Do you have butt/buttock pain when sitting? It may be due to a high hamstring strain.
How a high hamstring strain can cause buttock pain
A sudden or repeated stretch/load to the hamstring muscles can cause a strain in the muscle tendon. This will result in irritation and pain which we call tendinopathy (Grimaldi, 2018). When the strain occurs in the hamstring tendon near the ischial tuberosity (see figure below) of the pelvis it is called proximal hamstring tendinopathy and will result in butt pain. If you want more information on this pathology, watch this video: Is tendon pathology a continuum?
What do hamstrings do?
The hamstrings are a group of muscles that attach from the sit bone (ischial tuberosity of the pelvis) and extend to the back of the lower leg (tibia and fibula). They function to extend the hip, flex the knee and provide stability to the knee. (Schache et al 2012, Rogers & Raja 2023)
Stretch and Compression of the Hamstring
Stretch and/or compression of the hamstring muscle at the ischial tuberosity will cause pain in the buttocks (Soslowsky et al. 2002, Cook & Purdue 2012, Grimaldi 2018, Mallaris et al 2016).
Stretch: The tendon is put on stretch when the hip is flexed and the knee is extended which occurs in activities such as downward dog or when kicking a soccer ball!
Compression: This can occur when there is direct pressure on the tendon when a person is sitting or when the tendon is compressed along the ischial tuberosity when it is strained across the bone.
Symptoms of proximal hamstring tendinopathy include:
- deep achy pain in the mid or outer buttocks near your sit bones (aka ischial tuberosity)
- pain may extend midway down the back of your thigh (hamstring muscle)
- pain may extend below the knee if your sciatic nerve is compressed which would also give you feelings of pins & needles and/or numbness (paresthesia) (Mattisussi and Moreno 2016)
What makes buttock pain worse?
- prolonged sitting (i.e driving)
- sitting on hard surfaces
- bending over to tie shoes or put on socks
- yoga postures like downward dog
- walking up a steep incline
- leaning your torso forward (i.e. washing dishes at the sink)
- garden work such as raking or pulling out weeds
Tips to decrease buttock pain
- As much as you think stretching might be the right thing to fix your achy hamstring, please do not stretch it! This will only increase the tensile load and cause compression of the tendon and pain.
- If you have to sit, consider the following: use a wedge cushion or a donut, sit in a softer chair, sit up straight, and avoid leaning your body forward to reach your desk, an alternative is to use a sit/stand desk
- If driving, move the seat closer so you do not have to lean to reach the steering wheel or stretch out your legs to reach the pedal
- If you have to forward bend, think about bending your knees when tying your shoes, kneeling down when pulling weeds out of the garden, or bending your knees when lifting.
What exercises are safe?
Physiotherapists can help design a specific exercise program that will protect the hamstring by managing the load on the injured tissue while progressively strengthening the muscle. Typically exercises start with isometric holds and then progress to moving through the range of motion with resistance. For example, you might start with a bridge hold using both legs and then progress to repetitions through the range. Progressing exercises can be tricky and people often do too much too soon. For best results, book an appointment with one of our Physiotherapists in order to assess the reason for your butt pain and to develop a rehabilitation program specific to your needs.