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The upper attachment
The hamstring tendons attach to the ischium, the bone beneath the buttock, transferring force between thigh and pelvis.
Tendinopathy describes tendon pain and impaired function; it does not necessarily mean simple inflammation.
Understand the picture
The upper tendon attachment
Sitting bone
The tendon attaches beneath the buttock.
Proximal tendon
Transfers force and may be sensitive to pressure.
Muscles
Load changes with hip and knee movement.
Common difficulties
Prolonged sitting, fast running, hills or bending may provoke gradual pain.
Location alone cannot confirm the cause. Note which durations, positions and efforts change symptoms.
Chapter sources [7]
Load and compression
Deep hip bending can increase pressure at the attachment. More running or prolonged bent positions may contribute.
There is no single harmful posture. Work demands and sport both influence the plan.
Chapter sources [7]
When to consider another cause
Sudden pain after an accident with major bruising or weakness needs assessment for acute injury, including tendon avulsion.
Numbness, spreading pain or new weakness also requires assessment, including the back and nerves.
Examination and scans
History, appropriate tests and function guide diagnosis. Imaging may help with uncertainty or suspected substantial injury.
Tendon changes on a scan do not necessarily explain all pain. Images need clinical context.
Chapter sources [7]
Choosing treatment
Education, activity adjustment and progressive strengthening are options. A 2025 trial found no significant primary-outcome differences between individual physiotherapy and shockwave therapy.
That does not prove equivalence for everyone, guarantee an individual result or confirm that either technique is available at this practice.
Loading without constant irritation
Begin with tolerable loading, then build strength and range. Deep hip bending may need temporary modification.
Repeated forceful stretching may aggravate the attachment. Discuss exercise choice and dose instead of always seeking a stretch.
Chapter sources [7]
In everyday life
A runner with desk work
At the desk
Reduce prolonged uncomfortable pressure.
During running
Temporarily adjust hills and speed.
At review
Compare sitting, running and next-day response.
Chapter sources [7]
Sitting and travel
Try seating that reduces pressure and alternate positions. Break up journeys that provoke pain.
A runner with desk work may need to adjust both training and long uninterrupted sitting.
Chapter sources [7]
Returning to running
Speed, hills and stride length change hamstring demand. Short easy runs may precede harder sessions.
Avoid increasing distance, hills and speed together. Next-day sitting tolerance can help reveal the overall response.
Chapter sources [7]
Monitoring progress
Persistent tendon problems can take months to improve. Compare meaningful tasks rather than expecting immediate pain relief.
If progress stalls or symptoms change, reassess the cause and load rather than simply repeating more sessions.
Chapter sources [7]
Your questions
Must I stop all activity?
Not always. Retain tolerable activity while reducing what clearly aggravates symptoms.
Chapter sources [7]
Is stretching essential?
No. Stretching that compresses and irritates the attachment may be unhelpful.
Chapter sources [7]
Is shockwave treatment better?
The cited trial found no significant primary-outcome difference. It cannot establish universal superiority or equivalence.
Chapter sources [1]
What about a sudden pop?
That differs from gradual tendinopathy. Seek prompt assessment for possible acute injury.
Chapter sources [2]
Sources and references
- [1] Rich et al.: Physiotherapy Compared With Shockwave Therapy for Proximal Hamstring Tendinopathy, RCT (2025)
- [2] AAOS OrthoInfo: Muscle Strains in the Thigh
- [3] NHS — Back pain: urgent neurological symptoms
- [4] NHS: DVT (deep vein thrombosis)
- [5] NHS: Compartment syndrome
- [6] CGDIS: Appeler le 112
- [7] Rich et al.: Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy, Clinical Commentary (2025)
Text updated on
Medical review: awaiting Hasib Selimovic.