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Distal Hamstring Tendinopathy - Causes, Symptoms, Treatment

Experiencing pain in the back of the knee? Hamstring injuries can be both tricky and frustrating to identify, manage, and treat.

Within this article, we’re going to delve into one of the more common injuries characterised by this back-of-the-knee pain; distal hamstring tendinopathy. There are a bunch of reasons that your hamstring might be hurting – distal hamstring tendinopathy is one of many injuries common in sports where running, jumping, and kicking is required.

At NQ Physio Solutions, we know just how uncomfortable this injury can be. We’re going to delve into what causes this injury, the most common symptoms, and how to successfully treat the injury, so you can get back to your favourite sports or exercise.

Table of Contents

What is Distal Hamstring Tendinopathy?

Distal hamstring tendinopathy is a chronic tendon injury that causes chronic knee pain. Also known as lower hamstring tendonitis or semimembranosus tendinopathy, distal hamstring tendinopathy is characterised and most recognised by ongoing pain around the back of the knee.

The hamstring is made up of three main muscles that run down the back of your thigh – semimembranosus, semitendinosus, and biceps femoris. When these tendons are over-used during sport, exercise, and running, they can become inflamed and cause tendinopathy.

Distal hamstring tendinopathy can often be confused with other injuries or concerns in the same area, with the same primary symptom of pain around the back of the knee. While distal hamstring tendinopathy is an overuse injury, it can happen quickly (during a single training session, race, or match) or gradually, over time.

Symptoms of Distal Hamstring Tendinopathy

As mentioned earlier, the main and most common symptom of distal hamstring tendinopathy is pain in the back of the knee. However, other common symptoms that you’re likely to experience include swelling, warmth, and limited mobility.

It’s not uncommon for this injury to also result in pain that radiates up the back of the thigh, or down the calf. Right after the immediate injury, it will be sore after exercise, and when left untreated, it will get pretty uncomfortable during exercise too.

Other symptoms that you might notice include:

  • Weakness in the area
  • Worse with running and jumping
  • Stiffness in the mornings
  • Loss of motion
  • Decreased strength on isometric contractions

What Causes Distal Hamstring Tendinopathy?

When we exercise and strengthen, we’re creating micro-trauma in our muscles and tendons, making them stronger for next time. Your muscles and tendons require time to restore and rebuild the micro-trauma caused during exercise. When you allow enough recovery time, the muscles repair and strengthen.  This process is known as adaption. However, if you create more micro-trauma in these muscles and tendons before they have fully recovered, you can cause overuse injuries like tendonitis and tendinopathy.

Distal hamstring tendinopathy is often directly related to overuse and poor load management. When we train to regularly, don’t give enough time to recover, and increase load too quickly, we can cause a failed healing response of the tendon, resulting in degeneration of the tendon. 

Distal hamstring tendinopathy is most common in runners, sprinters, AFL players, basketball, netball, and soccer.

How Can it Be Treated?

The most important treatment for distal hamstring tendinopathy will be rest and recovery from aggravating exercise. In order to get back to your favourite sports, you’re going to need to let the area properly heal and recover. Treatment should also include:

  • Rest from running, jumping, hopping
  • OTC pain relief to help with immediate discomfort
  • Specific tendon loading exercises prescribed by a Physiotherapist or other health professional to allow a successful return to activity

It’s important to seek medical help from a physiotherapist or sports physiotherapist to ensure you’re getting the right treatment for your injury.

Physiotherapy to Manage & Treat Distal Hamstring Tendinopathy

With the right treatment, distal hamstring tendinopathy can be successfully managed and prevented. Treatment will include recovery, rehab exercises to re-strengthen, and manual therapy. For some, treatment can help to get you back to your favourite sport within a few weeks, for more chronic conditions, you’ll need to strengthen the area again and it can take up to eight weeks to fully recover.

If you’re currently experiencing pain and suspect distal hamstring tendinopathy, we recommend seeing a physio right away – getting the right diagnosis early on will ensure you’re on the path to recovery faster!

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