Distal Hamstring Tendinosis Recovery Advice
Hey, I have been struggling with a stinging pain in the back of both knees for quite a few months now and it keeps getting worse so thought I’d try for some advice from others.
For some background, my work involves visiting and walking around brownfield/agricultural sites 2-3 times a week and means I have to do about 10-15k steps on these days. Sitting breaks do provide temporary relief whilst walking. I bring this up as I think this is consistently aggravating both knees and not giving them appropriate time to recover. I have now asked work if I can reduce these visits to bigger sites so I don’t have to walk as much. Pain has generally come after larger physical demands of it but starts hurting during standing and walking on site visits now.
The first discomfort I felt in the back of my left knee came after a 15-mile run in September 2025. Was running about 25 miles a week on average over this time. This was very minor and not something I would even class as a pain, just a tweak I felt after finishing the run. This hung around in the background but wasn’t something major as I only felt it during runs and it still allowed me to run two half marathons in early October and then early November. I noticed in between these runs, doing hamstring curls on the machine in the gym started to hurt this area on the weight id usually do and so I stopped doing this exercise.
After the second half I was struggling with this back of the knee pain in both legs now (right behind and inside of knees), but it only occurred during running. One night in late November I went on a very light run which was limited significantly by this pain, and then I played an hour of football later that night. I felt ok after on the night but the morning after was a bigger pain in the back of both knees and really limited my movement (7/10 pain).
I stopped running for about 3-4 weeks to let it rest and then went back to running over Christmas. I did a few short runs but felt it behind my knees every time and then the day after a 5-mile run in early January the same major knee pain was back which stopped me running again. After this, I stopped running again and started to do some hamstring stretches given to me from a GP phone call appointment I got through work, but this only seemed to make things worse and resulted in pain afterwards for a day or two. I went on a very light, short run at the end of January and I felt discomfort, which then turned to pain later in the day whilst walking.
I returned to doing leg exercises at home after seeing an NHS physio in March and followed their plan for a month but increasingly continued to experience pain after demanding less and less of my legs. I saw a private physio at the end of April who diagnosed this issue as distal hamstring tendinosis and scaled my exercises way back to just doing static holds of two exercises once a day. I did this for a week until he moved me onto the same exercises but with the hamstring in a more stretched position but this seemed to cause more pain and so I have returned to the original exercises ever since.
Ice did seem to reduce pain so I did this every day after my NHS appointment, but private physio said not to do this as it’s a tendon issue and he wants me to keep it loose. Have been adding heat to it everyday since. I have received acupuncture and soft tissue massage to both legs once a week for two weeks, but these just seem to make my legs feel very vulnerable and a bit achy immediately and a few days after.
Legs still have full range of motion and have not been buckling at all.
The pain threshold in the back of my legs has reduced steadily since January to the point now where I can walk/stand for about 10 mins until I am in pain and have to push through it. Following aggravating it, it remains in pain the next day. As I have read more about this, I believe this is now at the chronic stage.
I can give more information if needed. Feel very stuck right now and knees are getting worse so any advice would be appreciated. Cheers