Hamstring Tendinopathy

Proximal hamstring tendinopathy is one of the more commonly missed diagnoses in lower limb pain - the symptoms overlap with sciatica and referred lumbar pain, which means many people spend months being treated for the wrong thing. We use ultrasound to confirm the diagnosis directly, which changes the treatment plan entirely. 

What is Hamstring tendinopathy?

Hamstring tendinopathy refers to pain and dysfunction at the proximal hamstring tendons - the tendons of the biceps femoris, semimembranosus, and semitendinosus muscles, at the point where they attach to the ischial tuberosity, the bony prominence at the base of the pelvis (commonly known as the 'sit bone').

This condition is sometimes called proximal hamstring tendinopathy or high hamstring tendinopathy, and it is distinct from a hamstring muscle tear or strain. As with other tendinopathies, the problem typically reflects a failure of the tendon to adapt to load rather than acute tissue damage, and it often responds poorly to rest alone.

The hallmark of proximal hamstring tendinopathy is deep, aching pain at the sit bone. Typical symptoms include:

• Pain and tenderness at the base of the buttock, over the ischial tuberosity

• Discomfort when sitting, particularly on hard surfaces or for prolonged periods

• Pain when running, especially at speed or during uphill running

• Stiffness and deep buttock ache after activity

• Pain when stretching the hamstrings (hamstring stretches can aggravate the tendon)

Symptoms can be confused with sciatica or referred pain from the lumbar spine, so accurate diagnosis is important.

Proximal hamstring tendinopathy is most common in distance runners and athletes involved in sports requiring repeated hip flexion and extension. Contributing factors include:

• Running, particularly at pace or on hilly terrain

• Sports involving sprinting, kicking, or lunging movements

• Sudden increases in training load or intensity

• Prolonged sitting on hard surfaces (which compresses the hamstring tendons)

• Reduced hip and gluteal strength, or altered lumbopelvic mechanics

It can also occur in less active individuals, particularly those who sit for extended periods with the hips flexed.

Treatment focuses on gradually reloading the hamstring tendons in a controlled way, combined with addressing contributing factors. Importantly, passive hamstring stretching is generally discouraged in the early phase of rehabilitation, as it increases compressive load on the tendon insertion.

Common treatment elements include:

• Load management - modifying sitting positions, training volume, and provocative activities

• Progressive hamstring and gluteal strengthening exercises

• Avoidance of provocative positions such as prolonged sitting on hard surfaces or deep hip flexion

• Hip and pelvic control work to address biomechanical contributors

• Manual therapy to associated structures where appropriate

For persistent cases, focused shockwave therapy is an effective treatment option that stimulates the natural healing response within the tendon and reduces pain. It is more comfortable and effective than radial shockwave therapy due to the deep location of the hamstring tendon, and typically achieves results in fewer sessions.

Hamstring tendinopathy is frequently misdiagnosed, and symptoms can overlap significantly with other causes of buttock and posterior thigh pain. At Tenby Health & West Wales Ultrasound, we use clinical assessment alongside diagnostic ultrasound to confirm the diagnosis, assess the degree of tendon change, and rule out other pathology.

This informs a structured and individual treatment plan that may include:

• Diagnostic imaging to confirm the nature and extent of tendon involvement

• Focused shockwave therapy for appropriate cases

• Supervised rehabilitation with progressive hamstring and hip loading

• Practical guidance on activity modification and return to running

What to do next

If deep buttock or posterior thigh pain is affecting your daily life, the most important first step is a proper assessment.

Book a new patient consultation (£65) and we’ll assess your symptoms, confirm the diagnosis, and explain your options clearly - whether that’s shockwave, rehabilitation, diagnostic ultrasound, or a combination. Most people leave their first appointment knowing what’s going on for the first time.

View our pricing and packages: tenbychiropractic.co.uk/pricing-and-cancellations.

 Related Pages: Focused Shockwave Therapy | Tendon Pain & Injuries  | Thigh Ultrasound Scan