Some running injuries are dramatic. This one is just relentless.
It starts as a deep ache right where you sit down, at the bony point under your backside. It is worse on hard chairs. It is worse driving. It is worse at the start of a run and particularly on hills and faster efforts.
And it has probably been there for months, because this is one of the slowest injuries in running to resolve and one of the easiest to make worse with the obvious treatment.
It is a problem with the hamstring tendon where it attaches to the sitting bone, and it behaves differently from a hamstring strain.
How to recognize it
The location is the giveaway. Pain right at the bony point you sit on, sometimes spreading a little way down the back of the thigh but usually centered there.
Sitting makes it worse, and the harder the surface the worse it is. Most people with this condition have worked out which chair in the house to avoid.
Driving aggravates it, particularly longer journeys.
Running uphill makes it worse. So does running faster. Both involve the hamstring working harder in a lengthened position, which is exactly what this tendon dislikes.
Stretching it feels like it should help and usually makes it worse, which we will come back to.
And it warms up. It frequently hurts for the first portion of a run, eases somewhat, and is then considerably worse the following morning. That pattern catches people out because it feels like running is helping.
Why it is different from a hamstring strain
A hamstring strain is usually a moment. You felt something go, probably during a fast run or a sprint, and it hurt immediately.
This is gradual. There is no moment, just a slow onset over weeks, and it rarely stops you running in the early stages. It just makes everything slightly uncomfortable and then progressively more so.
The structure involved is the tendon at the very top of the hamstring, where it attaches to the sitting bone, rather than the muscle itself.
And the management is different, which is why treating it like a strain tends to disappoint.
The stretching problem
This is the most important practical point in the article.
The instinct with a sore hamstring is to stretch it. The back of the leg feels tight, stretching ought to loosen it, and plenty of people have been told to do exactly that.
With this condition, the common stretches frequently make things worse.
The reason is compression. When you bend forward with a straight leg, or pull your knee toward your chest, you compress the tendon against the bone it attaches to. That compression is a large part of what irritates it in the first place.
So the classic forward fold, the seated toe touch and the lying knee to chest stretch are all doing exactly the thing the tendon does not tolerate.
The tell is simple. If stretching gives you temporary relief and then leaves you worse several hours later or the next morning, stop.
That does not mean the leg should never be lengthened. It means the aggressive end range stretching most people reach for is the wrong tool here, particularly early on.
What actually helps
Tendons respond to load. Not rest, and not stretching. Progressive, controlled loading.
The sequence generally looks like this.
Early on, when things are irritable, we use loading that does not involve much compression. That means working the hamstring with the hip in a relatively neutral position rather than bent forward. Bridges, and holds rather than fast movements, are typical starting points.
As things settle, we progress the load and gradually introduce positions involving more hip flexion, which is where the compression lives. This is done deliberately and in stages rather than all at once.
Later, we build toward the demands of running, including faster and longer loading, and eventually hills.
Throughout, we progress by how the tendon responds the next morning rather than by how it feels during the session.
The sitting part
Managing the compression outside of training matters as much as the exercises.
Avoid the hardest chairs. A cushion helps, and so does a slightly reclined position which takes some pressure off the sitting bone.
Break up long periods of sitting, including on drives.
Avoid sitting with your legs crossed on that side.
And if your work involves hours at a desk, this is worth addressing properly, because eight hours of compression a day will outweigh what you are doing in a twenty minute session.
Running while you treat it
Most people do not have to stop entirely, though some need a short break at the start.
What generally changes.
Hills come out first. They are the biggest provocation.
Speed work comes out next, or gets reduced substantially.
Volume reduces, and flat easy running usually continues in some form.
And the next morning rule applies to runs as well as exercises. If you are worse the following day, that was too much.
Cross training helps maintain fitness. Cycling is sometimes uncomfortable because of the seated position, so it is worth testing rather than assuming.
Be ready for it to take a while
This is the part nobody wants to hear.
Proximal hamstring tendinopathy is known for being slow. Months rather than weeks is the normal timeframe, and some cases take longer.
Progress is also not a straight line. There will be good weeks and setbacks, and a flare in week eight does not undo the previous seven.
The most common reason it drags on for a year is not that the condition is untreatable. It is that people start a program, feel better in a few weeks, and stop before the tendon has rebuilt its capacity. Then they return to hills and speed and it comes straight back.
Finishing the job is the difference.
When it is not this
A few things in the same region worth distinguishing.
Referred pain from the lower back, which can produce buttock pain and frequently comes with symptoms further down the leg.
Deep gluteal pain involving the nerve, which tends to produce more of a burning or electrical quality and sometimes numbness or tingling.
Hip joint problems, which more commonly produce groin pain.
And in adolescents, an injury to the growth area at the sitting bone, which is a different problem needing different management.
If your symptoms include numbness, tingling, weakness, or pain traveling below the knee, that points elsewhere and warrants assessment.
When to get it checked
Pain that came on suddenly during a fast run with a sense of something tearing, which suggests a strain rather than a tendon problem and may need imaging.
Significant bruising.
Weakness rather than pain limiting what you can do.
Numbness, tingling or pain traveling down the leg.
Pain at rest or at night that is severe.
And any symptoms in a young runner who is still growing, which should be assessed rather than managed as an adult tendon problem.
Get a plan that finishes the job
This condition responds well to the right loading program and poorly to almost everything else, including rest, stretching and hoping.
Running Injury Expert Rehab offers a free discovery visit at no cost and no obligation. You will get a thorough assessment, confirmation of what you are actually dealing with, and a loading program set at the right starting point with a clear plan for progressing it back to hills and speed.