Proximal hamstring tendinopathy is an irritation or degeneration of the hamstring tendons near their attachment point on the pelvis, at the ischial tuberosity (the “sitting bone”). The condition is typically an overuse injury resulting from repetitive strain the tendon cannot tolerate, rather than a sudden, acute tear. Recovery is a structured process that shifts focus from initial pain control to long-term strengthening, restoring the tendon’s capacity to handle load.
Recognizing the Symptoms
Symptoms include a localized, deep ache or sharp pain felt in the lower buttock region. This pain often begins subtly and progresses gradually, unlike the immediate, sharp pain and bruising associated with a muscle strain.
The discomfort is aggravated by activities that either compress or load the tendon. Prolonged sitting on hard surfaces frequently worsens symptoms due to direct pressure on the ischial tuberosity. Running at faster speeds or performing movements involving hip flexion, such as lunging or squatting, can also intensify the pain. Tenderness can usually be pinpointed by firmly touching the tendon attachment right under the buttock crease.
Immediate Management: Rest and Pain Relief
Management begins by reducing the load on the irritated tendon to calm symptoms. This is known as relative rest, which involves modifying or temporarily ceasing only the specific activities that cause pain, rather than complete immobilization. For example, a runner may stop sprinting but substitute low-impact activities like swimming or cycling, provided they remain pain-free.
For acute pain, cold therapy can manage localized discomfort. Apply an ice pack wrapped in a thin towel to the painful area for 15 to 20 minutes. This can be repeated every four to six hours during the first 48 to 72 hours to reduce local irritation.
Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may provide temporary relief from pain and inflammation. Discuss the use of these medications with a healthcare provider, as they are a temporary solution and do not address the underlying tendon weakness.
Structured Rehabilitation and Strengthening
Long-term recovery requires a structured rehabilitation program focused on progressive loading to rebuild the tendon’s strength. Once acute pain subsides, the focus shifts from resting to introducing specific exercises. Physical therapy is often recommended to guide this progression and ensure the load is appropriate for the recovering tendon.
The gold standard for tendon rehabilitation is eccentric loading exercises. An eccentric contraction means the muscle is activated while it is simultaneously lengthening under tension. This type of controlled loading stimulates the tendon to adapt and strengthen its structure. Examples include seated hamstring curls, where the injured leg slowly resists weight as the knee straightens, or controlled single-leg deadlifts.
Exercises should begin at a manageable intensity and slowly increase in volume and resistance over several months. Perform the exercises with a controlled tempo, often a slow five-second lowering phase, allowing for high tension without excessive speed. Consistency is paramount, as tendons require a minimum of 12 weeks of focused loading to show significant improvement.
When to Seek Professional Medical Care
Self-management strategies involving relative rest and basic pain control should show some improvement within four to six weeks. If pain levels do not decrease after this period, or if symptoms worsen, consult a doctor or physical therapist.
Immediate medical attention is necessary if you experience sudden, sharp pain accompanied by a popping sensation, significant bruising, or an inability to bear weight on the leg. These symptoms suggest a more severe injury, such as a high-grade tear or an avulsion (where the tendon pulls away from the bone). A professional can also assess for potential nerve involvement, as the sciatic nerve runs close to the hamstring attachment. Persistent pins and needles or numbness requires evaluation.
Specialists may offer advanced treatment options if conservative measures fail. These can include ultrasound-guided corticosteroid injections to reduce local inflammation and allow the patient to engage more effectively in strengthening exercises. Injections are typically used to facilitate physical therapy, as strengthening remains the long-term solution for tendon recovery.