High Hamstring Tendinopathy

High Hamstring Tendinopathy goes by a few names, it’s also known as proximal hamstring tendinopathy or high hamstring tendinitis and refers to inflammation or irritation of the common origin (ischial tuberosity) of the hamstring muscles. The origin is where the muscles tendon attaches to the bone in your buttock.

Reasons for High Hamstring Tendinopathy

A quick search of the internet reveals that there seem to be 3 reason for high hamstring tendinopathy.  The reasons or main causes  associated with the onset of your deep buttock pain are;

Over use;

This seems to be the most commonly written about on the internet. Specifically in relation to middle or long distance runners, but it can happen to anyone.

The common factor seems to be change that happens to soon or too fast for your ability to cope. Examples could be, changes in exercise  (more walking, lifting heavier weights (shopping could be included here!) cycling and running more too). Running and cycling faster or doing more hills are other examples. Even something as simple as changing the way you carry load may be enough to make your hamstring tendon symptomatic. So going from shopping bags to a rucksack or vice-versa may be a cause pain to start.

After back pain;

This seems to be due to the pain irritating the sciatic nerve, The cause of the sciatica nerve irritation doesn’t appear to be indicated

Traumatic or sudden onset;

Possibly due to a slip or slide and sudden contraction of the biceps femoris pulling and irritating the tendon and where it attaches to the bone. There also seems to be where the fibrosis or sticking of the sciatic nerve to the muscle occurs.

Other causes ,

I think these are better thought of as maintaining factors.

Adhesions between the sciatic nerve and one of the hamstring muscles.
The fascia covering the hamstrings is scared and bound to other structures and as a result may inhibit sciatic nerve function, and also shorten range of motion.

Gluteal weakness can cause overuse of the hamstring muscles. This can cause shortening and tightness in the hamstrings and potentially lead to high hamstring tendonopathy.


High Hamstring Tendinopathy gives you pain in the lower buttock on the part of the pelvic bone you should be sitting on. The pain in the buttock has been described as very sharp or like a tooth ache all the time. There doesn’t seem to be any inflammation in the ischial tuberosity although it’s painful to pressure, most notably sitting. When I had this I wasn’t able to sit comfortably for about 6 months. The pain I had when driving was almost unbearable.

Contraction of the hamstring muscles causes pain in the buttock as does a hamstring stretch . Standing does not cause pain buttock although a slight pull maybe noticed in back of the knee on the outside. Tightness may also be noticed in the upper hamstrings.


The first goal is to stop further sensitivity, so I may suggest reducing or even stopping potential causes and irritants initially. Cutting back on exercise, reduce sitting (try standing, kneeling or even laying down)

Next, deal with any active inflammation. Ice around the insertion and tendon may help in the short-term, but I prefer heat on the muscle belly feels good and may help release any tightness in the muscle itself.

In the early stages do not stretch the hamstring muscles, as this will pull on the tendon and further irritate it. I found rollering ineffective.
Get it examined so it can be diagnosed and treated as quickly as possible as this may shorten the duration of the condition.

Kinesiotaping and massage can help reduce pain and sensitivity to allow you rehab to do your home treatment to help getting you back to your life and activities quicker


Treatment by me is always based on the needs of you as an individual patient, because of that it is hard to give a definitive treatment guide.

first stage

I often look for ways to stop further sensitization of the area, while keeping you doing the activities you love.

Second stage

is to find ways to decrease pain and sensitivity. this may involve massage and other techniques to the muscles, but as you’re an individual I’ve found that rather than using a one size fits all protocol, or exercise sheet I’ll use some of the methods or rational detailed below.

Back pain and sciatica link

To manage the potential link between low back pain and sciatica nerve, treatments I have in the past have included soft tissue techniques to the Iliolumbar Ligament, Lumbar Erector Spinae, and Multifidus. Sometimes manipulation on the lumbar spine may be necessary although articulation can be used instead. Also soft tissue to the gluteal area and the deep hip rotators (piriformis and it’s relationship with the sciatic nerve deserve extra attention), but taking care to avoid the ischial tuberosity and the proximal part of the hamstrings.

Massage techniques

When treating the hamstring a variety of soft tissue/massage techniques are used. The techniques chosen depend on the goals for that particular stage of treatment. I normally take care to not stress or tension the upper hamstring tendon until the later stages of treatment.

Home Treatment

As you start to improve and your capacity for movement improves I’ll start to bring in one or two appropriate exercises for where you are on the pain/recovery line.


High hamstring Tendinopathy is a debilitating condition that can affect many aspect of your life. Simple things that we take for granted such as sitting down and eating a meal to leisure activities like running can become excruciating. I don’t want that to happen to you.

Not only have I treated numerous people with high hamstring tendinopathy, I’ve suffering from it as well. I understand the frustration that it can give, so aim to get you back to your normal activities as quickly as possible. I have the experience to diagnosis, treat and also advise on a rehabilitation program to try and stop it reoccurring.

Please note. I can’t give a diagnosis online, If you live or work in the Glasgow area it may be an idea to book an appointment. Click to book an appointment now.

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7 Responses

  1. I started having pain in the butt early this year and it really makes it uncomfortable to sit. It feels like it’s right in the bones that we sit on. I’ve had varied leg issues over the last couple of years; had a swollen knee about 4 years ago, twisted my ankles several times and ending up half crippled for a week or more (I used to twist my ankles a lot in my younger years)and it seems as though all these infirmities just aggravated things and caused this recurrent pain in the butt! Luckily it comes and goes.

  2. I have been suffering from this dull pain when I sit down for about 4 months, went to physios but in vain. Sometimes I also get my right sciatic nerve iritated and hurts till just below the knee. Now am going to a chiropractor. I have been 4 times, hope it works. I just don’t know where to go or to whom to go to cause when I went to my sports doctor she said I cannot find anything wrong with you. So confused and in need of help. Sitting down became impossible and I work in an office all day.

  3. Dull, usually very slight ache in left buttock, feels like the bone aching. Only becomes a problem on long distance drives when I become quite uncomfortable, no amount of massaging or changing position will make it go away, not quite bad enough to stop the car but uncomfortable and irritating. HH tendinopathy sounds a possibility. I’m fit, cycle regularly and play 5-a-side once a week. 46.

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