Buttock-Hamstring Pain

Although City2Surf is behind us, many people are continuing with their running as the September marathon/half-marathon/9k bridge run approaches. So in keeping with the running theme, it seemed worthwhile to talk about buttock-hamstring tendinopathy. We have more detailed information on hamstring injuries here.

Hamstring tendinopathy is often described as a pain at the bottom of the buttock that may radiate down along the hamstring. The source of pain is believed to be at the attachment point of the hamstring on the pelvis.


This condition can affect 12.5% of long-distance runners and is more common in the non-professional but still competitive runners. It typically starts gradually and worsens with continued running/training. The start of the run is often the most painful, with some relief possible with continued warm-up. It may also be painful to sit for prolonged periods, especially on harder surfaces. Hamstring stretching typically provides no relief and possibly makes the symptoms worse.


Possible causes of buttock-hamstring pain include:

  • Overstriding: heel contact occurs well in front of the runner’s centre of mass
  • Increase in hill training
  • Sudden increase in speed training
  • Sudden increase in distances

A thorough physiotherapy assessment can confirm your diagnosis and an ultrasound or MRI is generally not necessary.


Treatment is specific to the person and depends on factors such as overall strength and conditioning, the time until the race, and the severity of the injury. It could include any of the following:

  • Adjusting training as necessary, such as the amount of hills, distances, striding technique, etc.
  • Loading program for the hamstrings using body weight or other resistance training
  • Addressing other biomechanical factors in the back or pelvis that could be contributing to the problem

Rarely do runners with this condition need anything beyond a good rehabilitation program but in more severe cases your Physiotherapist could refer you to a Sports Physician to discuss medication, injection, or surgical options.