Hamstring Injuries and Proximal Hamstring Tendinopathy
Hamstring problems are a common cause of pain at the back of the thigh or deep in the buttock. Symptoms can range from a sudden sharp pain during sport to a more persistent ache that worsens with walking, running, bending forward, or sitting for long periods. Some patients notice tightness, weakness, or reduced confidence with activity, particularly when returning to exercise.
Hamstring injuries can affect the muscle itself or the tendon, including the proximal hamstring where the tendon attaches high up at the pelvis. Identifying the exact source of pain is essential for effective treatment and long-term recovery.
Understanding Hamstring Pain
Hamstring conditions generally fall into two main patterns.
Acute hamstring injury often occurs during sprinting, sudden acceleration, or overstretching. This may cause immediate pain, tenderness, bruising, and difficulty continuing activity.
Proximal hamstring tendinopathy is a longer-standing condition affecting the upper part of the tendon near the sitting bone. It commonly causes deep buttock pain, discomfort when sitting, and pain with uphill walking, running, or hip-hinge movements. Symptoms often develop gradually and can persist if the tendon continues to be overloaded.
Both conditions benefit from early, accurate assessment to guide appropriate management.
Ultrasound Assessment at The London Ultrasound Clinic
Your appointment includes a detailed clinical assessment combined with a high-resolution diagnostic ultrasound scan. Ultrasound allows us to directly visualise the hamstring muscles and tendons in real time, including the proximal hamstring origin at the pelvis.
This assessment helps to:
- Identify muscle strains, tears, or scarring
- Assess tendon thickening, degeneration, or inflammation
- Differentiate between acute injury and tendinopathy
- Exclude other causes of posterior thigh or buttock pain
By clearly identifying the structure responsible for your symptoms, ultrasound allows us to provide an accurate diagnosis and tailor your treatment plan with confidence, rather than relying on symptoms alone.
Conservative Management
Most hamstring injuries and proximal hamstring tendon problems respond well to conservative care, which is always the first line of treatment:
Activity modification and load management to reduce stress on the muscle or tendon
Progressive hamstring and gluteal strengthening specific to your diagnosis
Advice on posture, sitting tolerance, running mechanics, and training errors
Education and reassurance regarding recovery timelines and safe return to activity
This structured approach aims to reduce pain, restore strength and control, and support a safe return to everyday activities and sport.
Ultrasound-Guided Injection
If symptoms persist despite appropriate rehabilitation, an ultrasound-guided injection using steroid and local anaesthetic may be considered in selected cases, particularly for proximal hamstring tendinopathy. Ultrasound guidance ensures accurate placement around the affected tendon while avoiding nearby structures, helping to reduce inflammation and pain and allowing rehabilitation to progress more comfortably.
Injection treatment is used to support recovery and is always combined with an appropriate strengthening programme.
Recovery and Ongoing Care
Following assessment or treatment, you will be provided with a clear rehabilitation plan focusing on progressive loading, movement control, and gradual return to activity. Many patients notice steady improvement in pain, sitting comfort, and functional movement over the following weeks as strength and confidence return.
Our aim is to deliver a premium, personalised service that combines expert ultrasound assessment, precise treatment, and practical rehabilitation advice, helping you recover fully and return to the activities that matter to you.
