Buttock Pain When Sitting or Running? It May Be Proximal Hamstring Tendinopathy
For many active women in their 40s to 60s, deep buttock pain becomes a daily burden. It may start as a dull ache when sitting, show up after a run, or flare during yoga stretches. At first, it seems like a tight muscle or a pulled hamstring as an Austin, TX manual physical therapist can share. But when it lingers, worsens, or doesn’t improve with rest and stretching, it may actually be a condition called proximal hamstring tendinopathy (PHT).
PHT is a chronic tendon issue where the hamstring tendon near your sit bone becomes irritated from overload. It’s common, frustrating, and often misunderstood. The good news is that with the right treatment approach, it’s very treatable. Let’s walk through what causes this condition, how to recognize it, and what truly works to get you back to the activities you love.
Understanding the Tendon Problem
Your hamstrings are large muscles that run down the back of your thigh. They attach to your pelvis at a bony point called the ischial tuberosity which is commonly known as the “sit bone.” Where the muscle meets the bone, there’s a thick, rope-like tendon. That’s where PHT occurs. Unlike a sudden hamstring strain you might feel during a sprint, PHT develops slowly. It’s caused by repeated stress to the tendon, often from running, lunging, or deep stretching. Over time, the tendon becomes irritated and less tolerant to load. If not managed well, this can lead to pain and decreased performance in your workouts and everyday life.
Why Stretching Isn’t the Answer
It’s very common for people to try stretching when something feels tight. But when it comes to a tendon, especially one under compression like the high hamstring, aggressive stretching can actually make things worse. Deep forward bends in yoga or long passive hamstring stretches often pull directly on the sensitive area, delaying healing. If you feel a pulling pain right at your sit bone during stretches, that’s a red flag. The tendon needs time to calm down and strengthen, not be pulled harder. Stretching is not inherently bad, but it needs to be replaced early on with strategies that rebuild tendon strength. That is why we at Move Empower Concierge Physical Therapy recommend consulting with a physical therapist before trying new exercise routines.
What Triggers PHT in Active Women
Proximal hamstring tendinopathy is especially common in women between 40 and 60 years old. This is not because women in this age group are weak but because it’s a combination of factors that come together. Hormonal shifts during perimenopause can change collagen properties, affecting tendon strength. Busy lifestyles often mean inconsistent training, rushed workouts, or returning to activity after time off. Overuse patterns in running, cycling, yoga, or group fitness can overload the tendon. Prolonged sitting, especially during work or travel, also keeps the tendon under pressure.
Often, it’s a perfect storm. You may not even notice until the pain sticks around for weeks or months. By then, it’s a chronic problem that needs more than a simple rest-and-stretch plan.
What It Feels Like
The hallmark of PHT is pain deep in the buttock, near the sit bone. It might feel sharp, achy, or pinchy. Many people notice discomfort when sitting for long periods, during or after running, especially on hills, or with exercises that involve lunging or bending at the hips. Stretching often worsens the pain, and there may be morning stiffness that eases as you move. These symptoms often lead people to think it’s a pulled muscle or sciatic nerve issue. But if stretching makes it worse and rest hasn’t helped, PHT should be on the radar.
Common Movements That Aggravate PHT
Certain activities can keep the tendon irritated. Running, especially with sudden mileage increases, hill work, or long strides, can load the tendon beyond its current capacity. Cycling, with the hip in a flexed position, adds compression, particularly during long rides. Strength training exercises like deadlifts, lunges, or kettlebell swings can also be too much, too soon. Even sitting, especially on hard surfaces for long stretches, can put pressure on the tendon. And while yoga and Pilates are beneficial for many people, deep forward bends can pull directly on the sore area.
The good news is that these activities don’t need to be avoided forever. The goal is to adjust and modify them based on your tendon’s current tolerance.
What Actually Helps? (Hint: It’s Not Just Rest)
Rest alone doesn’t fix chronic tendon problems. In fact, complete rest can make the tendon even less tolerant to load. The gold standard for treating PHT is progressive loading which is building strength and resilience in a slow, structured way. This approach starts with easier movements and gradually moves toward more challenging tasks like running or lifting. Over time, this helps the tendon adapt and heal.
In the early stages, isometric exercises are very helpful. These involve holding a muscle contraction without moving the joint, such as a bridge hold or a static hamstring curl. These movements can reduce pain while keeping the tendon engaged. As pain improves, we move into eccentric and heavy slow resistance exercises. These involve slowly lowering against resistance and using controlled, heavier loads to rebuild strength. Examples include Romanian deadlifts, hip hinges, and progressive bridging exercises.
In some cases, additional treatments can support recovery. Shockwave therapy uses sound waves to stimulate healing and reduce pain. Stimpod therapy helps calm overactive nerve signals, and cold laser therapy uses light to support tissue repair. Manual therapy and nerve gliding can reduce tension in surrounding tissues and improve comfort with movement. These techniques are not a replacement for exercise, but they can enhance your progress when used as part of a full plan.
Why Individualized Rehab Matters
No two cases of PHT are exactly the same. A generic program might work for someone else but not for you. At Move Empower Concierge Physical Therapy, we build plans that match your current activity level and pain tolerance. We design your program around your lifestyle and the activities you care about, whether it’s running, hiking, yoga, or something else. This approach allows for clear, steady progress without flaring up your symptoms.
Many patients feel frustrated when a program feels too easy or too painful. That’s why a tailored plan, with expert guidance and thoughtful progression, makes a big difference.
Daily Habits That Support Healing
Recovery isn’t just about what you do in a workout. Everyday habits can either support or slow your progress. Avoid sitting for long periods when possible. Try to stand, walk, or change positions every 30 to 45 minutes. If you need to sit for work or travel, use a cushion or wedge to reduce pressure on the sit bone. Replace deep hamstring stretches with strength-based mobility exercises that target the glutes and hamstrings. Warming up before workouts with hip hinges and glute activation prepares your tendon for movement. Building core and glute strength helps take pressure off the hamstring, spreading the work to stronger areas.
These simple changes reduce irritation and help your tendon recover.
How to Prevent It From Coming Back
Once your symptoms improve, it’s important to maintain tendon health. Prevention focuses on consistency, smart planning, and long-term strength. Avoid big jumps in mileage or intensity. Keep a regular strength routine focused on your glutes, hamstrings, and back. Add cross-training activities like walking or cycling to reduce repetitive stress. Make sure your training schedule includes recovery days. And most importantly, listen to your body. If you notice a new ache deep in your buttock, scale back and adjust before it becomes a bigger issue.
You don’t have to be perfect, but you do want to be consistent. Strength before flexibility, and steady effort over time, are the keys to resilient tendons.
When to Reach Out for Help
You don’t have to wait until the pain is unbearable. If your symptoms have lasted more than four to six weeks, if pain is interfering with your workouts, running, or sitting, or if stretching seems to make it worse, it’s time to get support. A physical therapist can help you understand what’s going on and guide you through a plan that actually works.
At Move Empower, we offer free discovery visits to talk through your history and your goals. Whether you’re returning to running, training for a hike, or just want to sit without pain, we can help you map a path forward.
Proximal hamstring tendinopathy is a frustrating but treatable problem. It’s common in active women, especially between 40 and 60, and shows up in everyday life with pain during sitting, running, or stretching. But with the right blend of progressive strengthening, activity changes, and supportive care, it can improve.
You do not have to choose between staying active and living with pain. Your tendon can become strong and resilient again with the right plan.
Book a Free Discovery Session to talk with Move Empower Concierge Physical Therapy about your goals.