis Tendinopathy Information

Hamstring tendinitis, hamstring tendinosis, and hamstring tendinopathy are often used interchangeably, a concept that confuses many seeking medical information on hamstring tendon injuries. Looking at the suffixes added to the main word may add some clarity. In tendinosis, the “osis” refers to chronic degeneration of the tendon at a cellular level. This is most often caused by tiny microscopic tearing of the tissue over time. Whereas, in tendinitis, the “itis” refers to an inflammatory process of the tendon. Medically, tendinitis most often denotes an acute injury to the tendon that causes an immediate inflammatory response. In tendinopathy, the “pathy” refers to a disease process of the tendon. Since tendinosis and tendinitis often occur together, tendinopathy is often used to describe the two different processes collectively.




Hamstring Tendinitis / Tendinopathy

Anatomy As It Relates To Hamstring Tendinopathy

The hamstrings is the muscle group located on the upper portion of the back of the leg. It consists of three muscles - the biceps femoris, semitendinosus, and semimembranosus. All three originate at the ischial tuberosity (the bony bumps located under your buttocks), but the biceps femoris inserts at the lateral part of the knee and the semitendinosus and semimembranosus insert at the medial knee joint and medial tibia. Since the hamstrings cross not one, but two major joints (the hip and knee), it’s highly susceptible to injury.
Together, these muscles contribute to knee flexion, hip extension, and rotation of the leg in and out.
Motions such as jumping, kicking, running and such that require the knee to bend and the hip to straighten wouldn’t be possible without the hamstring muscles and tendons. During running activities, the hamstrings will tighten so that the body doesn’t fall forward during stopping. Tendons are rope like structures that attach muscle to bone. The hamstring tendons begin at the ischial tuberosity and attach just under the back of the knee along the outer edges of the tibia and fibula. As the hamstring muscles contract, they pull upon their end of the tendons, thereby pulling the bones attached to the opposite ends of the tendons.

What is Hamstring Tendinopathy?

Hamstring tendinopathy is inflammation (tendinitis) and/or the degenerative process (tendinosis) of one or more of the hamstring tendons located on either the ischial tuberosity (hip) or just under the knee on the tibia or fibula.

What Causes Hamstring Tendinopathy?

Tendinosis is usually an accumulation of small, often unnoticed, tendon injuries that fail to heal. As these unnoticed injuries accumulate over time, symptoms become more noticeable. The cellular damage to the tendon tissue may be the cumulative result of repetitive stresses being placed on the hamstring tendons or the result of partially healed episodes of tendinitis.

Traumatic injury, overuse, or repetitive stress to the hamstring tendon can cause acute irritation, inflammation, and swelling of the tendon, which is called tendinitis.

While tendons are tough and fairly flexible, sporting activities that require jumping, running, sprinting, sharp sudden movements, and sharp and sudden stops and starts increase the load and stress placed on the hamstring tendons and leave them at high risk of injury. Of course, tendons also become more brittle, thinner, and less elastic as we age. Other risk factors include any of the following:

* overpronation
* differences in leg lengths that affect the way a person walks or runs
* muscular imbalances
* obesity
* long periods of inactivity followed by highly stressful and prolonged exercise

What Are The Symptoms Of Tendinopathy?

When discussing tendinopathy of the hamstrings, keep in mind that symptoms may occur either around the back of the knee (low hamstring tendinopathy) or around the ischial tuberosity at the back of your upper thigh/ lower buttocks area (high hamstring tendinopathy).

As mentioned above, tendinosis often occurs gradually over time. Pain usually progresses through three stages:

1. Only after vigorous or prolonged activity.
2. Pain that occurs during and after activity
3. Pain that may occur even during normal activities of daily living.

Other warning signs of tendinosis are localized:

* stinging or burning
* tenderness to the touch
* dull achy feeling
* stiffness

Tendinitis may produce any of the following symptoms:

* mild to severe pain and tenderness along the affected hamstring tendon
* stiffness
* possible localized swelling, redness, heat, and bruising
* pain may intensify during activity, especially running, jumping, and kicking activities
* weakness in the affected limb


Strengthening Exercises

These Hamstring Exercises are ideal to build strength and flexibility.

Massage Treatment

These Hamstring Massage Techniques are of great value in pain relief; circulation stimulation; dispersing blood and fluid accumulations; swelling reduction; and relaxing muscle spasms, especially when used alongside the Sinew Therapeutics liniments and soaks.




This stage is characterized by swelling, redness, pain, and possibly a local sensation of heat, indicating inflammation. If coolness makes your pain feel better, then the Acute Stage Treatment is recommended.




The acute stage starts the moment an injury occurs and lasts until the swelling and inflammation are gone. The swelling is the result of the blockage of blood, tissue fluids and circulation in the hamstring because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating; blood and fluids back up behind the injured hamstring, causing pain, inflammation, lumps and swelling.

The sensation of heat is due to the warming action of the blood and fluids overheating in the injured hamstring as they back up and accumulate. Stiffness and decreased mobility are due to spasms in tendons and ligaments that have contracted reflexively beyond their normal range from the impact of the injury.

As ligaments and tendons stretch and tear, blood from ruptured blood vessels becomes trapped in the local tissues. As the trapped blood clots up, it sticks the tissues together creating adhesions. Adhesions cause pain, inflammation and restricted movement because the layers of tissue that used to slide smoothly across one another now adhere and snap which interferes with normal functioning. It is essential to break up clotted blood as quickly as possible to prevent adhesions and scar tissue from forming.

During the acute stage it is very important to restore normal circulation to the hamstring, break up clotted blood and stagnant fluids, reduce swelling, and reduce the redness and heat associated with inflammation. By restoring the flow of blood, fluids, and circulation in the hamstring, then pain is relieved, damaged tissues can regenerate with healthy functional tissue, and the hamstring can strengthen and regain it's mobility.




1. Apply the Sinew Herbal Ice on your hamstring to reduce redness, swelling, and inflammation while dispersing accumulated blood and fluids to help restore normal circulation to the hamstring. This first-aid treatment is used in place of ice to significantly speed up the healing process. It reduces the swelling and inflammation more effectively than ice, allowing you to more quickly regain range of motion. Acute Sinew Liniment can be used in-between applications.

Ice is not recommended because it does not help repair damaged tissues and keeps everything in the injured area frozen, causing the stagnation of blood and fluids and the contraction of muscles, tendons and ligaments. In Chinese sports medicine ice is not used and is considered a culprit in injuries that donít heal well.

2. Massage your hamstring with Acute Sinew Liniment to relieve pain, reduce swelling and inflammation, break up clotted blood and stagnant fluids, and stimulate circulation of blood and fluids to help cells quickly repair damaged tissues. Sinew Herbal Ice can be used in-between applications.

3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.





This stage begins once the swelling and inflammation are gone, but you still feel pain, stiffness, weakness, and/or sensitivity in cold and damp weather. If heat makes your pain feel better, then the Chronic Stage Treatment is recommended.



The chronic stage begins once the swelling and inflammation are gone, but you still feel aching pain and stiffness. This is because there are still accumulations of stagnant blood and fluids in your hamstring that are blocking circulation and blood supply to damaged tissues, creating residual pain, stiffness and weakness. You may actually feel hard nodules like sand in the tissue, indicating accumulation, calcification, and adhesions, which all cause pain, stiffness, and joint instability.

Your hamstring may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. When you move your hamstring you may hear a clicking or popping sound from the tendons and ligaments slipping very slightly in and out of their natural alignment indicating weakness and joint instability, causing chronic pain and a cycle of reinjury. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.

Increasing circulation and blood supply to the damaged tissues is very important in treating chronic injuries because tendons and ligaments do not have an extensive direct supply of blood. That is why chronic injuries can be slow to heal. Increasing local circulation also prevents cold and dampness from penetrating the injured area, preventing pain and stiffness.

During the chronic stage it is very important to break up remaining accumulations of blood and fluids, and increase circulation and blood supply to the damaged tissues. By increasing circulation and blood flow in the hamstring, then pain and stiffness is relieved, and the tendons and ligaments can strengthen to restore stability.



1. Massage your hamstring with Chronic Sinew Liniment to relieve pain and stiffness, strongly stimulate circulation and blood flow to damaged tissues, and promote the healing of overstretched tendons and ligaments. The Sinew Relaxing Soak can be used in-between applications.

2. Soak your hamstring with the Sinew Relaxing Soak to relax muscles and tendons that are in spasm, ease joint pain and stiffness, and improve range of motion. The Sinew Relaxing Soak is particularly useful if you feel tightness in your hamstring. The soak can be used by saturating a towel in the liquid and applying it to your hamstring. Chronic Sinew Liniment can be used in-between applications.

3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.