Hamstring Tendinopathy: A Progressive Loading Protocol for Runners

The hamstrings are an essential group of muscles that are located on the posterior (back side) of the thigh. Due to their position in the body, the hamstrings function to provide shock absorption and propulsion while running. But, there comes a time where a sudden increase in mileage, poor gluteal function, or various other factors can cause too much repetitive strain on these muscles, thus leading to tendinopathy.

Because the hamstring group is composed of three muscles (semitendinosis, semimembranosis, and biceps femoris), the location of your pain may vary. Some prime areas are at the origin of all three hamstring muscles on the ischial tuberosity OR at the insertion points by the anteromedial, posteromedial, and posterolateral knee joint.

Anytime you are experiencing pain, it’s important to find a competent healthcare provider. Most overuse injuries are too multifactorial to resolve solely from this article. But, I’m hopeful it will at least provide you with some guidance in facilitating the process to pain-free movement.

With the growing research (here and here) on slow eccentric loading to resolve overuse tendon injuries, what are the most effective exercises in reducing pain and resolving tendinopathy at the hamstrings? Or, if you choose to look at it from a preventive viewpoint… which exercises can be used to increase the loading capacity and strength, as a means to reduce the overall likelihood of future injury?

The following exercises are in order from simple to advanced. The goal is to use these exercises as a way to progressively load the hamstring muscle group and reverse the tendinopathy.And, with all rehabilitation programs, other methods are recommended in addition to this loading protocol to increase positive outcomes. This may include modifying your running mileage, incorporating pain relief methods, and using an appropriate form of manual therapy.

Programming recommendations vary from 2x/day at 3 sets of 10-15 repetitions, to every other day. Initially, the dose has to be manipulated based on how you respond. Therefore, using the 24-hour rule is important. Simply, it's fine to feel pain during and up to 24-hours after loading the desired area. As long as pain does not persist past 24-hours then the appropriate load has been applied.

Let’s dive into the progression:

Note: While performing each of the exercises below, it's important to realize that this is a progression. Do not complete each exercise at one time, but start at the beginning and progress to the next exercise in 3-4 weeks.

Exercise #1: Long Lever Bridge

Exercise #2: Long Lever Bridge with Marching

Exercise #3: Eccentric Ball Curl

Exercise #4: Supine Ball Curl

Exercise #5: Barbell Hip Thrust

Exercise #6: Romanian Deadlift

Exercise #7: Single Leg Deadlift

Thank you for reading this article! If you have any questions or comments, please feel free to leave them below.