High hamstring tendinopathy can be a frustrating injury to overcome, causing buttock pain and pain around the top of the hamstrings.

In this video, I’m going to show you five exercises we almost always give to runners who present with cases of high hamstring tendinopathy, also known as proximal hamstring tendinopathy.

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First, we need to understand the nature of the injury.

The clue’s in the title here; high up at the top end of the hamstring muscles we find their common origin, where their tendons insert onto the ischial tuberosity of the pelvis, that's the bony part towards the bottom of your butt cheek.

Being a tendinopathy we know that it’s this conjoined tendon that currently in disrepair. This is very much one of your typical overuse type running injuries, and in my experience comes as a result of chronic overload of the hamstring tendons, usually with a more acute trigger.

What do I mean by overload?

Well, if there’s one thing that tendons don’t particularly enjoy it’s the combination of being compressed while under high tensile loads. They are great at dealing with tension when in an optimal position, but when you add compression, it’s a simple trigger for tendon problems.

Now, because of the specific way in which the tendon attaches to the rear part of the ischial tuberosity near your butt crease, loading the hamstrings in increased amounts of hip flexion will begin to compress the hamstring tendon against the bone. Repeat this excessively and you’re on a fast track to high hamstring tendinopathy.

So what kinds of exercises load the hamstrings in this high hip flexed position?

Well, anything that’s going to force an increased stride length, such as speed work and hill reps. These are also often the aggravating factors that trigger symptoms when runners are trying to train through cases of high hamstring tendinopathy.

Now, when it comes to fixing the injury, it’s important we take this understanding of the injury and it’s anatomy into account. As with most tendinopathies, we need to load the hamstring tendons to stimulate healing and repair, and to build strength in the hamstring muscles themselves - muscular weakness is also a risk factor to tendon problems, don’t forget!

We need to ensure however that we load the hamstrings and their tendons in such a way that doesn’t create this combination of tendon compression under tension. In other words, while initially rehabbing the injury we need to look for hamstring exercises that avoid working into too much hip flexion.

To begin with we focus on isometric exercises such as a simple double leg bridging exercise to help engage the glutes and hamstrings, and load the hamstring origin tendon without flexing the hip.

A simple progression is to incorporate a single leg variety of this isometric hold exercise. The single leg bridge. Most runners find this much tougher than the standard double leg version!

When these become easier, you can progress to working the hamstrings through range of motion at the knee, while still avoiding loaded hip flexion. To begin with, we can use an unloaded exercise such as prone hamstring curls, then add resistance from the other leg to increase eccentric demand on the hamstring muscles and tendon.

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ABOUT ME: I'm a runner, sports rehabilitation specialist and coach based in the UK (Norwich and London).

Since 2007 I've been working with athletes focusing specifically on helping distance runners and triathletes overcome injury and improve performance through developing their individual running technique.

Running biomechanics has become a geeky little passion of mine!

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