Hamstring Tendon Pain: Causes, Symptoms and Treatment Options

Written and medically reviewed by
Dr Dinesh Sirisena
Consultant in Sports, Exercise & Musculoskeletal Medicine
Triaxis Sports & Joint Clinic

Hamstring tendon pain can occur where the hamstring tendons attach near the lower buttock or around the back of the thigh and knee. A common cause of persistent upper hamstring pain is proximal hamstring tendinopathy. Symptoms may be worse with running, prolonged sitting or deep hip bending. Many cases can be managed without surgery through activity modification, progressive strengthening and rehabilitation. When symptoms persist, ultrasound-guided minimally invasive treatments, including shockwave therapy, platelet-rich plasma (PRP), targeted injections and Tenex ultrasonic tenotomy, can help relieve pain and support a confident return to running, sport and comfortable sitting.

What causes hamstring tendon pain?

Hamstring tendon pain may develop from repeated loading, changes in training or an acute injury. When pain develops gradually near the lower buttock, one possible cause is proximal hamstring tendinopathy. Sudden pain during sprinting, kicking or stretching may instead suggest an acute muscle or tendon injury.

The hamstrings are a group of muscles at the back of the thigh. Their tendons connect these muscles to the pelvis and bones around the knee.

At the upper end, the hamstring tendons attach to the ischial tuberosity, often called the sitting bone.

This area experiences considerable load during running, sprinting, jumping and other sporting movements. A sudden increase in training volume, speed or intensity may place greater demand on the tendon.

Hamstring tendon problems are one of several possible causes of lower body pain.

What does proximal hamstring tendinopathy feel like?

Proximal hamstring tendinopathy commonly causes deep pain near the lower buttock where the hamstring tendon attaches to the pelvis. Symptoms may become more noticeable during prolonged sitting, running, squatting or walking uphill. Unlike an acute hamstring strain, symptoms can develop gradually without one obvious injury.

Common symptoms may include:

• Deep lower-buttock pain
• Pain around the sitting bone
• Discomfort during prolonged sitting
• Pain during or after running
• Pain during faster running or sprinting
• Discomfort when walking uphill
• Pain during deep squatting or lunging
• Tenderness around the upper hamstring

However, pain in this area does not automatically mean the hamstring tendon is responsible.

The hip, lower back, nerves and other soft tissues can produce similar symptoms. The Triaxis guide to hip pain explains other possible causes of pain around the buttock, hip and upper thigh.

Is hamstring tendinopathy different from hamstring strain?

Yes. Hamstring tendinopathy usually develops gradually with repeated loading, while a hamstring strain typically occurs suddenly when muscle or tendon fibres are injured. A sudden injury may cause sharp pain, weakness, bruising or difficulty continuing the activity.

This distinction is important because the assessment and management may differ.

For example, an athlete who suddenly feels sharp pain while sprinting may have an acute hamstring strain rather than tendinopathy.

More significant injuries can involve partial or complete tendon tears. A clinical assessment can help distinguish between gradual tendon pain and acute injury.

Who is more likely to develop hamstring tendon pain?

Hamstring tendon pain can affect both active and less-active people. Runners and athletes involved in repeated sprinting, acceleration or changes of direction may place greater loads on the hamstrings. Training changes, previous injuries and prolonged sitting may also be relevant.

Sports and activities that place greater demands on the hamstrings can include:

• Running
• Football and futsal
• Rugby
• Athletics and sprinting
• Badminton
• Tennis
• Pickleball
• Padel
• Weightlifting

However, participating in these activities does not mean someone will develop hamstring tendinopathy.

Training history, strength, previous injuries and how the symptoms developed should also be considered.

Can hamstring tendon pain improve without surgery?

Many cases of proximal hamstring tendinopathy are initially managed without surgery. Management commonly involves education, adjusting aggravating activities and progressively strengthening the hamstring and surrounding muscles. Rehabilitation aims to gradually improve the tendon’s ability to tolerate the demands of everyday activity, exercise and sport.

A rehabilitation programme may include:

• Adjusting training volume or intensity
• Progressive hamstring strengthening
• Hip and gluteal strengthening
• Trunk and pelvic control
• Gradual return to running
• Progressive higher-load exercises
• Sport-specific rehabilitation
• Ultrasound-guided minimally invasive procedures when symptoms persist

Complete rest is not always necessary. Instead, activity can often be modified while strength and loading capacity are gradually rebuilt.

Should I stretch a painful hamstring tendon?

Stretching is not automatically appropriate for every person with hamstring tendon pain. Some positions that combine deep hip bending with a straight knee may increase compression around the proximal hamstring tendon and aggravate symptoms. Rehabilitation therefore usually focuses on appropriate loading, strength and function rather than stretching alone.

Exercise selection should depend on the individual’s symptoms and clinical assessment.

As rehabilitation progresses, exercises may become more demanding to prepare the hamstring for running, sprinting or other sporting activities.

Do I need an MRI or ultrasound for hamstring tendon pain?

Not everyone with hamstring tendon pain requires imaging. Assessment usually begins with the history and physical examination. MRI or musculoskeletal ultrasound may be considered when symptoms persist, the diagnosis is uncertain or a more significant muscle or tendon injury is suspected.

MRI can provide detailed images of the hamstring muscles, tendons and surrounding structures.

Musculoskeletal ultrasound can assess selected tendons, muscles and surrounding soft tissues in real time.

However, imaging findings should always be considered together with the person’s symptoms and clinical examination. An abnormal scan does not automatically explain how much pain someone experiences.

What minimally invasive procedures can help hamstring tendon pain?

When lower-buttock pain persists despite rehabilitation, ultrasound-guided minimally invasive procedures can ease pain, stimulate healing in the tendon and help you progress rehabilitation with confidence. Options at Triaxis include shockwave therapy, platelet-rich plasma (PRP), targeted ultrasound-guided injections, Tenex ultrasonic tenotomy and sciatic nerve hydrodissection. None of these involve open surgery, and each is matched to the findings of your assessment.

Because each procedure targets a different part of the problem, an accurate diagnosis comes first. Ultrasound shows the hamstring tendon, the sitting bone and the nearby sciatic nerve in real time, allowing precise treatment while protecting surrounding structures. Find out more about ultrasound-guided procedures at Triaxis.

Shockwave therapy (ESWT)

Extracorporeal shockwave therapy delivers acoustic pulses through the skin to the upper hamstring tendon, with no needles and no downtime, so most people return to work straight away. It is one of the best-studied treatments for this condition. In a randomised controlled trial of professional athletes with chronic proximal hamstring tendinopathy, 85% of those treated with shockwave achieved at least a 50% reduction in pain at three months, compared with 10% receiving standard conservative care [1]. A more recent randomised trial found shockwave therapy to be as effective as individualised physiotherapy, with higher patient satisfaction [2].

Platelet-rich plasma (PRP)

PRP is a concentrated preparation of your own platelets, which carry growth factors involved in tissue repair. It is injected precisely into the affected area of the tendon under ultrasound guidance. A 2026 systematic review of randomised controlled trials found that PRP produced comparable or better outcomes than control treatments for hamstring and other hip-region tendon conditions, including a faster return to sport after hamstring injury [3]. PRP is particularly useful for long-standing tendinopathy and for selected partial tendon tears.

Ultrasound-guided injection

A precisely placed injection of local anaesthetic, sometimes combined with a corticosteroid, can settle irritation around the tendon origin or an inflamed bursa near the sitting bone. Ultrasound guidance places the medication accurately around, rather than into, the tendon. Studies of ultrasound-guided injection for high hamstring tendinopathy report meaningful symptom relief, creating a window to progress strengthening [4]. Learn more about ultrasound-guided steroid injections.

Tenex ultrasonic tenotomy

When assessment identifies chronic, degenerative tendon tissue that has not responded to other treatments, Tenex removes the damaged tissue through a tiny skin opening under local anaesthetic and ultrasound guidance, helping the tendon heal. Ultrasound-guided tendon procedures around the hip and pelvis, including the proximal hamstring, have shown improvement in most patients treated [5], and a 2026 systematic review describes needle tenotomy and ultrasonic debridement as effective options for persistent tendinopathy [6]. Learn more about Tenex therapy.

Sciatic nerve hydrodissection

The sciatic nerve runs very close to the upper hamstring tendon. In some people, a thickened tendon or surrounding scar tissue irritates the nerve, adding tingling or pain that travels down the back of the thigh. Hydrodissection uses a precise, ultrasound-guided injection of fluid to gently free the nerve from the surrounding tissue, easing these nerve symptoms. Learn more about nerve hydrodissection.

Comparing minimally invasive options for hamstring tendon pain

Procedure	What it targets	Key benefit
Shockwave therapy (ESWT)	Upper hamstring tendon	Needle-free with no downtime
Platelet-rich plasma (PRP)	Long-standing tendinopathy and selected partial tears	Uses your own healing factors
Ultrasound-guided injection	Irritation around the tendon or bursa	Settles pain to help rehabilitation progress
Tenex ultrasonic tenotomy	Chronic degenerative tendon tissue	Removes damaged tendon tissue
Sciatic nerve hydrodissection	Irritated sciatic nerve near the tendon	Frees the nerve to ease leg symptoms

Procedures work best as part of a complete plan. Most people continue a tailored strengthening programme alongside any procedure, which helps maintain the improvement and lowers the chance of symptoms returning.

When should I seek medical assessment for hamstring pain?

Consider assessment if hamstring or lower-buttock pain persists, repeatedly returns or begins to limit sitting, walking, running or sport. Assessment may also be appropriate after a sudden injury involving a pop, marked weakness, bruising or difficulty walking, as these features may suggest a more significant hamstring injury.

Consider medical assessment if:

• Pain persists despite modifying activity
• Sitting becomes increasingly uncomfortable
• Running repeatedly causes symptoms
• Significant bruising develops
• You notice weakness
• You experience a sudden pop or tearing sensation
• Walking becomes difficult
• Numbness or neurological symptoms develop

How is hamstring tendon pain assessed at Triaxis Sports & Joint Clinic?

Assessment at Triaxis Sports & Joint Clinic focuses on identifying the likely source of symptoms and distinguishing gradual tendon problems from acute muscle or tendon injuries. The assessment may consider hamstring strength, hip function, movement, training history and the person’s sporting or occupational demands.

Depending on the clinical findings, assessment and management may include:

• Sports Medicine assessment
• Musculoskeletal Medicine assessment
• Strength and movement assessment
• Review of training or activity demands
• Sports or musculoskeletal ultrasound where appropriate
• Patient education
• Rehabilitation planning
• Shared decision-making
• Ultrasound-guided procedures where appropriate, including shockwave therapy, PRP, injections, Tenex and hydrodissection

The aim is to understand the condition and develop an appropriate management plan based on the individual’s symptoms, function and activity requirements.

Frequently Asked Questions About Hamstring Tendon Pain

Why does my hamstring hurt near my buttock?

Pain where the hamstring meets the lower buttock may be related to proximal hamstring tendinopathy, particularly when symptoms develop gradually and are aggravated by sitting or running. However, hip, lower-back and nerve conditions can cause pain in a similar area. The location of pain alone therefore cannot confirm the diagnosis.

Can I run with hamstring tendinopathy?

Some people can continue running with temporary modifications. This may involve adjusting distance, speed, hills or training frequency. Others may need a greater reduction in running while symptoms settle. The aim is usually to find a manageable level of activity while gradually rebuilding hamstring strength and loading capacity.

How long does hamstring tendinopathy take to improve?

There is no fixed recovery period. Tendon rehabilitation often requires time because the hamstring needs to gradually adapt to increasing loads. Recovery can depend on how long symptoms have been present, activity demands, strength and response to rehabilitation. Return to sport is therefore usually based on function rather than a fixed number of weeks.

Is sitting bad for proximal hamstring tendinopathy?

Prolonged sitting can aggravate proximal hamstring tendon pain in some people because the tendon is located close to the sitting bone. Changing sitting positions, reducing long periods of uninterrupted sitting and taking regular movement breaks may help manage symptoms while rehabilitation progresses.

Should I massage a painful hamstring tendon?

Massage may feel comfortable for some people, but it does not replace progressive rehabilitation. Direct pressure over a sensitive proximal hamstring tendon may also aggravate symptoms. Management should focus on identifying the likely source of pain and gradually improving the hamstring’s ability to tolerate activity.

Is hamstring tendon pain the same as sciatica?

No. Hamstring tendon pain involves the tendon, while sciatica involves irritation of the sciatic nerve. Both can cause pain around the buttock or back of the thigh. Tingling, numbness or pain travelling further down the leg may suggest nerve involvement, although clinical assessment may be needed to distinguish the cause.

Can ultrasound show hamstring tendinopathy?

Musculoskeletal ultrasound can assess the hamstring tendon and surrounding soft tissues. However, scan findings should be interpreted alongside the person’s symptoms and physical examination because structural tendon changes do not always correspond directly with pain. MRI may also be considered when additional information is required.

Does hamstring tendon pain require surgery?

Most cases of proximal hamstring tendinopathy begin with non-surgical management, including activity modification and progressive rehabilitation. Surgical assessment may be considered in selected persistent cases or for significant tendon injuries. An acute complete tendon rupture is different from tendinopathy and requires individual assessment to determine appropriate management.

What non-surgical procedures can help hamstring tendinopathy?

Several ultrasound-guided options can help when rehabilitation alone has not settled symptoms. These include needle-free shockwave therapy, PRP injections using your own platelets, targeted injections to settle irritation, Tenex to remove degenerative tendon tissue, and hydrodissection when the nearby sciatic nerve is involved. Shockwave therapy and PRP are supported by randomised controlled trials. The right choice depends on what your assessment and ultrasound show.

What does current research say about proximal hamstring tendinopathy?

Current research supports a rehabilitation-led approach, with education and progressive exercise as the foundation of care. A 2025 clinical commentary describes proximal hamstring tendinopathy as affecting both active and less-active people, with common symptoms including lower-buttock pain during prolonged sitting, squatting, uphill walking and running PubMed. Alongside rehabilitation, randomised trials support shockwave therapy and PRP for persistent cases, giving people a range of effective, minimally invasive options when exercise alone is not enough.

About the Author

Dr Dinesh Sirisena is a Consultant in Sports, Exercise & Musculoskeletal Medicine. His clinical work includes the assessment and management of sports injuries and musculoskeletal conditions involving muscles, tendons, ligaments, joints and related structures.

Medical Disclaimer

This article provides general educational information and does not replace individual medical advice, diagnosis or treatment. Hamstring and buttock pain can have several causes. Decisions about imaging, rehabilitation, medication or procedures should be based on the individual’s symptoms, medical history and clinical assessment.