Adapting the bridge exercise for high hamstring tendinopathy
- Maryke Louw
- Apr 7
- 5 min read
Many people recovering from high hamstring tendinopathy feel despondent if their prescribed bridge rehab exercises are painful. The bridge is the classic strengthening exercise for this condition, so they feel they’re not going to get better if they can’t do them. If this is you, don’t despair – there are ways around this problem.
Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.
In this article:
We've also made a video about this:
👉 Read more about other aspects of high hamstring tendinopathy here.
How much pain is acceptable?
A certain amount of pain and discomfort during your bridge exercises is to be expected. Researchers agree that pain up to a level of 3 out of 10 is acceptable during and after the exercises as long as it calms down within a few hours.
💡 But it can be difficult to decide what a 3, 5, or 8 out of 10 really means. So, in our clinic we tend to advise that “a bit” or “niggle level” more than your usual pain is acceptable.
If the pain is significantly more or to such an extent that it really annoys you, it is likely too much. You might not necessarily worsen your injury, but your pain will increase, and this as such might prevent you from getting better. It’s like prodding a bruise all the time – the injury won’t get worse, but the pain isn’t going to settle down any time soon either.
Also, if the increased pain (regardless of the intensity) caused by the exercise session hasn’t settled down to its pre-session level within 24 hours, you should also do something about it.
Here are some things you can try.
How to adapt bridges for high hamstring tendinopathy
Reduce the repetitions and/or how long you stay up
The number and intensity of rehab exercises have to be right for where you are in your recovery journey and for what your injured tendon can handle at each stage.
💡 It’s not just about how strong your tendon is – it can be very strong but also super sensitive, in which case the pain gets triggered if you go above a certain level.
The good news is that this hypersensitivity will also calm down if you pitch your rehab exercises and other activities at an acceptable level.
Starting with very short holds, long rest intervals, and very few repetitions is often a good way to avoid flare-ups and establish a baseline.
Once you’ve established a baseline of exercise that doesn’t irritate your tendons, you can gradually build up to more challenging sessions.
Don’t go for the “perfect bridge” at the start
Also, you don’t have to do the “perfect” bridge right from the word go. Many of my patients find that trying to force that last bit of movement to get their hips fully straight really aggravates their pain.
When this happens, I tell them to stop just before they reach that point. This allows their injured hamstring tendons to get used to it gradually. As it becomes less sensitive, they can usually progress to doing a full bridge.
Here’s a video demo of what I mean.
Foot placement
See whether placing your feet closer to your bum makes things easier. The further away from your bum your feet are, the more your hamstrings work; the closer they are, the more your glutes have to work.
As your injured tendon becomes stronger, you can gradually move your feet further away to make things more challenging.
Don’t squeeze too hard
Some people feel that they don’t get value from doing bridges if they don’t feel it in their glutes (their butt muscles). However, squeezing too hard with your glutes might cause you some unnecessary pain.
💡 Don’t worry if you can’t “feel” your glutes working – it’s impossible to get into the bridge position without using your glutes.
So, instead of thinking about getting a squeezing feeling, think about, “Can I feel that I'm doing the movement right? Can I feel that I'm going up, and I feel my hips get to a point where they're not gonna go higher, and that's where I stay; I'm not bothering with squeezing anything, I'm just looking to sustain the position.”
An alternative to bridges for high hamstring tendinopathy
There is a significant portion of our high hamstring tendinopathy patients that just cannot do a bridge – it sets off their pain no matter what. In these cases, hamstring curls can work well.
💡 Hamstring curls are in any case useful to include in your rehab (in addition to the bridge exercise if it doesn't give you trouble) for high hamstring tendinopathy, because it works the hamstring muscles eccentrically which resembles how these muscles work when we move.
This is what a hamstring curl looks like:
The best option is to do these on a hamstring curl machine in the gym. They allow you to select the weight quite accurately and then increase it gradually as your injured tendon gets stronger.
If you don’t have access to a gym, lying on your front and doing the hamstring curls against the resistance of an exercise band is the way to go. (I once had a patient who found the exercise band annoying, so he taped a weight to his boot instead!)
As with many rehab strengthening exercises, you can start off with doing isometric holds if you find that doing an actual curl is too painful. So, you just hold your leg still against the resistance of the weight or exercise band.
Be flexible
👉 I mean flexible in the figurative sense here.
I find that rehab programmes should be a fluid thing. In very few cases the type of exercise and the level of difficulty at which it has to be done is the best combination right from the outset.
💡 Quite often, there are little niggles that come out, and you have to change the exercise or adapt the level of difficulty up or down. The rehab plan also has to increase in intensity as the injury recovers.
That’s why having review sessions with your physio at regular intervals is important. If you're stuck on an exercise for your high hamstring tendinopathy and it’s painful, discuss it with them so they can adapt your programme.
You can find examples of bridge progressions in this article.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.