Proximal hamstring tendinopathy is a condition affecting the origin of the hamstring muscles — the point where they attach to the ischial tuberosity, the bony prominence you sit on. When this tendon becomes degenerate or irritated, it causes pain and stiffness in the deep buttock region.
It is classified as a tendinopathy rather than a tendinitis, because the underlying problem is degeneration of the tendon tissue rather than acute inflammation.
Who gets proximal hamstring tendinopathy?
This condition is particularly common in:
- Runners — especially long-distance runners and those who run hills or speed sessions
- Cyclists — prolonged hip flexion loads the hamstring origin significantly
- Rowers and cross-trainers
- Sedentary workers who sit for long periods on hard surfaces
- Those who have recently increased their training load or changed surface
Symptoms of hamstring tendinopathy
The hallmark symptom is deep aching pain in the buttock, typically:
- Worse with sitting, especially on hard surfaces or for prolonged periods
- Provoked by running — particularly at pace or uphill
- Felt when bending forwards with straight legs
- Present at the start of activity, often easing with warm-up, then returning afterwards
- Sometimes radiating down the back of the thigh, which can be confused with sciatica
In some cases, particularly with high-load activities, there may also be pain or weakness when the hamstring is loaded in a lengthened position — such as during deadlifts or stretching.
Diagnosis
Clinical diagnosis is based on the characteristic history and tenderness over the ischial tuberosity. Imaging is used to confirm the diagnosis and rule out other causes.
Diagnostic ultrasound is very effective at identifying tendon thickening, hypoechoic (degenerate) areas, and intratendinous tears at the hamstring origin.
Treatment Options for Proximal Hamstring Tendinopathy
Ultrasound-Guided Cortisone Injections for Hamstring Tendinopathy
Ultrasound-guided cortisone injections can help relieve pain from hamstring tendinopathy by delivering anti-inflammatory medication precisely to the affected area while avoiding nearby nerves, blood vessels and healthy tendon tissue. Using real-time ultrasound improves the accuracy of the injection, making treatment safer and more effective than landmark-guided techniques.
Ultrasound-Guided PRP Injection for Hamstring Tendinopathy
For patients who have a significant degree of tendon degeneration on imaging, PRP (platelet-rich plasma) injection is an effective adjunct.
PRP is derived from your own blood. After processing, the growth factor-rich plasma is injected directly into the degenerate area of the tendon under ultrasound guidance. This stimulates a healing response in tissue that would otherwise struggle to regenerate.
At Alton Pain Clinic, PRP is always performed with ultrasound guidance to ensure the injection reaches exactly the right location within the tendon.
This article is intended for informational purposes only and should not replace professional medical advice. If you are experiencing persistent symptoms, please consult a qualified clinician.
Frequently Asked Questions
How do I know if I have proximal hamstring tendinopathy or sciatica?
Both conditions can cause pain in the buttock that radiates into the thigh. Key differences: hamstring tendinopathy pain is typically localised to the sitting bone and worsened by sitting or forward bending; sciatica tends to radiate further down the leg, often into the calf or foot, and may be accompanied by tingling or numbness. An ultrasound assessment can help distinguish between the two.
Should I stretch my hamstrings if I have proximal hamstring tendinopathy?
Counter-intuitively, aggressive hamstring stretching is often contraindicated in proximal hamstring tendinopathy. Stretching in a hip-flexed position places high tensile load on the degenerate tendon and can worsen symptoms.
How long does proximal hamstring tendinopathy last?
Without treatment, this condition can become chronic. With appropriate injections where indicated — most patients achieve significant improvement within three to six months. Some complex cases take longer.