TENDINOPATHYProximal Hamstrings


The hamstrings are composed of three muscles that run from just behind your knee to your buttocks at a point commonly called the "sitting bones".

Tendinopathy is caused by an overload of the tendon. Either the external stress (e.g. increased training load, poor biomechanics, etc.) has been too much, or the tensile strength of the tendon is too little, resulting in overload and subsequent degeneration of the tendon.

Symptoms normally manifest deep in the buttock whilst walking or running, but especially especially when accelerating or running at a high pace. Irritation may also be felt while sitting down.

This is a difficult condition to diagnose and the incorrect treatment can severely retard your healing. So, make sure that you have a clear diagnosis before beginning HSR Training. If you haven't, make sure you consult a health professional who specialises in the rehabilitation of musculo-skeletal injuries.


How to perform Heavy Slow Resistance Training

The Protocol:

Week Reps Sets RPE* Rest Between Sets
1 15 4 6/10 1-3 min
2-3 12 4 6.5/10 1-3 min
4-5 10 4 7/10 1-3 min
6-8 8 4 7.5/10 1-3 min
9-12 6 4 8.5/10 1-3 min
* RPE: Rate of Perceived Exertion. See more on this below.

You will perform three tendon specific exercises (we have given two examples, double up on one of them), three times per week with one days rest between each session. If you are still able to run (if you experience more than 3/10 pain while running, stop!), do not run on the day that you do the HSR exercises. You may need 36-48 hours rest between activities that usually aggravate your tendon. You will begin with 4 sets of 15 repetitions in your first week and progress your reps as shown in the table above.

The movement is slow and controlled, three counts up, three counts down. This is important. Performing the movement faster will reduce the effectiveness of the exercise. Give yourself 2-3 minutes to recover between exercises. A nice way to do that is to perform another strength exercise in between your HSR exercise sets.

Of great importance is your Rate of Perceived Exertion (10 being the most you’ve ever exerted yourself, 0 being no exertion at all). If your RPE is too low, you are loading the tendon below the necessary threshold and risk aggravating it. Make sure that RPE is always above a 6/10 (rather too high than too low). Tendons need to be loaded sufficiently to adapt optimally.

If you feel that you can only tolerate two of the three exercises for the first few weeks (the muscles often protest before the tendon does!), listen to your body, start there and slowly build up. It is obviously ideal to follow the protocol as closely as you can, however, we have had success in treating tendinopathies with only two exercises per session. We have found that for some people, four sets of three different exercises (twelve sets in total!) is a bit too much, so we adjust accordingly.

The key is to keep a record of how your tendon responds. Make a note of your pain levels (score out of ten) upon rising in the morning, running (if able), and during and after your HSR sessions. When you experience an increase in pain, particularly 24 hours after activity, you know that you are over-loading the tendon. If you are loading your tendon correctly, your pain should not get worse during the HSR session.

If your pain increases or if you are in any doubt, get the advice and assistance of a health professional who specializes in musculo-skeletal injury rehabilitation.

HSR Training is hard core - but so worth the effort. A bit of sweat is better than persistent and debilitating pain any day.

Happy healing!

Prone hammy curl with resistance band



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Unilateral bridge with foot on chair



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