High hamstring tendinopathy
Why does my sitting bone hurt when I sit or run uphill?
Pain where the hamstring tendons attach at the sitting bone, common in runners. Progressive tendon loading is the core of treatment.
What it feels like
A deep ache at the sitting bone at the bottom of the buttock, worse with sitting on hard surfaces, running uphill or fast, lunging and deep hip bending, often stiff at the start of a run.
What is actually happening
The hamstring tendons attach to the sitting bone. With increased loading, especially positions that compress the tendon against the bone, such as deep hip bending and stretching, the tendon can become painful and less tolerant of load.
How it is assessed
Assessment includes tenderness at the sitting bone, graded loading tests such as bridging and single-leg tasks, hamstring strength, and screening of the low back and hip, which can cause similar buttock pain.
How it is treated
A clinical review in JOSPT recommends reducing tendon compression (for example, avoiding deep hamstring stretching and long periods of sitting on hard surfaces) and progressive tendon loading: from isometric holds to heavier strength work and then running and sprinting. A systematic review found limited but supportive evidence for exercise-based treatment and shockwave therapy. Running load is adjusted and rebuilt gradually.
What to do first
Stop stretching the hamstrings hard, sit on a cushioned surface, reduce hills and speed work for now, and have it assessed to start a loading programme.
Where this is assessed
- The Runner's Academy St. Clair West · Mon/Wed/Fri · 3:00 PM – 6:30 PM Book at Runner's Academy
- Athlete's Care Sports Medicine Centres Yonge & Eglinton · Mon/Wed/Fri · 8:00 AM – 2:00 PM Book at Athlete's Care
- Push Pounds Sports Medicine Downtown Toronto · Tue/Thu · 8:30 AM – 6:30 PM Call Push Pounds to book
References
This page is based on the following clinical practice guidelines and research.
- Goom TS, Malliaras P, Reiman MP, et al. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management. J Orthop Sports Phys Ther. 2016;46(6):483-93.
- Nasser AM, Vicenzino B, Grimaldi A, et al. Proximal Hamstring Tendinopathy: A Systematic Review of Interventions. Int J Sports Phys Ther. 2021;16(2):288-305.