High (Proximal) Hamstring Tendinopathy Risk Factors

The most significant risk factor for hamstring injury is a history of previous hamstring injury, with risk of re-injury 2 to 6 times that of healthy individuals.¹Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.^,2Gabbe B, Finch C, Bennell K, Waj-swelner H. Risk factors for hamstring injuries in community level Australian football. Br J Sports Med 2005;39:106-10. Therefore, proper initial management of an acute hamstring injury may be paramount to preventing future injury in an active population. Listed below are factors that increase a person’s likelihood of developing high (proximal) hamstring tendinopathy.

• Running. People who run middle and long distances have a higher incidence of high (proximal) hamstring tendinopathy.³Fredericson M, Moore W, Guillet M, Beaulieu C. High Hamstring Tendinopathy in Runners: Meeting the Challenges of Diagnosis, Treatment, and Rehabiliation. Phys Sports Med 2005;33:32-43.
• Jumping and kicking. Like runners, people who regularly jump or kick, such as dancers or track athletes, may develop this chronic condition.⁴Askling C, Lund H, Saartok T, Thorstensson A. Self-reported hamstring injuries in student-dancers. Scand J Med Sci Sports. 2002;12(4):230-235^,5Askling C, Tengvar M, Saartok T, Thorstensson A. Sports related hamstring strains: two cases with different etiologies and injury sites. Scand J Med Sci Sports. 2000;10(5):304-307^,6Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM. Strength imbalances and prevention of hamstring injury in professional soccer players: a prospective study. Am J Sports Med. 2008;6(8):1469-1475
• History of high (proximal) hamstring tendon tear(s). A history of partial or full thickness tendon tear may increase the likelihood of chronic tendinopathy.¹Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.^,2Gabbe B, Finch C, Bennell K, Waj-swelner H. Risk factors for hamstring injuries in community level Australian football. Br J Sports Med 2005;39:106-10.
• History of another lower extremity injury. Previous injury to the other lower limb, or injuries to other muscles or tendons in the same lower limb, may also increase the risk of high hamstring tendinopathy.⁷Orchard J, Marsden J, Lord S, Garlick D. Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. Am J Sports Med 1997;25:81-5.^,8Thelen D, Chumanov E, Sherry M, Heiderscheit B. Neuromusculoskeletal models provide insights into the mechanisms and rehabilitation of hamstring strains. Exerc Sport Sci Rev 2006;34:135-41.^,9Fields K, Bloom O, Priebe D, Foreman B. Basic biomechanics of the lower extremity. Prim Care 2005;32:245-51.

  See Common Running Injuries: Calf and Shin Pain

• Lack of flexibility and muscle weakness. Risk factors for high (proximal) hamstring tendinopathy reported in the literature are muscle weakness, lack of flexibility, inadequate warm-up, and muscle fatigue.¹Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.^,2Gabbe B, Finch C, Bennell K, Waj-swelner H. Risk factors for hamstring injuries in community level Australian football. Br J Sports Med 2005;39:106-10.^,10Ali K, Leland J. Hamstring strains and tears in the athlete. Clin Sports Med 2012;31:263-72.

• Older age. As people age, their muscles and tendons can lose some strength and elasticity, which may increase chances of hamstring tendinopathy.¹¹McCarthy MM, Hannafin JA. The Mature Athlete: Aging Tendon and Ligament. Sports Health. 2014;6(1):41-48. Dio:10.1177/1941738113485691. High (proximal) hamstring tendinopathy tends to be more common in middle-aged and older athletes.
• Muscle imbalances. Muscle imbalance between the hamstrings and quadriceps has been shown to lead to an increased incidence of high (proximal) hamstring injury, potentially leading to chronic hamstring tendinopathy.⁷Orchard J, Marsden J, Lord S, Garlick D. Preseason hamstring muscle weakness associated with hamstring muscle injury in Australian footballers. Am J Sports Med 1997;25:81-5.^,8Thelen D, Chumanov E, Sherry M, Heiderscheit B. Neuromusculoskeletal models provide insights into the mechanisms and rehabilitation of hamstring strains. Exerc Sport Sci Rev 2006;34:135-41.^,9Fields K, Bloom O, Priebe D, Foreman B. Basic biomechanics of the lower extremity. Prim Care 2005;32:245-51.

While some risk factors such as age cannot be changed, others, such as muscle imbalances and lack of flexibility, can be addressed through physical therapy.

See Treatments for Chronic High Hamstring Tendinopathy

Patients should work with their medical professional to strengthen weak muscles, increase flexibility in tight muscles, and optimize alignment and form where applicable.