That nagging pain in the back of your thigh can really put a damper on things, especially when it flares up every time you sit down. Hamstring pain, and specifically hamstring pain sitting, can limit what you’re able to do and how comfortable you feel while doing it. From your ability to work to the enjoyment of your downtime, hamstring issues can impact your overall quality of life.
Often, this type of pain is caused by hamstring tendinopathy, which basically means the tendons in your hamstring are inflamed or starting to break down.
This article provides a deep dive into hamstring tendinopathy, with a special focus on that discomfort you feel when you’re sitting. We’ll cover:
- Hamstring anatomy
- Common causes of hamstring pain
- Symptoms to watch out for
- Treatment options
- Prevention strategies
Our goal is to give you a complete picture of what’s going on and offer practical ways to manage and prevent hamstring pain from taking over your life.
Anatomy of the hamstrings and their role in sitting
To understand why you might feel hamstring pain when sitting, it’s helpful to know a little about hamstring anatomy and how the muscles function.
Hamstring muscle group
The hamstring muscle group is made up of three muscles: the biceps femoris, the semitendinosus, and the semimembranosus. All three originate at the ischial tuberosity, also known as your “sitting bone,” and they attach below your knee.
The main job of the hamstrings is to flex your knee and extend your hip. These muscles work together to enable all kinds of leg movements.
The ischial tuberosity and compression
The hamstring tendons are very close to the ischial tuberosity. Because of this anatomical relationship, the tendons are susceptible to compression when you’re sitting.
When you sit for a long time, you reduce blood flow to the area and increase the amount of pressure on those tendons. When blood flow is reduced, it can cause pain and slow down the healing process if there’s been an injury.
What causes hamstring pain when sitting?
Several factors can contribute to hamstring pain when you’re sitting. Here are some of the most common:
Proximal Hamstring Tendinopathy (PHT)
Proximal hamstring tendinopathy is often the culprit when you experience pain in your hamstring area while sitting. PHT is a condition that affects the hamstring tendons where they connect to the ischial tuberosity (sitting bone) on your pelvis.
Tendinopathy has two main stages:
- Reactive stage: This is the early stage, marked by inflammation and small tears in the tendon.
- Degenerative stage: This is a chronic stage where the collagen in the tendon becomes disorganized, and the tendon may thicken.
Intrinsic risk factors
Some risk factors are related to your body itself. These include:
- Age: As you get older, your tendons lose elasticity, which makes them more vulnerable to injury. People over 40 are at greater risk of PHT.
- Previous hamstring injury: If you’ve injured your hamstring in the past, you’re more likely to injure it again.
Extrinsic risk factors
Other risk factors for hamstring pain while sitting have to do with your habits and activities. These include:
- Overuse and overload: Repetitive strain and excessive loading on the hamstring tendons can lead to tendinopathy. This can be related to activities like running, cycling, or even just sitting for long periods of time with bad posture.
- Poor posture: Slouching and other incorrect sitting positions can compress the hamstring tendons, leading to pain.
- Inadequate warm-up and stretching: If you don’t adequately prepare your muscles before exercise, you increase your risk of injury.
How does hamstring tendinopathy relate to sitting?
Hamstring tendinopathy has a few key symptoms that become especially noticeable when sitting:
- Deep buttock pain: The pain is often located deep in the buttock, near the bony part you feel when you sit, called the ischial tuberosity.
- Sitting makes it worse: When you sit for a long time, the hamstring tendons compress against the ischial tuberosity, which intensifies the pain.
- Pain that travels: The pain can radiate down the back of your thigh, following the path of the hamstring muscles.
- Stiffness: You might feel tightness in your hamstring muscles, even when you’re not moving.
- Exercise makes it worse: Any activity that uses your hamstrings, like running, squatting, or lunging, will likely increase your pain.
- Tenderness: If you press on the hamstring tendons near the ischial tuberosity, it will likely feel tender.
Basically, hamstring tendinopathy causes pain in the buttock and thigh that gets worse when you sit and use your hamstrings.
How to diagnose hamstring tendinopathy
If you have pain in your hamstring when sitting, your doctor will probably use a combination of physical examination and imaging to diagnose the problem.
Physical examination
During a physical exam, your doctor will:
- Press on the ischial tuberosity to check for tenderness.
- Ask you to move your leg to assess your range of motion.
- Perform special tests, such as the Bent Knee Stretch Test.
Imaging
Your doctor may also order imaging tests, such as:
- MRI, which can show tears or inflammation in the tendons.
- Ultrasound, which can show the structure of the tendon and blood flow to the area.
Differential diagnosis
Other conditions can cause similar symptoms to hamstring tendinopathy. Your doctor will want to rule out:
- Sciatic nerve pain
- Ischiofemoral impingement
Conservative treatment options for hamstring pain when sitting
If you’re experiencing hamstring pain when sitting, there are many non-surgical approaches you can try to relieve your discomfort. These include physical therapy, activity modification, and ergonomic adjustments.
Physiotherapy and rehabilitation
A physical therapist can guide you through a program designed to reduce your pain and get you back to your normal activities.
- Activity modification: The first step is often to adjust your activities to reduce the strain on your hamstrings. This might mean avoiding prolonged sitting or using ergonomic supports like a coccyx cushion or standing desk.
- Pain management: You can manage pain and inflammation with ice therapy and over-the-counter pain relievers like NSAIDs (nonsteroidal anti-inflammatory drugs).
- Stretching and range of motion exercises: Gentle hamstring stretches can improve flexibility and reduce stiffness. Your physical therapist can show you the stretches that are right for you.
- Strengthening exercises: Strengthening your hamstrings and the muscles that support them is key. Heavy, slow resistance training is often used to strengthen the hamstring muscles themselves. Glute-strengthening and core-strengthening exercises can also help stabilize your pelvis and reduce strain on your hamstrings.
- Gradual reloading: Gradually returning to your normal activities is essential to avoid re-injury. Listen to your body and avoid pushing through the pain.
Other conservative treatments
In addition to physical therapy, other conservative treatments can provide relief.
- Ergonomic modifications: Adjusting your workspace can reduce compression on your hamstrings. A standing desk can eliminate sitting altogether. If that’s not possible, try a cushion with a cutout for your ischial tuberosities (the “sit bones”).
- Manual therapy: Massage and soft tissue release can help to relieve muscle tension and improve blood flow to the hamstrings.
- Acupuncture: Some people find acupuncture helpful for pain relief.
Injection therapies for hamstring tendinopathy
If rest, physical therapy, and other conservative treatments haven’t brought you enough relief, your doctor might recommend injection therapy to help reduce the pain of hamstring tendinopathy.
Corticosteroid injections
Steroid injections can reduce inflammation and bring you short-term pain relief, but repeated injections can weaken the hamstring tendon and shouldn’t be considered a long-term fix.
Platelet-rich plasma (PRP) injections
Platelet-rich plasma injections involve injecting a concentration of your own platelets into the hamstring tendon. The goal is to stimulate healing and tissue regeneration in the affected area, although research on the effectiveness of PRP injections for hamstring tendinopathy is ongoing.
Shockwave therapy (ESWT)
Extracorporeal shockwave therapy is another treatment option that may help the hamstring tendon heal and reduce pain. Typically, a doctor will recommend 3 to 5 shockwave treatment sessions, often in conjunction with physiotherapy.
When is surgery necessary for hamstring tendinopathy?
Surgery is almost always the last resort for hamstring tendinopathy. But it may be necessary if you have a severe tear in your hamstring tendon or if the tendon has pulled completely away from the bone.
The surgical procedure involves reattaching the hamstring tendons to the ischial tuberosity.
After surgery, you will need to complete a rehabilitation program to regain strength and function in your hamstring. Full recovery after surgery can take at least six months.
Preventing Hamstring Pain While Sitting
So, how can you avoid hamstring pain when you’re stuck in a chair all day? Here are a few tips:
- Sit up straight: Good posture is key. Make sure your back is supported, and your feet are flat on the floor (or use a footrest if they don’t reach).
- Take breaks: Get up and move around every 20-30 minutes. Even a short walk to the water cooler can make a difference.
- Stretch regularly: Incorporate hamstring and hip flexor stretches into your day. There are plenty of stretches you can do right at your desk.
- Strengthen your muscles: Strong hamstrings and glutes help support your body and prevent pain. Consider adding exercises like squats, lunges, and hamstring curls to your workout routine.
- Warm up before exercise: Don’t jump straight into intense activity. A proper warm-up prepares your muscles for the workout ahead.
- Increase intensity gradually: Don’t overdo it. Slowly increase the intensity and duration of your workouts to avoid straining your hamstrings.
Final Thoughts
Hamstring pain while sitting can be a real pain in the butt — literally! We’ve explored the anatomy of the hamstring muscles, the many reasons why they might hurt when you’re seated, and the telltale signs that it’s time to take action. We’ve also covered various treatment strategies, from simple stretches to more advanced interventions, along with practical tips to prevent future flare-ups.
In many cases, conservative treatments and changes to your daily habits can go a long way in relieving hamstring pain. However, if your pain persists or worsens despite your best efforts, don’t hesitate to seek professional help. A physical therapist, sports medicine doctor, or other qualified healthcare provider can properly diagnose the root cause of your pain and develop a personalized treatment plan to get you back to sitting — and living — comfortably.