Hamstring Tendinopathy (Sitting-Bone Pain)

Overview

The hamstrings run down the back of the thigh and attach at the top to the ischial tuberosity — the "sitting bone" you can feel under each buttock. Proximal hamstring tendinopathy is a condition where this tendon attachment becomes painful and less able to tolerate load. The pain is a deep, localised ache right at the sitting bone, sometimes spreading a little down the back of the thigh, and it is characteristically worse when sitting, especially on hard surfaces or for long periods.

It is most common in distance runners, sprinters, hurdlers and footballers, and in people who have recently added hill running, speed work or deep hamstring stretching. It also occurs in those who sit for long hours, where the tendon is compressed against the bone. Because the tendon is slow to adapt, this condition tends to develop over weeks to months and can be frustratingly persistent if it is managed with rest alone.

The approach with the strongest support is progressive loading: gradually strengthening the hamstrings in positions that do not compress the tendon, then building towards running and sport. This takes patience, but most people make steady progress with a well-structured programme.

Causes and risk factors

• A sudden increase in running volume, hill work, sprinting or hurdling
• Long periods of sitting, compressing the tendon against the sitting bone
• Deep hamstring stretching or yoga positions that load the tendon in a stretched position
• Weak hamstrings and glutes relative to training demands
• A previous hamstring tear that was not fully rehabilitated
• Lumbar or pelvic stiffness altering how load reaches the tendon
• Age — tendons become less tolerant of sudden change from the thirties onwards

How we may be able to help

We confirm the diagnosis with specific tendon-loading tests, palpation at the sitting bone, and by ruling out other causes of buttock pain such as the lumbar spine, sacroiliac joint, sciatic nerve and piriformis. We assess hamstring and gluteal strength, your running mechanics where relevant, and your daily sitting habits.

Our physiotherapists build a staged loading programme: starting with isometric holds that often reduce pain, progressing to heavy, slow strengthening such as bridges and hip hinges, and finally to energy-storage work like running drills and sprinting. We also advise on modifying sitting and temporarily avoiding stretches that compress the tendon. Manual therapy and dry needling can help the surrounding hamstring and gluteal muscles that become tight and protective.

For tendinopathy that has persisted despite a proper loading programme, focused shockwave therapy is a recognised option used to stimulate the tendon's repair response and reduce pain at the attachment. It is delivered over a course of sessions after assessment and alongside, not instead of, the strengthening work. Our chiropractor can address lumbar and pelvic stiffness that adds load to the tendon, and interferential therapy may be used for short-term pain relief.

What you can do at home

• Sit on a cushion or wedge, and avoid hard seats and long sitting periods
• Pause deep hamstring stretches, forward folds and hurdler stretches for now
• Start with isometric hamstring holds (e.g. a bridge held for 30–45 seconds) as shown by your therapist
• Reduce hill running and speed work, keeping to flat, easy running if pain allows
• Progress strengthening gradually; mild discomfort during exercise that settles within 24 hours is acceptable
• Be patient — tendons take weeks to months to adapt, and consistency matters more than intensity