Shockwave Therapy for proximal hamstring tendinopathy (PHT).
Proximal hamstring tendinopathy (PHT) is a condition where the upper part of the hamstring tendons, where they attach to the pelvis, become painful due to overload and poor tendon healing.
It occurs at the ischial tuberosity (the “sit bone”) - high up in the back of the thigh, close to the buttock crease. The hamstring muscles attach here via strong tendons
Typical symptoms of proximal hamstring tendinopathy (PHT);
-
Deep pain in the lower buttock / upper hamstring
-
Pain with:
-
Running, especially sprinting
-
Hills or speed work
-
Long strides
-
Sitting on firm surfaces
-
Often worse at the start of activity or after prolonged sitting
What are the main causes of proximal hamstring tendinopathy?
Proximal hamstring tendinopathy (PHT) usually isn’t caused by one single thing — it’s the result of repeated overload of the hamstring tendons where they attach to the sit bone (ischial tuberosity). Plus a few common contributing factors. The big ones:
1. Chronic overuse / training errors
This is the most common driver.
-
Sudden increases in running volume, speed, or hills
-
Lots of sprinting, acceleration, or deceleration
-
Frequent deep hip flexion under load (e.g., deadlifts, squats, lunges)
-
Not enough recovery between sessions
The tendon doesn’t get time to adapt → microscopic damage accumulates.
2. Prolonged sitting (compression)
-
Long periods of sitting—especially on hard surfaces—compress the tendon right at its attachment.
-
Cycling, desk work, or long drives can aggravate this, particularly if combined with high training loads.
Compression + tensile load is a classic recipe for PHT.
3. Reduced hamstring load tolerance
Often due to:
-
Weakness in the hamstrings (especially at long muscle lengths)
-
Poor eccentric strength (important for running)
-
Previous hamstring strains that didn’t fully rehab
The tendon ends up doing more work than it can handle.
4. Poor lumbopelvic or hip control
-
Weak glutes or trunk stabilisers
-
Anterior pelvic tilt or excessive lumbar extension during movement
-
Poor running or lifting mechanics
These increase strain on the proximal hamstring during everyday and sport-specific tasks.
5. Sudden changes in activity or lifestyle
Examples:
-
Returning to sport after a break
-
Switching from treadmill to outdoor running
-
Starting a new strength program
-
Increasing sitting time while maintaining training load
The tendon hates abrupt change.
6. Age-related tendon changes
-
Tendons become less elastic and slower to adapt with age (commonly 30–60 yrs)
-
Load tolerance decreases if training isn’t well managed
We can speed up your recovery from injury with a combination of Myofascial release, Radial and Focused Shockwave Therapy within the same sessions.
Depending on whether it is Acute or Chronic, 3 - 6 sessions are generally required for most people to gain complete pain relief and make a full recovery from proximal hamstring tendinopathy (PHT).
The new way to treat MSK.
How Shockwave Therapy helps with proximal hamstring tendinopathy (PHT).
Shockwave Therapy helps PHT by stimulating the injured tendon and restarting the body's natural healing process. The main benefits of Shockwave Therapy for PHT are;
1. Stimulates tendon healing
Shockwaves create controlled mechanical stress in the tendon, which increases local blood flow and microcirculation. Shockwave triggers the release of growth factors (e.g., VEGF, nitric oxide) and stimulates tenocytes (tendon cells) to produce healthier collagen. This is especially useful in chronic PHT, where the tendon has essentially stalled in a failed-healing state.
2. Reduces pain sensitivity (neuromodulation)
Shockwave has a direct pain-modulating effect that temporarily disrupts pain signaling in local nerve endings. It reduces substance P (a pain-related neuropeptide) and desensitizes the tendon–nerve interface. This can lower pain enough to allow better loading and rehab, which is where real recovery happens.
3. Improves tendon load tolerance
Shockwave doesn’t strengthen the tendon by itself but it does make the tendon more responsive to progressive loading. It also helps previously painful exercises become tolerable and can shorten the time it takes to progress strength work. Think of it as unlocking the door so rehab can actually work.
4. Helps with neovascularization (selectively)
In chronic tendinopathy, abnormal new blood vessels and nerves can grow into the tendon. Shockwave may disrupt this pathological neovascularization, which is associated with pain.
Best results come when Shockwave therapy is paired with structured, progressive hamstring loading.
Take your recovery to the next level with scientifically proven Shockwave technology. Shockwave Therapy is clinically proven and well approved by top orthopedics and is now used by well established professional sports bodies, such as elite Premier League Football and Rugby Union clubs.