Proximal hamstring tendinopathy is a common cause of lower buttock and sit bone pain in runners and active people, especially when sitting or training loads change quickly.

What Is Proximal Hamstring Tendinopathy?

Proximal hamstring tendinopathy (PHT) occurs when the hamstring tendon becomes sensitive or overloaded where it attaches to the sit bone (ischial tuberosity). Many people describe a deep ache in the lower buttock. It often appears in runners, field-sport athletes, and people who sit for long periods.

For background on hamstring injuries, see Hamstring Pain.
Learn more about load-related conditions: Overuse Injuries.

Why Does This Condition Develop?

PHT usually develops from repeated tendon loading. Running, sprinting, change-of-direction movements, hill training and bent-forward positions place high demand on the tendon. When training loads increase too quickly, the tendon may not adapt well.

Common Signs and Symptoms

People with PHT often report:

• A deep ache at the lower buttock or sit bone
• Pain with running, especially hills or speed work
• Pain when sitting on firm surfaces
• Tightness or pulling through the back of the thigh
• Discomfort during hamstring stretch positions

See also: Hip, Groin & Buttock Pain FAQs.

What Increases Your Risk?

Several factors may raise the likelihood of developing PHT:

• Previous hamstring injury
• Sudden increases in running distance or speed
• Reduced gluteal or hamstring strength
• Poor tolerance to prolonged sitting
• Training errors, including rapid return to sport

To learn about related tendon conditions, visit Common Tendon Injuries.

The Phases of Tendinopathy

Tendon conditions follow recognised stages:

1. Reactive Tendinopathy – a short-term protective response after a sudden load increase.
2. Tendon Dysrepair – ongoing overload leads to structural changes and persistent symptoms.
3. Degenerative Tendinopathy – longer-term change requiring gradual strengthening progressions.

More detail: What Is a Tendinopathy?

How Is PHT Diagnosed?

Your physiotherapist will assess:

• Tendon sensitivity around the sit bone
• Hamstring and gluteal strength
• Running technique and loading patterns
• Flexibility, pelvic control and trunk stability

Imaging such as MRI or ultrasound may assist in selected cases.
See: Hamstring Injury Diagnosis.

Treatment Options That May Help

Your physiotherapist may recommend:

• Load modification for running and sitting
• Progressive strengthening of the hamstrings and gluteals
• Heavy slow resistance training
• Improving pelvic and trunk control
• Gradual return-to-running planning

Eccentric strengthening can play a role when introduced at the right stage.
Learn more: Eccentric Strengthening |
Tendon Healing Tips

Latest Research

Recent reviews highlight progressive loading and education as the primary management strategies. Adjunct options such as shockwave therapy or guided injections may be considered in long-standing cases.

See: NCBI Tendinopathy Overview.

What To Do Next

PHT can be persistent without the right plan. Early assessment and a structured strengthening program usually offer the best results. Your physiotherapist can guide load adjustments, exercise progressions and running modifications tailored to your goals.

Explore: Common Running Injuries |
Running Analysis

Related Articles

• Hamstring Pain
• Tendinopathy Physiotherapy Treatment Strategies
• Hamstring Strain
• Tendinopathy Phases
• Common Tendon Injuries
• Piriformis Syndrome
• Greater Trochanteric Pain Syndrome
• Hip Adductor Tendinopathy
• Gluteal Tendinopathy

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References

1. Nasser AM, et al. Proximal hamstring tendinopathy: a systematic review of interventions. Int J Sports Phys Ther. 2021;16(3):932–947. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8016446/
2. Campos-Villegas C, et al. Clinical progression and load management for proximal hamstring tendinopathy. Int J Sports Phys Ther. 2024. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11065772/
3. Rich A, et al. Treatment of proximal hamstring tendinopathy with individualised physiotherapy. Int J Sports Phys Ther. 2025. Available at: https://ijspt.scholasticahq.com/article/138308…
4. Rich A, et al. Participant experiences of physiotherapy and shockwave therapy for proximal hamstring tendinopathy. Physiother Pract Res. 2025. Available at: https://www.sciencedirect.com/science/article/pii/S2468781225001742
5. Baldassarri M, et al. Porcine collagen injection therapy for proximal hamstring tendinopathy in athletes. Sports (Basel). 2025;13(10):359. Available at: https://www.mdpi.com/2075-4663/13/10/359