A deep, nagging pain right at the bottom of the buttock isn’t something most people would immediately associate with a hamstring problem.
Yet it’s something we see in clinic and it can sometimes go undiagnosed for quite some time.
Patients often describe pain right underneath the buttock, sometimes extending into the very top of the back of the thigh. It may be particularly uncomfortable when sitting for long periods, running, walking uphill or exercising.
And one of the things we often hear is:
“I thought I’d pulled my hamstring, but it just isn’t getting better.”
Sometimes, it isn’t actually a hamstring strain at all.
It can be a condition called proximal hamstring tendinopathy.
What is proximal hamstring tendinopathy?
Your hamstring muscles run down the back of your thigh and attach via their tendons to the bottom of your pelvis, around the area you actually sit on.
Proximal hamstring tendinopathy affects the tendon around this upper attachment.
Like other tendons in the body, this area can become painful when the demands being placed upon it exceed what it is currently able to tolerate.
Unlike a typical muscle strain, which often has a more obvious moment of injury, proximal hamstring tendinopathy can develop gradually and become surprisingly persistent.
One of the classic clues is pain when sitting, particularly on a firm chair or during a long car journey.
Some people notice symptoms during or after running. Others experience pain when bending forwards, climbing hills, lunging or returning to exercise.
And although hamstring problems are often associated with runners and sportspeople, you certainly don’t have to be an athlete to develop proximal hamstring tendinopathy.
Why doesn’t resting always solve the problem?
This is where tendon problems can become frustrating.
Rest may temporarily reduce the symptoms, particularly if you stop doing the activities that aggravate the area. But simply avoiding everything that hurts doesn’t necessarily improve the tendon’s ability to cope when you return to those activities.
So you rest.
It starts to feel better.
You start running, exercising or doing more again.
And the pain returns.
Tendons also have a relatively limited blood supply compared with muscle tissue, which is one of the factors that can make persistent tendon problems challenging to manage.
For some patients, particularly where symptoms have become longstanding, treatment may therefore involve more than simply rest and exercise. This is where treatments such as focused shockwave therapy may form part of a structured rehabilitation programme.
The aim isn’t simply to make the painful area feel better in the short term. We also need to progressively improve the tendon’s ability to tolerate load again.
Making sure the hamstring tendon really is the problem
Before treating proximal hamstring tendinopathy, it’s important to establish that the tendon is actually responsible for the symptoms.
Pain around the buttock and back of the thigh can have several different causes, and treating the painful area without understanding where the symptoms are coming from isn’t necessarily going to solve the problem.
A thorough physiotherapy assessment allows us to look at the history of the problem, how and when the symptoms occur, strength, movement and the activities that aggravate the pain.
From there, we can establish the likely diagnosis and decide on the most appropriate treatment plan.
Focused shockwave therapy for proximal hamstring tendinopathy
At Physioelite, one of the treatments we use for proximal hamstring tendinopathy is focused shockwave therapy, alongside an individual rehabilitation programme.
Focused shockwave delivers acoustic energy into a targeted area of tissue and is used in the management of a number of persistent tendon conditions.
Where we feel it is clinically appropriate, treatment may combine focused shockwave with progressive strengthening and rehabilitation designed around the activities that particular patient wants to return to.
This is important because treating the tendon is only one part of the picture.
Ultimately, we also want to improve its capacity to tolerate the demands being placed upon it, whether that’s sitting comfortably at work, walking, returning to the gym, running or getting back to sport.
Is that persistent ‘hamstring strain’ worth getting checked?
If you’ve had an annoying pain just underneath your bottom or at the very top of your hamstring for weeks or even months, particularly if sitting or exercise aggravates it, it may be worth having it properly assessed.
Repeatedly stretching it, resting it or simply hoping it will eventually disappear may not address what’s actually causing the problem.
And if you’ve been telling yourself “I’ve just pulled my hamstring” for the last few months, there may be more to it.
If these symptoms sound familiar, you can book a free 15 minute telephone consultation to discuss what’s been happening and whether an assessment may be appropriate.
