Here is a running injury with an odd signature: it often hurts more when you sit down than when you run. If you have a deep, nagging pain right at the sit-bone, that bony point at the bottom of your buttock, and it is worse after a long drive or a day at your desk, this may be for you.
That pattern is typical of proximal hamstring tendinopathy. Here is what it is, why sitting makes it worse, what the evidence says actually helps, and when it is worth getting assessed.
In this article
What is proximal hamstring tendinopathy?
Proximal hamstring tendinopathy is an overload problem of the hamstring tendons where they attach to the sit-bone (the ischial tuberosity) at the base of the buttock. The tendon becomes irritated and loses some of its capacity to handle load, which brings on a deep, localised ache at that spot.
Unlike a sudden hamstring strain, where the muscle is torn during a sprint, this builds up gradually and tends to grumble on, especially with the specific loads that compress or stretch the tendon.
Why does sitting make it worse?
The tell-tale feature of this condition is pain with sitting, and there is a good reason for it. Sitting presses the sit-bone, and therefore the tendon, against the surface you are on, which compresses an already sensitive tendon. That is why hard chairs, long drives and even sitting through a meal can be uncomfortable.
Activities that combine bend-forward positions with load, such as running uphill, lunging and squatting deeply, tend to aggravate it for the same reason. The tendon does not like being compressed and loaded at the same time.
Who tends to get it?
Proximal hamstring tendinopathy is reported in long-distance runners, sprinting athletes and change-of-direction sports. It often appears after a spike in training, a return to running, or a jump in hill work or speed sessions. Common features include:
- Deep pain right at the sit-bone, at the bottom of the buttock
- Pain that is worse with sitting, especially on hard surfaces or long drives
- Pain with running, particularly faster or uphill running, lunging and deep squats
- A gradual onset rather than a single tearing moment
If that sounds like your pain, the encouraging news is that it usually responds to the right kind of loading rather than to rest alone.
What helps, and why rest alone is not the fix
It is tempting to simply stop and wait for a grumbly tendon to settle, but tendons generally do not recover their capacity by resting. They need to be loaded, in a graded and appropriate way, to rebuild.
The tell-tale sign
The defining feature of proximal hamstring tendinopathy is deep sit-bone pain that is worse with sitting and running.
Load it, do not just rest it
Management centres on a staged, progressive tendon-loading programme alongside reducing the compressive loads that aggravate the tendon, rather than rest alone.
A typical plan reduces the aggravating compression early (managing deep sitting and deep-hip-flexion loads), then progressively loads the tendon and hamstring so it can handle running again.
How do you get started safely?
A sensible way to begin includes:
- An assessment to confirm the tendon is the source and rule out other causes of buttock pain
- Early load management, including easing the deep sitting and compressive positions that flare it
- A staged, progressive strengthening programme for the hamstring and tendon
- Gradual reintroduction of running, speed and hills as the tendon adapts
- Simple changes like a cushion or standing more if long sitting is a trigger
A physiotherapist can match the loading to your stage and your goals rather than a generic routine. If you would like guidance, our team offers physiotherapy in Mount Gravatt for runners across Brisbane's southside.
When should you seek help?
Consider getting assessed if
You have deep sit-bone or buttock pain that is worse with sitting and running, pain that is limiting your training, or pain that is not settling. Seek prompt review if you had a sudden painful tearing sensation with bruising and weakness, which can suggest a more significant hamstring injury, so it can be assessed and your plan tailored to you.
Helping You Perform at Your Best
At ACE Sports Medicine in Upper Mount Gravatt, our physiotherapists provide personalised, progressive rehabilitation for runners with hamstring tendon pain, for people across Brisbane's southside. We will confirm the source, manage the aggravating loads, and build a staged loading plan back to running.