Proximal Hamstring Tendinopathy: A Literal Pain in the Butt for Atlanta Runners
When a runner comes to us complaining of a deep, nagging pain right under your sit bone, they’re usually convinced their dealing with a glute injury. More times than not, it’s actually proximal hamstring tendinopathy.
This is one of the most frustrating injuries we see at our running physical therapy clinic in Atlanta, largely because runners often do everything they’re told will help… and still don’t get better.
They rest.
They stretch.
They foam roll.
They ease back into running.
And yet, the pain keeps coming back.
That’s usually because the issue isn’t a hamstring muscle strain at all. Proximal hamstring tendinopathy behaves very differently than a typical muscle injury. Learn more about tendinopathy.
What Is Proximal Hamstring Tendinopathy?
Your hamstrings attach high on your pelvis at a bony landmark called the ischial tuberosity, what most people refer to as the sit bone. This attachment point is under constant demand when you run, particularly as speed increases.
During faster running your hamstrings work not only to control your leg as it swings forward, but also to help drive your leg forward during push off. That combination places a lot of load right where the tendon meets the bone.
Over time, if that load exceeds what the tendon can tolerate, the tendon starts sending warning signals. That’s tendinopathy.
Why Runners Are Especially Prone to High Hamstring Tendinopathy
This injury shows up most often in runners who are:
Consistent and motivated
Training with some level of speed or intensity
Progressing mileage or workouts thoughtfully but perhaps a bit too quickly
Common contributing factors we see include:
Regular speed work or tempo runs
Hill training or treadmill incline running
Overstriding or reaching too far out in front
Weak glutes forcing the hamstrings to do more work
Poor pelvic control, especially late in runs
None of these mean you’re doing something “wrong.” They simply change how much stress the tendon is asked to handle.
What Proximal Hamstring Tendinopathy Feels Like
One reason this injury is so frustrating is how vague it can feel. It’s important to know what patterns runners should look out for. Runners often describe:
A deep ache directly under the sit bone
Pain that shows up during faster running but not easy jogging
Discomfort that lingers after long runs
Pain with sitting, especially on harder surfaces
Symptoms that improve slightly with rest but never fully resolve
Because the pain isn’t sharp or dramatic, many runners keep training through it which slowly entrenches the problem. This injury doesn’t have to sideline your training if you know how to handle it correctly.
Why This Is Not Just a Hamstring Strain
This distinction matters more than most runners realize.
A muscle strain typically:
Has a clear moment of injury
Improves steadily with rest
Responds well to gentle stretching early on
Proximal hamstring tendinopathy behaves very differently. It develops gradually, lingers for months and often worsens with stretching. Treating a tendon problem like a muscle injury is one of the biggest reasons runners stay stuck.
What Actually Helps Proximal Hamstring Tendinopathy
This is one of the few running injuries where the advice to “stretch it out” can actually backfire.
Stretching the hamstrings increases both tension and compression right at the tendon attachment on the sit bone. For an already irritated tendon, that’s like poking a bruise over and over again.
Recovery usually requires a shift in mindset. Instead of trying to “calm things down” with rest and stretching, the goal is to gradually rebuild the tendon’s tolerance to load while avoiding the specific stressors that flare it up.
That process typically includes:
Temporary training modifications
Speed work, hills and aggressive pacing often need to be reduced initially. This doesn’t mean stopping all running, it just means staying within a range the tendon can tolerate. Our priority is to keep Atlanta runners running.Progressive hamstring loading
Early-stage isometric exercises often help reduce pain. From there, strength work becomes slower, heavier and more intentional. Random exercises don’t work here. You have to make sure you get the correct progression of exercises.Glute strengthening and pelvic control
When the glutes aren’t doing their job, the hamstrings pick up the slack. Improving hip strength and stability often takes significant strain off the tendon.Running mechanics adjustments
Overstriding is a big driver of high hamstring load. Small changes in cadence or stride length can meaningfully reduce stress without changing how running feels.
Why This Injury Takes Time (and Why That’s Okay)
Tendons adapt more slowly than muscles. That’s frustrating, especially for runners who are used to bouncing back quickly or have an upcoming race like the Publix Marathon or Peachtree Road Race.
Most runners start to notice meaningful improvement within 8–12 weeks when following a structured plan. Chronic cases can take longer, especially if the pain has been present for many months. Just remember, you can still be running during this timeframe!
The key isn’t speed. It’s consistency and patience with the right loading strategy.
When to See a Running Physical Therapist in Atlanta
If you’re a runner in the Atlanta area and:
Your sit-bone pain has lasted longer than a month
It flares every time you add speed or hills
Sitting after runs is uncomfortable
You’ve tried resting without lasting improvement
It’s time for a running-specific physical therapy evaluation.
At Tempo Physical Therapy & Performance, we work with runners dealing with stubborn tendon injuries like proximal hamstring tendinopathy every week. Our approach looks at strength, pelvic control and running mechanics, not just the pain. We want to find the root cause.
The Bottom Line
Proximal hamstring tendinopathy doesn’t mean you have to give up speed forever. It means your tendon needs a smarter, more intentional path back to full capacity.
With the right plan, most runners don’t just return to pain-free running; they return with better mechanics, better strength, and more confidence in their training.
If you’re a runner in Atlanta that’s ready to stop guessing and start addressing the root cause, we’re here to help. Book a free consultation with us to get back to training with that pesky pain in the butt.
