Deep buttock pain or upper thigh pain that is worse when sitting for long periods, running uphill, or doing forward lunges can be a frustrating and confusing symptom. For many people, the diagnosis is proximal hamstring tendinopathy — a condition affecting the tendons that attach the three hamstring muscles to the sitting bone (ischial tuberosity). It is frequently misdiagnosed and often poorly managed, leading to months or years of unnecessary suffering.
This guide is for patients in Sydney’s north-west and the Southern Highlands who want to understand this condition and know what treatment options — including regenerative therapies — are available to them.
What Is Proximal Hamstring Tendinopathy?
The hamstrings are a group of three muscles (biceps femoris, semitendinosus, semimembranosus) that run down the back of the thigh. Their proximal tendons attach to the ischial tuberosity — the bony prominence you sit on. These tendons are under load when the hip is flexed (bent forward) and the knee is extended, which is precisely the position of running, cycling, and sitting.
Like other tendinopathies, proximal hamstring tendinopathy is a degenerative condition rather than an acute inflammatory one. The tendon tissue develops disorganised collagen, becomes pain-sensitised, and fails to adapt to load. It is most common in runners — particularly masters runners (40+) and those who run hills — but also affects cyclists, triathletes, and people who sit for long periods on hard surfaces.
Symptoms
- Deep, aching pain in the buttock, particularly at the sit bone
- Pain that worsens with sitting on hard surfaces for extended periods
- Pain during or after running, especially uphill or during speed work
- Stiffness and aching after exercise that is slow to settle
- Pain with forward bending or hamstring stretching (stretching is often counterproductive in tendinopathy)
- In some cases, pain radiating down the back of the thigh (can be confused with sciatica)
Why It Is Commonly Misdiagnosed
Proximal hamstring tendinopathy is often confused with sciatica, piriformis syndrome, referred pain from the lumbar spine, or hip pathology. The pain location is unusual for a tendon condition (buttock rather than posterior thigh), and many clinicians are less familiar with the condition. MRI and ultrasound can confirm the diagnosis by showing characteristic changes in the tendon at the ischial attachment.
Conventional Treatment
Management follows tendinopathy principles:
- Load management — reducing or modifying the provocative activities (particularly running uphill and prolonged sitting on hard surfaces) is essential in the early phase
- Progressive tendon loading — a carefully graded programme of hamstring strengthening, specifically targeting the proximal tendon, is the cornerstone of rehabilitation. The key is to start with hip-dominant loading in a hip-neutral position (to avoid compressive loading on the tendon at the ischium) before progressing to more challenging exercises
- Avoid aggressive stretching — counterintuitively, aggressive hamstring stretching compresses the tendon against the ischium and worsens the condition. This is one of the reasons many patients inadvertently slow their own recovery
- Cortisone injection — may reduce pain short-term but evidence for long-term benefit in proximal hamstring tendinopathy is limited, and repeated injections can further weaken the tendon
- Shockwave therapy — emerging evidence supports its use as an adjunct to loading rehabilitation
PRP for Proximal Hamstring Tendinopathy
For patients who have undertaken a proper loading rehabilitation programme for 3–6 months without achieving satisfactory improvement, PRP offers a biologically targeted option. An ultrasound-guided injection places a concentrated preparation of your own growth factors directly into the degenerated area of the proximal hamstring tendon attachment.
The growth factors in PRP — particularly TGF-β and PDGF — stimulate the tendon’s own repair cells, promote healthy collagen synthesis, and help restore the structural integrity that is driving the chronic pain. PRP is most effective when combined with an ongoing, appropriately progressed rehabilitation programme.
Clinical experience and emerging research support PRP as a useful option for chronic proximal hamstring tendinopathy that has not responded to conservative care, offering improvements in pain and function with a very favourable safety profile compared to surgery.
Don’t Keep Guessing — Get an Accurate Diagnosis
If you have deep buttock pain that has been attributed to sciatica, a hip problem, or “just a tight hamstring” but nothing has worked, proximal hamstring tendinopathy may be the diagnosis you’ve been missing. Getting the right answer matters — because the treatment is specific and different from most of the things it gets confused with.
Dr John PRP provides thorough assessment and PRP treatment for hamstring tendinopathy, with patients attending from across Sydney’s north-west (Castle Hill, Norwest, Kellyville, Baulkham Hills) and the Southern Highlands (Bowral, Mittagong, Moss Vale).
Book a consultation today and get to the bottom of your buttock or hamstring pain.
For general information on tendon conditions, see Healthdirect Australia’s guide to tendinopathy.