Hamstring
Proximal Hamstring Tendinopathy
Quick answer
Proximal hamstring tendinopathy causes deep pain near the sit bone, typically aggravated by sitting, sprinting, hills and hip-hinge movements. Treatment centres on progressive hamstring loading with attention to compression, and shockwave therapy may be considered in selected persistent cases.
Common symptoms
- Deep buttock or sit-bone pain
- Pain with prolonged sitting or driving
- Discomfort sprinting or running hills
- Pain with deadlifts and hinging
Potential causes and contributing factors
- Rapid increases in sprinting or hill running
- High hinge-loading volume
- Prolonged sitting combined with training
Who commonly experiences it
Runners, sprinters, field-sport athletes and gym-goers doing heavy hinge work.
How it is assessed at Back2Health
- Palpation of the ischial tuberosity
- Hamstring strength testing at different hip angles
- Running and sitting tolerance
- Lumbar and nerve screening
Where shockwave may fit
It may be considered as an adjunct when symptoms persist despite a well-structured loading programme.
Where it may not fit
Sciatic nerve-related pain and lumbar referral must be distinguished, and treatment directly over major nerves is avoided.
Rehabilitation and alternative treatment
Whether or not shockwave is used, the rehabilitation plan does the long-term work. Alternatives and adjuncts may include physiotherapy alone, manual therapy where indicated, load management, footwear or equipment changes, and referral for imaging or a medical opinion.
- Low-compression isometric loading
- Progressive hamstring strength through range
- Running and sprint progression
- Sitting and driving adjustments
When medical referral may be needed
Pain travelling down the leg with numbness or weakness suggests nerve involvement and needs assessment.
Seek urgent care for major trauma, sudden inability to bear weight, suspected fracture, severe swelling or redness, fever, unexplained weight loss, progressive weakness, or loss of bladder or bowel control.
Proximal Hamstring Tendinopathy — questions patients ask
Aggressive stretching often increases compression at the tendon and can worsen symptoms.
Medical disclaimer. Information on this website is provided for general education and does not replace an individual clinical diagnosis or medical advice. Shockwave therapy is not suitable for every person or every condition. A qualified clinician must assess suitability.
Written by the Back2Health physiotherapy and rehabilitation team · Clinically reviewed by the Back2Health clinical team · Last reviewed 3 August 2026
Find out whether shockwave is right for your condition
Start with a clinical assessment. The Back2Health team will evaluate the source of your symptoms, explain whether shockwave is appropriate and build a rehabilitation plan around your goals.