Running with proximal hamstring tendinopathy – Tips to help recovery
- Maryke Louw
- Aug 15
- 5 min read
Proximal hamstring tendinopathy (aka high hamstring tendinopathy) can quite literally be a pain in the butt for runners. Learn how to decide whether you can run with proximal hamstring tendinopathy and how to adapt your running so it puts less strain on your injured tendons.
Remember, if you need help with an injury, you're welcome to consult one of our physios online via video call.
In this article:
I’ve previously discussed in detail what proximal hamstring tendinopathy is and how to diagnose it, but here’s a quick overview:
It’s an overuse injury affecting the tendons that attach the hamstring muscles to the sit bone (ischial tuberosity).
It’s caused by repeatedly overworking the hamstrings without enough recovery time, often combined with excessive compression of the tendons against the sit bone.
It usually affects only a small part of the tendon, which might lose some strength and become easier to irritate.
In some cases, the hamstring tendons may not actually lose any strength but just become very sensitive and irritated.
Recovery means giving the tendon time to rest, calm down, and then gradually to rebuild its strength (if needed) through a graded rehab plan – which might still include some running.
Movements that involve hip flexion (bending the hip forward) often make high hamstring pain worse because they press the injured tendons more firmly against the sit bones – a bit like pressing on a bruise.
Can I run with proximal hamstring tendinopathy?
It depends on whether you can find a way to adapt your running so it doesn’t aggravate your injury.
Once the hamstring tendons are injured, they often don’t have the strength or endurance to cope with your usual training loads. If you ignore the pain and keep running at a level that irritates them, the symptoms will usually get worse and eventually force you to stop running.
To help your injury recover, you’ll need to scale back your training to match your hamstring tendons’ current capacity. Research shows that staying active within these limits can actually help recovery better than resting the injury completely for a long time – it's all about getting the balance ⚖️ right.
How much pain is OK when I run?
The general rule when recovering from proximal hamstring tendinopathy is that it’s fine to continue with an exercise or activity as long as:
it doesn’t cause more than a slight increase in discomfort while you’re doing it, or in the 24 hours afterwards, and
any such increased discomfort settles down quickly.
If you notice a significant increase in symptoms – especially the day after a training session – it’s best to make the next training session much easier.
🤷♂️ But what exactly do I mean by a “slight” vs. “significant” increase?
This is where it gets tricky. You’ll sometimes hear physios say that 3 out of 10 or even 6 out of 10 pain is OK. And that’s true – research shows people can recover even if they train with some pain, as long as they don’t push it too far.
The challenge is that pain is subjective – my 3 might be your 8. Marathon and ultra-marathon runners often have a high pain tolerance, and I’ve found that if I tell them to limit symptoms to 3 out of 10, they end up pushing too hard because it doesn’t really feel like pain to them. The result? The pain never settles down.
That’s why I prefer to tell my patients it’s OK to feel a “slight niggle” in the high hamstring tendon area, but if you start thinking of it as pain it's a sign that you’ve taken things too far. And if you notice that you’re much more aware of your injury the next day – even if it’s not exactly painful – it could mean that you overdid it.
Also, if you’ve been training within these low discomfort limits but your recovery has stalled, it can sometimes help to cut back significantly on all activities – not just running but also your rehab exercises – and give the tendon a complete rest for a week or two before easing back into your running and rehab.
👉 It’s worth noting that increased pain does not necessarily mean your injury is getting worse. Pain is not linked to the severity of your injury (this is why we all experience it differently), but if you continue to irritate it, the pain can get so intense that it stops you from training and really takes over your life. Alison explains pain in detail in this article about Achilles tendinopathy.
How to adapt your training for high hamstring tendinopathy
The parts of your running training that you can adjust and experiment with include:
Running distance – shorter runs are generally better tolerated than long runs.
Speed – the faster you run, the harder your hamstrings work. Faster running also means more hip flexion, which increases compression of the tendons against the sit bones.
Terrain – uphill running works the hamstrings harder and requires more hip flexion, which again increases compression.
Running form – if you tend to overstride, it can help to shorten your stride slightly (see the section below).
Running form adjustments
The most important change you can make to your running form if you’re dealing with high hamstring pain is to reduce overstriding.
You might find this video useful – I explain the concept of overstriding and how it relates to high hamstring pain in more detail.
Why is overstriding a problem?
Overstriding is when your foot lands far out in front of your body. This position puts the high hamstring tendon in a spot where it’s more likely to be compressed against the sit bone. As mentioned earlier, that compression can really irritate an injured tendon.
How can you reduce overstriding?
I go through this in detail in the video mentioned above, but here are some of the cues I find most effective for reducing overstride in my patients:
Focus on taking slightly shorter steps – this naturally increases your step rate.
Lean your torso slightly forward (while keeping your back straight, not slouched) and aim to make ground contact under your body rather than in front of it.
Try to land softly.
Increase your step rate slightly (here’s a guide on how to do this).
Changing your running style can feel like hard work at first, and you’ll probably only manage it for short periods to start with.
💡 It’s best to make the transition gradually, because it forces “new” muscles and tissues to work harder than they’re used to. If you make the change too suddenly, you risk ending up with other injuries.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.