The proximal hamstring complex at the ischial tuberosity consists of the conjoint tendon (long head of biceps + semitendinosus) and the separate semimembranosus tendon. Complete proximal hamstring avulsion from the ischial tuberosity — occurring in water skiers, hurdlers, and dancers from forceful hip flexion with the knee extended — requires surgical reattachment within 4 weeks for optimal outcomes. Incomplete proximal tears (high hamstring tendinopathy) produce the characteristic deep ischial tuberosity pain during sitting and sprinting.
Hip extension force transmission from the ischial tuberosity; proximal hamstring origin — the most commonly strained muscle-tendon unit in sport
High hamstring tendinopathy (proximal hamstring tendinopathy at the ischial tuberosity) produces deep buttock-ischial pain during running and sitting. The ischiogluteal compressive load from sitting worsens symptoms. PRP injection at the ischial tuberosity combined with progressive eccentric hamstring loading is the evidence-based management. Complete avulsion requires surgical repair — tendons retract into the posterior thigh and lose blood supply if delayed beyond 4 weeks.
Complete ischial tuberosity avulsion requiring surgical reattachment within 4 weeks to prevent tendon retraction and ischaemic changes.
