Proximal Hamstring Tendinopathy: An Evidence-Based Guide for Physical Therapists

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Show Notes, Credit & References:
- https://fitnesspainfree.com/2026/02/proximal-hamstring-tendinopathy-an-evidence-based-guide-for-physical-therapists/

In today's episode we go over Proximal Hamstring Tendinopathy: An Evidence-Based Guide for Physical Therapists  - FPF Show Episode 189

Timestamps:
00:00 What PTs Need to Know About Proximal Hamstring Tendinopathy
00:00:31 What Actually Defines Tendinopathy (Pain vs Imaging)
00:01:17 Tendon Loading 101: Tensile vs Shear vs Compression
00:02:56 Why Hip Flexion = More Compressive Load at the Ischial Tuberosity
00:03:28 Free PHT Cheat Sheet (Ad Break)
00:04:30 Exercise Selection: Neutral Hip vs Flexed Hip Loading
00:05:13 Prevalence & Imaging Reality Check (MRI ≠ Symptoms)
00:08:27 Relevant Anatomy: Semimembranosus vs Conjoint Tendon
00:11:00 Perimenopausal Considerations & Hormonal Influence
00:11:47 Running Biomechanics: Late Swing & Early Stance Demands
00:13:01 Coaching Runners: Pelvic Tilt, Trunk Lean & Overstriding
00:14:47 End-Stage Rehab for Athletes: Eccentrics, B-Skips & Sprint Prep
00:16:23 Mechanism of Injury: Training Errors & Load Spikes
00:17:31 Excessive Stretching as a Risk Factor (Yoga/Pilates Trap)
00:18:47 Intrinsic Risk Factors: Age, BMI, Hormones, Medications
00:19:54 Insiders Academy Promo (Ad Break)
00:22:19 Fluoroquinolones & Tendon Rupture Risk
00:23:00 Hormone Replacement Therapy & Tendon Pain
00:24:01 Compression Debate: When to Unload vs Reload
00:26:22 Pathogenesis: What’s Happening Inside the Tendon
00:28:29 Clinical Presentation: “Sit Bone” Pain Patterns
00:29:54 Warm-Up Effect & 24-Hour Pain Monitoring Model
00:31:13 Squatting & Compressive Load Considerations
00:31:35 Objective Testing: Max Hip Flexion + Active Knee Extension
00:32:20 Strength Testing: Dynamometry & Length-Specific Testing
00:32:55 Functional Testing: Jumps, Sprinting & Return-to-Run
00:37:34 Clinical Test Cluster for Diagnosis (Arabesque, Bridge, Sitting)
00:38:53 Imaging: MRI vs Ultrasound — What Matters?
00:41:00 Imaging Doesn’t Always Match Pain
00:43:19 Differential Diagnosis: Sciatic, Stress Fracture, Avulsion & Lumbar Referral
00:45:00 When It’s Hard to Tell: Radicular vs Tendon Presentation
00:45:48 Final Thoughts + Insiders Academy + Hamstring Strain Video

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