Therefore, the pain monitoring meaningful task shall progress over time to movements which require greater hip flexion ranges, in order to accommodate for the increased capacity of the tendon to withstand loads throughout the exercise program. Consequently, the exercise program degree of difficulty is not only measured by commonly accepted variables such as load and volume but also by degrees of hip flexion.

In regards to proximal hamstring tendinopathy, adding more hip flexion means greater compressive forces are applied to the proximal insertion of the tendon, increasing tissue demands. In contrast, scores ranging from 4-10 are interpreted as an inability of the pathological tendon to adapt to the loading program given. The proposed system establishes a cut-off point at 3/10 on a pain scale where any score from 0-3, as assessed by the relevant meaningful task, is reflective of the tendon tolerance to the loading program.

In the context of this case scenario, the initial meaningful task to assess the proximal hamstring response to the proposed exercise program is 3 repetitions of the short lever single leg bridge. Goom, Malliaras (2), suggest a meaningful task to be monitored daily, at the same time, which will provide information regarding tendon irritability and capacity to withstand loads in 24 hours window by using pain levels as a parameter. Hence, disregarding pain signalling would likely limit motor control restoration and strength gains in the whole kinetic chain (6). That approach to load progression in tendinopathy also makes sense considering pain can potentially inhibit corticospinal activity and alter motor control. Considering the limited literature targeted at loading management strategies in proximal hamstring tendinopathy, the most accepted model is to progress loads using a pain monitoring strategy (2).

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