High hamstring tendinopathy is pain and reduced function in the hamstring tendons where they attach to the sitting bone at the base of the buttock. It typically causes deep buttock pain with sitting, running and bending forwards. Research is limited, but education and progressive strengthening are the recommended starting point.
Also known as proximal hamstring tendinopathy, PHT, high hamstring tendon pain, ischial tuberosity pain
Symptoms
- Deep pain in the lower buttock over the sitting bone
- Pain when sitting, especially on hard seats or for long periods
- Pain with running, particularly faster running or uphill
- Pain when bending forwards with straight legs or lunging
- Pain that warms up during exercise but is worse afterwards or the next day
- Sometimes pain spreading into the back of the thigh
Causes and risk factors
- Sudden increases in running volume, speed or hill work
- Activities that combine deep hip bending with load, such as lunges or yoga stretches
- Long periods of sitting that compress the tendon
- Weakness in the hamstring and buttock muscles
- Previous hamstring injury
What the evidence says helps
- A systematic review found too little evidence to recommend one treatment over another. It suggested trialling approaches that work in other tendon problems, such as progressive loading.1
- Clinical guidance and expert opinion favour education plus a graded strengthening programme, initially limiting positions that compress the tendon, such as deep hip bending and long periods of sitting.25
- Diagnosis is usually clinical, based on your history and pain provocation tests, and scans are not routinely needed.3
- A trial comparing individualised physiotherapy with shockwave therapy, both alongside advice and education, found similar improvements over 12 months.4
- Evidence for injections in high hamstring tendinopathy is of very low quality, so they are not a first-line option.1
Things you can try at home
- Sit on a cushion and take regular breaks from sitting
- Avoid hamstring stretches and deep forward bends while the tendon is sore
- Reduce running speed and hills for a while rather than stopping completely
- Start gentle hamstring strengthening, such as bridges, if pain allows
- Increase activity gradually and use next-day pain as your guide
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A sudden pop or tearing feeling at the top of the hamstring, with bruising or difficulty walking – seek urgent assessment the same day
- Numbness around the genitals or buttocks, or new bladder or bowel problems – go to A&E or call 999
- Buttock pain with fever or feeling unwell – get same-day medical help or call NHS 111
- Pins and needles, numbness or weakness spreading down the leg – see your GP urgently
- Pain with unexplained weight loss or a history of cancer – see your GP urgently
How Apollo can help
We assess your buttock, hip and lower back to tell high hamstring tendinopathy apart from other causes such as referred back pain. VALD testing allows us to measure hamstring and hip strength so your progress can be tracked. Our team explains how to manage sitting and training, guides a progressive loading programme and a staged return to running, and refers on if your symptoms suggest a tear or another problem.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Should I stretch my hamstrings if I have high hamstring tendinopathy?
Stretching that bends the hip deeply can compress the irritated tendon and often makes symptoms worse. Experts usually advise avoiding these stretches early on and focusing on gradual strengthening instead.
Can I keep running with high hamstring tendinopathy?
Often yes, with changes. Reducing speed, hills and distance to a level that does not cause lasting pain, while building strength, is a common approach. Your clinician can help set sensible limits.
How is it different from sciatica?
Both can cause buttock pain. High hamstring tendinopathy is usually felt deep over the sitting bone and is linked to loading the hamstring, while sciatica comes from an irritated nerve and often causes pain, tingling or numbness down the leg.
References
- Nasser AM, et al. (2018). Proximal hamstring tendinopathy: a systematic review of interventions. International Journal of Sports Physical Therapy. View source
- Goom T, et al. (2016). Proximal hamstring tendinopathy: clinical aspects of assessment and management. Journal of Orthopaedic & Sports Physical Therapy, 46(6), 483–493. View source
- Grimaldi A, et al. (2024). Current and future advances in practice: tendinopathies of the hip. Rheumatology Advances in Practice. View source
- Rich A, et al. (2025). Physiotherapy compared with shockwave therapy for the treatment of proximal hamstring tendinopathy: a randomized controlled trial. The American Journal of Sports Medicine. View source
- Nasser AM, et al. (2020). Proximal hamstring tendinopathy; expert physiotherapists' perspectives on diagnosis, management and prevention. Physical Therapy in Sport. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
