Hamstring Tendinopathy

Evidence: Promising, Mixed Evidence — ASPN 2024: Level I · Grade C

CAUSES

• Repetitive sprinting, hurdling, or sudden hip-flexion or knee-extension movements
• A history of hamstring strain
• Tightness or weakness in the hip and core muscles
• Prolonged sitting

SYMPTOMS

• Deep pain in the lower buttock or upper thigh
• Pain that worsens with sitting on hard surfaces, sprinting, or stretching
• Tenderness directly over the sit bone with pain radiating down the back of the thigh

IMAGING

MRI can show tendon degeneration or partial tearing at the hamstring. Ultrasound can also be considered, and can observe motion at the tendon.

CAN PRP HELP?

The research on PRP for hamstring tendinopathy has been mixed, but newer, larger studies show a real benefit — including a faster return to sport in athletes treated with PRP. It may be a reasonable second-line option once a structured physical therapy and home exercise regimen haven’t fully resolved symptoms.

Leukocyte Preparation: Leukocyte-Rich

Dosing: Short Series (1–3 injections)

Target Platelet Dose in Studied Protocols: 5.8–6.7 billion platelets in the trials behind this grade (gluteal cohort; hamstring-specific dosing wasn’t separately reported).

ASPN 2024 CONSENSUS GUIDELINE

ASPN grades this Level I, Grade C under the same combined “gluteal/hamstring tendinopathy” row as trochanteric bursitis — promising but inconsistent RCTs, with the hamstring-specific data notably weaker than the gluteal data graded alongside it.

Sources: D’Souza et al. (ASPN Consensus), Journal of Pain Research, 2024 · Kuhns et al., Arthroscopy, 2026 · Nasser et al., International Journal of Sports Physical Therapy, 2021

FREQUENTLY ASKED QUESTIONS

I have deep pain at my sit bones that’s worse sitting on hard chairs — could that be hamstring tendinopathy?

That’s a classic presentation. It’s degeneration of the hamstring tendons where they attach to the sit bone, typically from repetitive sprinting or sudden hip-flexion movements. Prolonged sitting itself can irritate the tendon origin.

Does PRP help athletes get back to sport faster with hamstring tendon injuries?

Newer, larger studies show benefit, including faster return to sport in treated athletes, even though the overall research history has been mixed. PRP can be a reasonable second-line option once a structured eccentric-strengthening program hasn’t fully resolved symptoms.

What PRP protocol is used for hamstring tendinopathy?

Leukocyte-rich PRP, given as a short series of one to three injections. ASPN grades this Level I, Grade C under the same combined row as trochanteric bursitis, with the hamstring-specific data weaker than the gluteal data graded alongside it.