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.8,9 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.6
  • See Common Running Injuries

  • Jumping and kicking. Like runners, people who regularly jump or kick, such as dancers or track athletes, may develop this chronic condition.10,11,12
  • History of high (proximal) hamstring tendon tear(s). A history of partial or full thickness tendon tear may increase the likelihood of chronic tendinopathy.8,9
  • 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.13,14,15
  • 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.8,9,16
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  • Older age. As people age, their muscles and tendons can lose some strength and elasticity, which may increase chances of hamstring tendinopathy.17,18 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.13,14,15

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.


  1. Orchard J. Biomechanics of muscle strain injury. N Z J Sports Med 2002;30:92-8.
  2. Gabbe 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.
  3. Askling C, Lund H, Saartok T, Thorstensson A. Self-reported hamstring injuries in student-dancers. Scand J Med Sci Sports. 2002;12(4):230-235.

Complete Listing of References