The Science of Proximal Hamstring Tendinopathy
Proximal hamstring tendinopathy is centered around one specific, exquisitely tender spot: the ischial tuberosity, or the "sitting bone." The pain is a deep, localized ache right in the crease of the buttock where the hamstring muscles originate from a thick, shared tendon. The most common mistake people make is treating this like a simple hamstring muscle strain and aggressively stretching it, which often makes it worse. A tendinopathy at the hamstring's origin is sensitive to both compressive and tensile loads. Aggressive stretching places a high tensile load on the tendon, while sitting on it directly compresses it against the ischial tuberosity. Both actions can perpetuate the pain cycle. The condition is often linked to altered running mechanics, commonly an "over-striding" gait where the foot lands too far in front of the body's center of mass, putting massive braking and tensile load on the hamstring at foot strike.