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Background: Hamstring injuries are common among traditional and recreational athletes. Diagnosis and treatment of some of the newly described injuries remain difficult and lack supporting evidence. In addition, complete treatment of other components that may contribute to the injury is vastly lacking in research. The purpose of this case report is to highlight the challenges associated with diagnosing and comprehensively rehabilitating hamstring injuries. Case Description: A 72-year-old active female was referred to physical therapy for chronic proximal hamstring pain. This pain had progressed to limiting her ability to turn over in bed and participate in her exercise class. Intervention: Initial examination led to treatment via instrument assisted soft tissue mobilization and eccentric exercise training. After initial benefits, the patient’s improvements plateaued and eventually her pain increased. The treatment plan was modified to address adductor magnus involvement and hamstrings via dry needling and continuation of eccentric exercises. Outcome Measures: The patient’s pain initially decreased to 4/10 with bed mobility by the 4th visit with the initial treatment approach. However, the patient’s improvement then plateaued for 3 weeks. By the 8th visit, the patient’s pain had increased again. Over the course of treatment, the patient’s Lower Extremity Functional Scale score improved from 66% to 89%; thus the treatment modification was put into place. The patient was able to fully return to her exercise class activities and perform rolling over in bed without discomfort. Discussion: This case suggests approaches to differentiate proximal hamstring tendinopathy from other hamstring injury in patients with complaints of hamstring and posterior thigh pain. This case also presents potential treatment approaches for and the regional interdependence of hamstring pain and surrounding musculature.