Symptoms of Chronic High (Proximal) Hamstring Tendinopathy

Patients with chronic high (proximal) hamstring tendinopathies will often complain of deep posterior hip/buttock pain of gradual onset aggravated by repetitive activities, such as running or biking and often will have pain that is worsened by prolonged sitting.¹Engebretsen A, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for hamstring injuries among male soccer players: a prospective cohort study. Am J Sports Med 2010;38:1147-53.^,2Gabbe B, Bennell K, Finch C, Wajswelner H, Orchard J. Predictors of hamstring injury at the elite level of Australian football. Scand J Med Sci Sports 2006;16:7-13.^,3Chumanov E, Heiderscheit B, Thelen D. The effect of speed and influence of individual muscles on hamstring mechanics during the swing phase of sprinting. J Biomech 2007;40:3555-62. Occasionally pain may radiate down the hamstring and be felt at the back of the thigh.

A Pain in the Butt

Below are some common features of the pain associated with high (proximal) hamstring tendinopathy.

Pain when sitting. Pressing or sitting down on the ischial tuberosity (sit bone) may be uncomfortable or even painful.⁴Puranen J, Orava S. The hamstring syndrome--a new gluteal sciatica. Ann Chir Gynaecol 1991;80:212-4.^,5Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.^,6Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8.^,7Cacchio A, Borra F, Severini G, et al. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med 2012;46:883-7.

Pain with repetitive activity. Biking, hiking, running and other repetitive activities can exacerbate the posterior pain. People with high (proximal) hamstring tendinopathy will often notice a pattern to their pain. For example, the pain may appear at the same time into a workout.

Pain with acceleration or sprinting. Runners may notice that pain appears or gets worse while accelerating or sprinting. The pain is typically worse just prior to heal strike, when the hamstring is firing to slow the body down. In some cases, severe pain may prevent athletes from sprinting.

Pain when bending at the hip. Similar to acute hamstring strains, chronic tendinopathy may cause pain at the ischial tuberosity, or sit bone, when the hip is fully flexed.⁵Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34.^,6Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8.^,7Cacchio A, Borra F, Severini G, et al. Reliability and validity of three pain provocation tests used for the diagnosis of chronic proximal hamstring tendinopathy. Br J Sports Med 2012;46:883-7. An example of this would be pain with tying shoes or bending at the waist to pick something up off the ground.

Sciatic Pain Caused by Hamstring Tendinopathy

Occasionally the sciatic nerve may become irritated or entrapped by an affected tendon’s scar tissue, causing sciatica-like symptoms down the leg.⁴Puranen J, Orava S. The hamstring syndrome--a new gluteal sciatica. Ann Chir Gynaecol 1991;80:212-4.

A person experiencing sciatic pain should report it to his or her doctor. This pain may be related to hamstring tendinopathy or it may be a sign of another problem, such as a pinched nerve in the lower back, piriformis syndrome, or sacroiliac dysfunction.