Introduction
Proximal hamstring injuries are common, particularly in athletes and individuals engaged in high-load resistance training or dynamic sports. They can lead to persistent symptoms if not managed appropriately.
They can be a frustrating and painful experience, especially if it makes simple activities like sitting, driving, or exercising uncomfortable.
If you’re experiencing pain in the upper part of your hamstring or deep in the buttock area from an upper hamstring injury, this guide will help you understand what’s going on and what you can do to recover.
What is a Proximal Hamstring Injury?
The hamstring muscles run along the back of your thigh and help with bending your knee and extending your hip. The term “proximal” refers to the upper part of the hamstring, where it connects to the pelvis at the sit bone (ischium).
Injuries in this area can happen suddenly (acute injuries) or develop gradually over time (chronic injuries).
Who’s at Risk and How These Injuries Happen
Proximal hamstring injuries often affect active individuals, especially those who engage in sports or fitness routines that involve sprinting, jumping, or heavy lifting.
Athletes in sports like track and field, football, rugby, and tennis are particularly vulnerable. Weightlifters, especially those performing deadlifts or squats, can also strain their hamstrings.
These injuries usually occur when the muscle is suddenly stretched too far or asked to produce a strong contraction in a stretched position, like when sprinting or picking up a heavy weight from the ground.
Less commonly, sitting for long periods on hard surfaces can cause chronic irritation and lead to tendon problems.
How Do These Injuries Happen?
Proximal hamstring injuries are often caused by:
- Rapid acceleration – Sprinting or explosive movements in sports like football, rugby, and tennis can put high stress on the hamstring.
- Sudden overstretching – Activities like doing the splits, hurdling, or an unexpected stretch (e.g., slipping on ice) can overstretch the hamstring and lead to a tear.
- Heavy lifting – Exercises like deadlifts or squats, especially with improper form or excessive weight, can strain the upper hamstring.
- Sustained sitting pressure – Sitting for long hours, especially on hard surfaces, can irritate the area and cause chronic tendon irritation (tendinopathy).
What Are the Symptoms of a Proximal Hamstring Injury?
The symptoms of a proximal hamstring injury depend on the severity, but may include:
- Pain deep in the buttock – Especially when sitting or driving.
- Pain with movement – Activities like running, bending forward, or squatting may trigger discomfort.
- Weakness in the hamstring – Feeling weaker when lifting the leg or pushing off when running.
- Stiffness and tightness – The area may feel tight, especially in the morning.
- Radiating pain down the leg – Some people feel discomfort extending down the back of the thigh or even to the calf.
- Pins and needles or numbness – If the nearby sciatic nerve is irritated, you may feel tingling sensations in the leg or foot.
What Else Could It Be? (Differential Diagnosis)
Other conditions can cause similar symptoms, so it’s important to consider different possibilities:
- Sciatica (nerve irritation) – Compression of the sciatic nerve can cause pain down the back of the leg, but this usually includes numbness or sharp, shooting pains.
- Hip joint injury – Labral tears or inflammation in the hip can sometimes cause pain in the buttock area.
- Gluteal muscle strain – The deep muscles in the buttocks can also be strained with heavy lifting or overstretching.
How Is It Diagnosed?
Your sports specialist will assess your symptoms and perform a physical exam to check for weakness, pain, and flexibility. Imaging tests like MRI or ultrasound can help confirm the diagnosis by showing any tendon damage or inflammation.
At LBSM your sports medicine consultant will be able to perform an ultrasound as part of their initial in-clinic assessment to ensure a quick and accurate diagnosis.
If other problems are suspected, or if a more detailed image of the hamstring tendon and surrounding tissues is required, then you might need an MRI.
Image 1 (axial view) and image 2 (sagittal view) of the left proximal hamstring shows high signal throughout all components of the proximal hamstring including semimembranosus and the conjoint tendon (joint Semitendinosus and Bicep Femoris tendon complex). There is also a florid reactive ischiogluteal bursitis.
How Can You Treat a Proximal Hamstring Injury?
Recovery depends on the severity of the injury, but almost all cases can be managed without surgery.
Here’s what helps:
1. Activity Modification
- Avoid deep stretching or exercises that put pressure on the hamstring (e.g., lunges, squats, or prolonged sitting).
- A hamstring cushion can help relieve pressure when sitting.
2. Strengthening Exercises
Bridges
- Start with isometric bridge holds (holding a bridge position without movement) to gently activate the hamstring without overloading it.
- Gradually progress to long-lever bridges (keeping legs straight) and later to controlled eccentric exercises (slow lengthening movements to rebuild strength).
Eccentric Hamstring Exercise
Power Deadlift
3. Shockwave Therapy
- A non-invasive treatment that stimulates healing and reduces pain.
4. Injections
- Corticosteroid injections can help calm inflammation in severe cases.
- Platelet-rich plasma (PRP) injections may help heal the tendon over time.
5. Surgery (Rarely Needed)
- In cases of complete hamstring tendon rupture or chronic non-healing injuries, surgery may be required to reattach the tendon.
At LBSM we work very closely with expert physiotherapists, strength and conditioning coaches, orthopaedic surgeons etc, therefore, whatever intervention is required, you will be referred to a trusted colleague who will ensure you receive the best possible care.
How Long Does Recovery Take?
Recovery time varies based on the severity of the injury and how well the rehabilitation program is followed:
- Mild injuries: 6-8 weeks
- Moderate injuries: 3-6 months
- Severe injuries (tendon tears): 6 months or more, sometimes requiring surgery
Takeaway Message
Proximal hamstring injuries can be painful and persistent, but with the right approach, most people recover well. Avoiding aggravating activities, following a structured rehabilitation plan, and using targeted treatments can help you get back to your normal activities safely.
If you’re struggling with persistent hamstring pain, consider consulting a sports medicine specialist for a personalised treatment plan. The sooner you start the right rehab, the better your recovery will be!
