Achy Buttock Pain due to Upper Hamstring Tendinitis

Following on from last weeks article on ‘Achy Buttock Pain’, this week I will discuss Hamstring tendonitis as a standalone source of achy buttock pain which is a real nuisance when sitting down. The Hamstrings muscle group consists of three muscles that all originate or have an attachment at the Ischial Tuberosity Bone that is located in the buttock. The three hamstrings muscles are Semitendonosis, Semimembranosous (both located on towards the inside of hamstring region) and finally the Biceps Femoris that is located on the outter hamstring area. The three standout roles of the hamstring muscles include bending the knee, extend the hip backwards, helps the trunk or spine bend forward by helping to stabilise the pelvis in a standing position.

Causes of Proximal Hamstring tendinitis

Anterior Tilting of the Pelvis - This occurs when pelvis assumes an abnormal forward tilting position due to tight Hip Flexor muscles and weak gluteal, hamstring, lower back, and abdominal (stomach area) muscles. Overtime this can stress the attachment point of the Biceps Femoris (outer hamstring) to ischial tuberosity.

Overly Dominant Hamstring Muscles – the hamstring muscles may be overly active in extending the Hip backwards due to a poorly firing Gluteus Maximus muscle. This issue would also suggest excessively tight Hip Flexor muscles. Signs that would suggest such a problem include prolonged or heavy heel striking of the patient when walking/running.

Treatment & Management

In treating this injury, I would advise the patient to refrain from aggravating activities such as hamstring stretching, running, cycling and instead rest the leg with the use of ice on the ischial tuberosity in order to reduce inflammation. Once the inflammation has matured to the formation collagen or scar tissue manual therapy to the hamstring belly and upper attachment can commence. Manual stretching of the cause factors namely the tight hip flexors is important also. Exercise rehabilitation is a phased load progression is extremely important. This means that the patient should commence isometric strengthening of the hamstring muscle which involved placing tensile constant at a very basic level on the hamstring muscles without moving the knee joint, thus helping to strengthen the hamstring tendon without aggravating pain. Once the symptoms begin to reduce in severity after 1-2 week duration, the patient can then progresses onto more stressful hamstring exercises. Strengthening of the gluteus maximus and lower back muscles is also included. In terms of the Athlete, a further progression is added that involves greater load be placed on the hamstring tendons with movement.

Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles.

Contact Number: 0504 26672

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Physiotherapy & Injury Rehabilitation Clinic in Tipperary

0504 26672


The Surgery, Fianna Road, Thurles


Riverside Medical Centre, 7 Upper

Irishtown, Clonmel

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