How To Alleviate Upper Hamstring Pain

Today’s video covers rehab exercises for upper or proximal hamstring tendinopathy (PHT), which describes a condition where pain occurs at the hamstring attachment on the backside of the pelvis - a literal pain in the butt.

This issue occurs when the hamstring tendon cannot meet external demand and is usually associated with situations where the tissue is repeatedly compressed against the pelvis and often begins after running hills, sprinting or sitting for prolonged periods. Running uphill and sprinting both place the hip in a position of increased flexion (increased tendon compression) and place increased demand on the hamstrings.

Symptoms associated with this diagnosis will be very local to the ischial tuberosity (sit bone) and provoked with isometric contraction of the hamstrings while the hip is in flexion, stretching the hamstrings or by palpation.

If you have this pain, a progressive tendon strengthening program, that is designed to increase tendon capacity, is best supported in the research. Behavior modification is also important and should include temporary rest from running (returning gradually with level running first), avoiding prolonged sitting and temporarily avoiding other activities such as deadlifting, lunges and deep squatting.

Presented here is an exercise progression that can be used to progressively increase tendon strength and encourage healing. These exercises gradually apply more stress to the hamstring origin. Find the options that produce mild to moderate symptoms and perform 3 sets of 8-12 repetitions every other day.

Goom TS, et al. Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management. J Orthop Sports Phys Ther. 2016.

[paulamccrary]

Thank you so much for this! My son had a pelvic avulsion fracture right in this area 8 weeks ago during a 100m race and is in PT now for his hamstring. He’s only done two weeks of PT and they say they will release him this week. He can do one leg bridges. That has been the extent of his therapy with some stretching. The article you shared gives me a place to help him at home with.

[isabelkimble]

I’ve had this for about 3 months, injured myself doing yoga, I actually felt a ‘snap’ doing a triangle. Stopped yoga and following this advice and exercises but not sure that it’s improving, not yet anyway. Really sore at times and really miss my yoga.

[HaydennPlays]

i play soccer and i sprinted as fast as i can to get back and pulled it and now i had to skip a week and i have a game today so this helps so much thank you so mych

[annlaurel]

Great explanation…. I enjoy learning and doing the exercises. It really help a lot!
Thank you

[myhorsejewel]

Thanks. This is totally helpful. 11:30 on Oct 4 2023

[MikeManske]

I'm in great shape at 76 but I'm competitive and over did circuit training weights in gym, no stopping and too many reps (40) 3 sets of 15 procedures =45 sets total done in 1.5 hours and the nagging pull in my butt has gone to 12+ hours 5 times now in the last 4 months of total intense pain. Since birth I've had L5S1 pushed out but played sports no problem. Bucks team ortho guy when I was 30 wanted to do fusing, I said no and glad I didn't since no real issues until I was maybe 70, so of course ortho doc today wants to fuse rather than address or even "LISTEN" to my butt hamstring issue because docs like to operate. Your 1st iso caused immediate pain in right hammy if I lift my left leg, so, does it still help if I do this with not lifting left leg? Thank you, I need some advice and docs do not do this very well!

[adrianakrieger]

Muito obrigada!!! Exatamente o que eu precisava!!💛💛🇧🇷🇧🇷

[Markkortbawi]

Hello Dr. Thank you for this video. Should I start with 1 exercise form the above which I find most suitable for me? or should I do all the 4 exercises per day?

[johnhodgeman]

I just got your book. You had directed me to another video and I saw the link and got it because I've had these issues in that region forever and it took one really smart physically therapist to tell me he doesn't believe in MRIs and injections and examined me and said my biggest problem is my low back and my QL muscles are overloaded because my glutes are not firing. This has been especially an issue because of the bulging disc in my naturally sacralized L5-S1 which also puts pressure on the facet joints in L4-L5. It is the disc. Is it sciatica. Is it piriformis. Is it my SI Joint, which is around where I felt and still feel this knawing dull pain like a muscle knot that I cant reach.

I eventually got rid of the pain by focusing on breathing through my stomach and fixing my anterior pelvic tilt.

Life happens and I couldnt work out for a while and now the dull pain is back.

I managed to give myself high hamstring tendinopathy by doing too much too quick too fast. Explosive bodyweight squats. I felt fine doing it. But it was the next day where I felt this pain in the upper back of my thigh I never felt before. I did my research and the most logical conclusion is high hamstring tendinopathy.

So squats were out and I focused on bridging and more core work.

Then I did something stupid and tried to incorporate bands in all my core work plus a band for two exercises that have given me issues in the past with this issue. Clamshells and lateral hip shuffles. Abduction is my kryptonite. In fact, moving by injuries side past mid line is my kryptonite. I thought I could attempt it one time and see how I feel after doing so much core and bridge work, as my hamstrings were feeling better and my knees were feeling better, meaning my hips were in better shape. Well, I guessed wrong.

I woke up the next day with the worst sciatica and piriformis/butt pain, all the way to my foot. I did what I could to to move the sciatica pain back to the source. My piriformis/glueteral pain went down the next day or two. and after some research, and I'm shocked none of the professionals I sought over the years has told me this, the hip flexors, specifically the psoas, is the antithesis of the glutes. If the glutes are weak, the psoas will be overactive and tight. For me, it's worse because the psoas is already tight from the bulging disc and anterior pelvic tilt.

So I think where I'm at now is my psoas are even tighter and that's putting more pressure on my weak glutes. My glutes maximus is in decent shape and still working on getting it to fire more but I think the high hamstring tendinopathy put even more pressure on my glutes and now I either have gludius medius tendinopathy or gludius medius tear outright, or both, on the injured side. I can feel the glute medius is inflamed and tight. Maybe even the minnius is affected, too.

This really puts a damper on my training. So one question is, do I work on rehabbing both my hamstrings and my glute medius or do I first do glute medius and then worry about the hamstrings later? I dont want to to a given hamstring excercise that may help the hamstrings but make the glute medius worse.

I can walk but I see long walking makes the pain worse. It's that psoas. I've released the psoas and I felt the pain go away but then it comes back because of the glutes and anterior pelvic tilt: Long and weak hamstrings and glutes and core is still not as strong as it should be. And tight quads, hip flexors (i.e. psoas-illac, TFL), and low back, leading to QL pain.

So my rehab plan was to use alternating heat and ice on the area as many times during the day as I can right up to bed time. I have my tens unit, as well. And between all that, I have a stationary bike that I can do slow cardio on that should put less pressure in the injured area than walking. And then I can focus on stretching my hip flexors and strengthening my glute medius/gluteal region. That's my plan. But I can feel that glute medius is blown up and feels like a memory foam when you touch it. It feels like it needs to be massaged to break up the scar tissue regularly while also rehabbing it.

Any tips or advice you have while dealing with this setback would be most appreciated. Thank you.

[greatjuankenobi]

I tore my hamstring about 2 yrs ago. Is it too late to rehabilitate it ? Will doing these strengthening exercising still help me. If so how long will it take to fix my issue? How often should I do these techniques a day and per week???? Can this help with chronic issues or only acute type?

[nextgk]

Thank you for the video. Having Pain on both sides from last two years….

[slocket]

As a power liter with hamstring tendonitis this injury is a nightmare a lot of my progress has been lost. I’ve only had the injury 3 weeks and it has me enraged

[duduzilemofolo]

Thank you so much will follow to the tee 👍

[charmimistry]

I have had an upper hamstring pain for few months. I believe it’s from overuse doing deadlifts. My left glute is weaker than my right. I want to heal my hamstrings so thank you for these exercises. While I do these exercises for my hamstrings are there exercises I should avoid? For example barbell squats, hip thrust machine, lunges… or can I modified them. I still want to continue to train my other leg muscles. Also should I focus on stretching my hip flexors?

[greatjuankenobi]

How would I know these exercises are actually helping or working and not making the issue worse? Just looking for a solution to my hamstring issue. TIA

[r.e.cooksjr.]

Wow. I thought I was just getting old. Thanks

[salonshrestha]

Hey doc
Im an soccer athlete and im having this ugly pain in my buttocks for 2 months . Should i do your excercise and rest or should i continue my regular training?

[mokrun]

When do you start running on this plan?

[tomshaw]

I’ve had this injury for the past three months, or at least I think it’s this injury. Pain when sitting/ driving and very stiff when I first start walking. I’ve done all the exercises known to man, had various physio appointments and taken two weeks off with no exercise. Nothing has made any difference, starting to think it’s permanently f***ed. 😢

[Godskingdomcouncelorcrystal]

I did rdl yesterday getting back in shape. On my left within hours pain, so stiff cant bend over, hamstring feels so tight, bruised and even burning in leg. Would this excercise help? I know not to stretch it though. Thanks.