Hamstring Tendinopathy: Why Sitting and Running Can Both Hurt
Written by: Dr. Richard Domenic Simeoni | Nano Physiotherapy | Hornsby, NSW
Pain high up at the back of the thigh or just underneath the buttock can be surprisingly persistent.
For some people, it mainly hurts when running. For others, sitting at a desk, driving, running uphill or accelerating can all aggravate it. One possible cause is proximal hamstring tendinopathy.
This is a condition affecting the hamstring tendon where it attaches near the sitting bone at the pelvis. It can develop gradually and, like many tendon problems, often becomes frustrating when it hangs around for weeks or months.
Physiotherapy can help by identifying the activities that are overloading the tendon, gradually rebuilding strength and improving its ability to tolerate running and everyday activity again. For more persistent cases, shockwave therapy may also be considered.
What Does Proximal Hamstring Tendinopathy Feel Like?
The hamstring muscles run down the back of the thigh and attach to the pelvis through strong tendons.
With proximal hamstring tendinopathy, pain is usually felt high up near the bottom of the buttock rather than through the middle of the hamstring.
Typical symptoms can include:
Pain when sitting for longer periods
Discomfort when driving
Pain during or after running
Pain with hills or faster running
Symptoms with sprinting or acceleration
Tenderness around the sitting bone
Pain when bending forward or stretching the hamstring
Unlike an acute hamstring strain, there often isn't one sudden moment where the injury happened.
Symptoms may gradually appear as training load increases.
Why Can Sitting Hurt?
One of the unusual things about proximal hamstring tendinopathy is that sitting can sometimes be just as irritating as exercise.
When you sit, particularly on a firm chair or with the hip bent for a long period, the tendon can be compressed around its attachment at the pelvis.
If the tendon is already sensitive, prolonged sitting can therefore become uncomfortable.
This doesn't mean sitting is damaging the tendon every time it hurts.
However, during a more irritable period, reducing long periods of continuous sitting or changing position more frequently can help manage symptoms while the tendon becomes stronger.
Why Do Running, Hills and Acceleration Aggravate It?
Running places significant load through the hamstrings, particularly as speed increases.
Hills, sprinting and acceleration can place even greater demands on the proximal hamstring.
This is why someone may be able to tolerate an easy flat run but develop pain when they start adding hills, intervals or faster sessions.
A common mistake is to repeatedly test the painful activity without giving the tendon enough time to adapt.
Instead, we generally want to temporarily reduce the activities that are strongly aggravating symptoms while progressively rebuilding the tendon’s capacity.
That doesn't necessarily mean stopping running completely.
Depending on the severity of symptoms, you may be able to continue running at a reduced distance, speed or frequency while rehabilitation progresses.
Progressive Strengthening Is Important
As with most tendinopathies, strengthening is a major part of treatment.
Early exercises may focus on loading the hamstring in positions that don't significantly aggravate symptoms.
As the tendon becomes more tolerant, exercises can gradually become heavier and more demanding.
This may include hamstring strengthening, hip and gluteal exercises and eventually more running-specific work.
For someone returning to sport, rehabilitation may progress towards higher-speed movements, hills, acceleration and sprinting.
The aim is not simply to get the tendon feeling better at rest.
We want it to become strong enough to tolerate the activities that caused the problem in the first place.
Can Shockwave Therapy Help?
For persistent proximal hamstring tendinopathy, shockwave therapy may sometimes be used alongside exercise rehabilitation.
Shockwave delivers acoustic pulses into the affected tendon area and is used for a range of longer-standing tendon problems.
The goal is to stimulate a biological response within the tissue and help reduce pain.
It shouldn't be viewed as a replacement for strengthening.
At Nano Physiotherapy, shockwave is generally considered as part of a broader rehabilitation program when symptoms have become stubborn or haven't improved as expected with more basic management.
Physiotherapy for Hamstring Tendinopathy in Hornsby
Proximal hamstring pain can be difficult to manage because the tendon is loaded during both exercise and everyday activities such as sitting.
At Nano Physiotherapy in Hornsby, we assess the activities that are aggravating the tendon, along with hamstring and lower-limb strength, hip movement and your current running or training load.
Treatment may include advice around temporarily modifying sitting and running, progressive strengthening, manual therapy where appropriate, and shockwave therapy for persistent cases.
If pain high at the back of the thigh or underneath the buttock keeps returning with running or sitting, a physiotherapy assessment can help determine what's contributing to the problem and provide a structured plan for getting back to normal activity.
