Proximal Hamstring Tendinopathy: A Systematic Review of Interventions.
Anthony Michael Nasser, Bill Vicenzino, Alison Grimaldi and 2 others
PMID 33842025WHAT IT FOUND
No treatment for proximal hamstring tendinopathy has high-quality evidence.
Shockwave therapy looked better than a weak multi-modal control in one small trial, but evidence was very low. Surgery had the most complications. Do not assume any single injection or procedure is proven.
Key findings
01There was no high or moderate quality evidence for any intervention, including surgery, injections, or shockwave therapy.
02Shockwave therapy showed superiority over a multi-modal intervention in one small RCT, but the control group received only three weeks of exercise, which is likely insufficient for tendon rehab.
03Surgical interventions resulted in the highest level of minor and major adverse events, with complications occurring in 10% of cases.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The evidence base is extremely weak, with no high or moderate quality studies. Most included studies were uncontrolled case series, which cannot prove treatment effects due to natural recovery and other confounders. The shockwave therapy trial compared it to a multi-modal intervention that likely provided insufficient exercise dosage, making the comparison unfair. Diagnostic criteria and outcome measures varied significantly across studies, preventing data pooling. Intervention adherence and post-surgical rehabilitation protocols were poorly reported in most studies.
Declared interests
The authors declared no conflicts of interest or funding sources.
The easy way to misread this
Do not interpret the positive results for shockwave therapy or surgery as proof of efficacy. The shockwave trial used a weak control group, and the surgical results came from uncontrolled case series that cannot distinguish treatment effects from natural history. The evidence for all interventions is very low.