What is it?

Hamstring origin tendon pain can be debilitating and is common among runners and even walkers. This short blog post will cover how to identify it and what the key steps to managing it are.

How do I know I have it?

  1. Pain localized to the sitting bone (see figure below)
  2. Pain that worsens when starting to run/walk, especially fast or up hills
  3. Pain that is often worse with sitting and the day after a run/long walk


There are many other tissues that can also produce similar pain, such as the back and hip, or the sciatic nerve. More than half of the patients who come to see me having been told they have hamstring origin pain often have components of other diagnoses, and many have strong sensitization features – which is when the nervous system and brain alter the pain experience – often the pain is easily triggered and amplified. So the key message is, please have your bottom pain properly diagnosed by an experienced health professional who see lots of these, especially if you are struggling!

What causes it?

Overuse is the main cause, and this often involves…

1. Increase in walking or running volume
2. Adding hills, faster walking or running to your exercise routine
3. Running with poor technique – ‘over-striding’ (landing with your foot too far in front of you – see picture below) is a classic
4. Predisposition due to genes, general health, and many other factors


How to fix it?

In a recent blog I outlined the basic principles of tendinopathy management (link here). In a nutshell the key steps are…

1. Stop aggravating the tendon
2. Rehabilitation to develop the tendon’s ability to withstand load
3. Consider changing your running or other movement patterns to reduce stress on the hamstring tendon

An important consideration is to have an individualized rehabilitation program. Every hamstring origin tendinopathy patient is different in how their injury presents. For example, some have really weak hamstrings or what is sometimes referred to as inhibition of the hamstring muscles – akin to the brain starting to forget the hamstrings exits and deciding not to use much. This leads to a vicious cycle of pain and weakness. Whereas, other people have good hamstrings but poor function in other muscles, such as the gluteus maximus, i.e. your strong bottom muscles. The hamstrings and gluteus maximus work together to extend your hip (see picture below). Restoring proper function and balance between hamstring and gluteus maximus function is critical and can only be achieved by thorough assessment of the individual deficits you present with and the best way to improve them.


Lots of people live with buttock pain unnecessarily. It may take time, but you can get rid of that pain in the bum!

Have a question? Contact me at:  peter@stage.bocki.com.au/csc