Chronic Proximal (High) Hamstring Tendinopathy

This condition is usually caused by repetitive movements such as running, rowing, biking or sitting for long periods. It is characterised by a deep buttock pain just at the top of the back of the thigh (hamstring muscles). It has a gradual onset which can worsen over time, becoming chronic, if not treated correctly. It can be aggravated with sitting, with constant activity and acceleration during sprinting. Conservative treatment includes rest and avoidance of aggravating factors, ice, stretching and strengthening. In some cases, rehabilitation may fail, and shockwave therapy may be a treatment option before injection therapy.

A randomised control study comparing the use of traditional conservative treatment with shockwave therapy found there was an 85% improvement in VAS scores (pain level measurement) in the group who had shockwave therapy compared to only a 10% improvement in the traditional conservative treatment (physical therapy and NSAIDs) after a three-month follow-up. Also, there was an 80% return to play from the shockwave group compared to 0% from the conservative treatment group. However, there were only small subject groups within this study.

Current evidence is very limited for the use of Shockwave therapy for chronic proximal hamstring tendinopathy. However, it may be a possible treatment option if other conservative treatment modalities have failed.


Cacchio A, Rompe JD, Furia JP et al. Shockwave therapy for the treatment of chronic proximal hamstring tendinopathy in professional athletes. Am J Sports Med. 2011;39(1):146-53.