Do you get buttock pain after sitting? Physiotherapy, exercise, shockwave therapy, ultrasound, and injections can help you recover and get back to running and sports.
What is it?
This condition affects the tendon where the hamstring muscles attach to the sit bone (ischial tuberosity). It typically causes deep buttock pain, worse when sitting for long periods, running, or bending forward.
Who does it affect?
- Dancers, runners, especially sprinters and long-distance athletes.
- Football and hockey players engage in repeated sprinting and kicking.
- Cyclists and people with prolonged periods.
How physiotherapy can help
- Exercise therapy/Physiotherapy:
Rehab starts with isometric (static) exercises to reduce pain, before gradually progressing to heavy slow resistance training and more dynamic loading. Building strength in both the hamstrings and glutes helps protect the tendon. Progress is carefully paced to avoid flare-ups while restoring function. - Shockwave therapy:
Sometimes used for persistent pain, shockwaves can help “kick start” the healing process. It improves blood supply to the tendon and reduces irritation, particularly when progress with exercise feels slow. - Diagnostic ultrasound:
Ultrasound imaging can confirm whether the tendon is the source of pain and detect changes in the surrounding tissue. It also helps rule out other causes of deep buttock or hip pain, such as bursitis or nerve irritation. - Injection therapy:
In cases where symptoms persist despite effective rehabilitation, guided injections may be considered. These can provide temporary relief, allowing you to progress exercises more effectively. - Other physio treatments:
Manual therapy can improve movement in the hip and lower back, making exercise more comfortable. Education is key – your physio will guide you on pacing, sitting strategies, and a gradual return-to-running plan. Taping or supports may also be used in sports or during activity as a short-term aid.
Take-home message
Proximal hamstring tendinopathy can be stubborn, but progressive rehabilitation and targeted physical therapy help most people return to pain-free running and sports.
References
Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management Thomas S.H. Goom, Peter Malliaras, Michael P. Reiman, and Craig R. Purdam Journal of Orthopaedic & Sports Physical Therapy 2016 46:6, 483-493Beatty, N. R., Félix, I., Hettler, J., Moley, P. J., & Wyss, J. F. (2017). Rehabilitation and Prevention of Proximal Hamstring Tendinopathy. Current sports medicine reports, 16(3), 162–171. https://doi.org/10.1249/JSR.0000000000000355