What is high hamstring tendonitis?

The hamstrings are the three muscles on the back of your thigh. At the top, they join into one thick tendon that anchors to the ischial tuberosity, the bony knob you sit on. When that anchor gets overloaded, the tendon frays and thickens. Doctors call it proximal or high hamstring tendinopathy. Patients usually say tendonitis, and so will we.

It shows up in runners who add hills or speed work, in people who go back to sport after years off, and in desk workers whose tendon is pressed against bone for eight hours a day. It also follows a fall onto the buttock or a slip with the leg sliding forward.

Is it hamstring tendonitis or sciatica?

The sciatic nerve runs right next to this tendon. That is why the two get mixed up, and why the wrong one gets treated.

• Tendon pain is local. It sits at the sit bone and maybe a hand’s width down the thigh. Nerve pain shoots past the knee into the calf or foot.
• Tendon pain hates firm chairs. Sitting on the sore side presses the tendon into bone. Many people shift onto one cheek or sit on a folded towel.
• Tendon pain shows up under a loaded stretch. Reach for your toes with straight legs, or lift your hips in a single-leg bridge with the knee nearly straight.
• Nerve pain brings numbness or tingling. Tendon pain does not.

Sometimes both are true. A thick, scarred tendon can irritate the nerve beside it, and back problems can also send pain into the buttock. We test the back, the sacroiliac joint and the tendon in one visit. More on sciatica and what mimics it and on back pain that is worse sitting.

Why won’t hamstring tendonitis heal on its own?

Tendons have a poor blood supply, so they heal slowly. This one gets pressed every time you sit, which keeps irritating it. Most people try rest first. Rest lowers the pain but also weakens the tendon, so the first long drive or run brings it right back.

Stretching makes it worse. A hamstring stretch pulls the tendon tight across the bone, which is exactly the load it cannot handle. Many people stretch harder because the hamstring feels tight. That tightness is the tendon guarding itself.

Body chemistry plays a role too. High blood sugar and insulin resistance make collagen stiff and brittle. Some antibiotics, called fluoroquinolones, and repeated cortisone shots weaken tendons as well. We ask about all of it.

How is hamstring tendonitis treated?

The base is loading, not resting. A good program starts with holds that put weight through the tendon without pressing it into bone, then builds to slow, heavy work over weeks. Sitting gets adjusted with a cushion and a break every 30 minutes.

When three months of that has stalled, we look at the tendon with ultrasound. If it is thick and frayed but still attached, we consider an injection. We avoid cortisone in this tendon. It can ease pain for a while, but it weakens tendon tissue, and this tendon is already weak. A full tear pulled off the bone is a different problem and gets a surgical opinion.

How does PRP for hamstring tendonitis work?

We draw your blood and spin it to collect the platelets. Platelets release growth signals that call in repair cells and tell them to make new collagen. Under ultrasound we place the concentrate into the damaged part of the tendon. Sometimes we also break up scarred tissue with the needle so the repair signal reaches it.

Results depend on dose and placement. A weak preparation injected near the tendon is a different treatment from a measured, high-platelet dose placed into the damaged fibers. That gap explains much of why some people say PRP did not work for them. The video above walks through it.

When the tendon is badly worn, we also discuss bone marrow concentrate. Your evaluation decides which one fits.

What does the research say about PRP for hamstring tendonitis?

A 2026 review of randomized trials looked at PRP for problems around the outer hip and buttock. Across the hamstring trials, PRP led to a faster return to sport than control treatments.

Broader guidance points the same way. A 2024 multispecialty pain guideline found that injected biologics can give better pain relief and function than usual care in well-chosen tendon problems. A 2025 European guideline on orthobiologics stresses that PRP preparation differs from clinic to clinic. That is why we control the preparation.

What is recovery like after a hamstring PRP injection?

You stay awake for the injection. We use local anesthetic with no sedation, so most people drive home. Expect soreness for about 48 hours. Sitting may be uncomfortable for a few days, so bring a cushion for the ride.

Skip anti-inflammatory pills like ibuprofen for a while, since they can blunt the platelet signal. Walking is fine. Gentle holds start in the first week, and heavier work builds over six to twelve weeks. Running returns once a single-leg bridge and a brisk walk feel easy. Whether you need a second injection depends on how the tendon responds.

Injections are performed at our regenerative clinic at 4477 Woodson Rd in St. Louis, and the front desk will route you when you check in. PRP is not covered by insurance. HSA and FSA funds can generally be used.

Frequently asked questions

What does high hamstring tendonitis feel like?

A deep ache at the sit bone that is worse on hard chairs, while driving, running uphill or bending forward with straight legs. Some people feel a pull a few inches down the back of the thigh.

Can hamstring tendonitis be mistaken for a back problem?

Often. The pain sits in the lower buttock, right where back and sacroiliac pain show up. A careful exam of all three in one visit sorts it out. See piriformis syndrome for another buttock pain that gets mislabeled.

Should I stretch my hamstring if it hurts at the sit bone?

No. Stretching pulls the tendon across the bone and usually makes it worse. Strength work under steady load is what helps.

How long does hamstring tendonitis take to heal?

With the right loading program, many people improve over three to six months. Tendons that have hurt for a year or more often need more than exercise alone.

Is PRP better than cortisone for hamstring tendonitis?

We do not inject cortisone into this tendon because it can weaken it. PRP supports repair rather than just turning down the pain.

Can I keep running with hamstring tendonitis?

Often yes, at a lower level. Flat, easy running is usually tolerated. Hills, sprints and long strides are the first things to cut.

Related reading

• Back pain that is worse sitting
• Sciatica, and what mimics it
• Piriformis syndrome
• Hip bursitis
• Tailbone pain
• Orthobiologics for back, spine and hip pain: PRP, bone marrow and fat

Tell us which chair hurts and how long you can sit before you shift. That answer narrows it fast.