Hip & thigh Sports Injury Physiotherapy
High Hamstring Tendinopathy
- Deep buttock pain near the sitting bone
- Pain worse sitting, especially on hard surfaces
- Pain accelerating when running
- Tenderness over the sitting bone
Quick answer
High hamstring tendinopathy is overload of the hamstring tendons where they attach to the sitting bone, causing deep buttock pain that is worse when sitting and when running. It responds to progressive loading rather than stretching, over three to six months.
Typical recovery
3–6 months
A typical range, not a promise — how long it takes depends on how long it has been going on, and on what you do between appointments.
This is a stubborn condition that is frequently mistaken for sciatica, and it is treated almost the opposite way to how most people instinctively treat it.
What it feels like
Deep pain near the sitting bone, at the very top of the hamstring. It is characteristically worse when sitting — particularly on hard chairs or when driving — and during the acceleration phase of running or when lunging. Pressing on the sitting bone reproduces it.
Unlike sciatica, there is no pins and needles or numbness, and the pain does not travel below the knee.
Why stretching makes it worse
The natural response to hamstring pain is to stretch it. But this tendon is being compressed against the sitting bone, and hamstring stretches increase that compression. Aggressive stretching is one of the most common reasons this condition drags on for a year or more.
How physiotherapy helps
- Reducing compression first: avoiding deep hip flexion, prolonged sitting on hard surfaces, and hamstring stretching
- Isometric loading early, which reduces pain and starts building tendon capacity
- Progressive strengthening — heavy, slow resistance work through increasing hip flexion angles
- Gluteal and trunk strengthening, since the hamstring is usually compensating
- Graded return to running, with attention to acceleration and stride mechanics
How long it takes
Three to six months is realistic, and longer if it has been present for years. Tendons adapt slowly. Progress is real but rarely fast, and the loading has to continue well past the point where pain settles.
Medically reviewed by Nasir Mughees, BPT, MPT, Orthopaedic Physiotherapy · Last reviewed September 2026