Understanding Proximal Hamstring Tendinopathy with Running


Do you get pain in your butt right under your glute that gets worse when you sit during work especially after a run?


Do you just dread hills, that achiness feeling after a long run, long car ride or sitting on hard surfaces?


Like so many of you, I thought that I should just stretch my hamstring and stop running and that would solve the problem.  Unfortunately, that is probably the worst thing you can do to overcome this stubborn pain in the butt!  Get my full story here


In this blog, we are talking about why runners get proximal hamstring tendinopathy (PHT)  


I provide clarity on the following questions:


– What is proximal hamstring tendinopathy

– Why do runners get high hamstring pain

– What does proximal hamstring tendinopathy feel like


I also reveal my top 4 (NEW and improved) tips for overcoming PHT as a runner


Whether you have recently been diagnosed, self diagnosed, or have been battling hamstring pain for years, this episode is for you!


Listen to the Podcast Episode during your next run!



Watch the LIVE video version of this episode below on YouTube!



Listen to my previous episodes on hamstring tendinopathy in runners


Listen to my previous episode with Mary on how she went from frustrated runner with PHT to NYC marathon finisher 

Learn how to do the Single Best Exercise for Glute Activation



[Download] FREE Return to Run Program after Injury


There are six parts of your running journey that need to be optimized so you can run strong and last long! Learn them here


Want Dr. Duane to answer your question on the podcast?  Submit questions here



Want Dr. Scotti’s guidance in finally overcoming your PHT pain with structured strength, recovery, nutrition, and run plan with full support and accountability to reach your highest potential as a runner? Book a call and learn more about Healthy Runner coaching here 


This Episode Sponsored By:

A big thanks to the Amino Company for your support for this episode!


If you have heard from any of the runners who I help with stubborn PHT, I always recommend they supplement our training with HEAL from the Amino Company.


Heal is an amino acid, whey and creatine based formulation designed to reduce recovery times and improve physical function after injuries by accelerating muscle repair while helping maintain a healthy inflammatory response.


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What Is Hamstring Tendonitis?


The hamstrings are a group of muscles on the back of the leg. The hamstrings include the biceps femoris, semimembranosus, and semitendinosus. These muscles work together to bend the knee and extend the hip. The hamstrings are powerful muscles and can become very tight and cause pain when being used consistently. The hamstrings originate at the ischial tuberosity, which is a bony landmark on the back of the pelvic bone. In a more general explanation, the hamstrings start high up on the thigh, or in the middle of our butt cheek. They run along the back of our thigh and insert on the tibia and fibula.


The 3 muscles that make up the hamstrings


Hamstring tendonitis occurs due to overuse and/or inflammation of the hamstring tendon. The inflammation can cause damage to the tissue in the form of microtears, which is what causes the pain. There is also the possibility that the hamstring will pull on the origin site at the bone, therefore causing pain in the upper thigh.


How Do I know If I have Hamstring Tendonitis?

The symptoms associated with hamstring tendonitis can either be proximal, near the upper thigh, or distal with pain closer to the knee.


Hamstring Muscle Attachment Site at Butt Bone


The most common symptom is pain or burning higher up in the butt or down lower at the knee. There can also be swelling in the back part of the knee as well. Generally, with hamstring tendonitis, the pain will get worse with repetitive exercise and with putting pressure on it (sitting during your work day after you go for a run). Perhaps the pain will go away when you’re resting, but in the middle of your long run you start to feel the pain. The pain can either be sharp, achy, or a burning sensation.


What Causes Hamstring Tendonitis?


OVERUSE, OVERUSE, OVERUSE. Hamstring Tendonitis is an overuse injury! This happens due to the hamstring experiences continuous load and tension on it through activity. When you’re running (especially the long runs), every time you push off and land your hamstring is absorbing some of the force. Running requires repetitive bending of the knee and extension of the hip, meaning the hamstrings are also constantly being forced to contract and relax to move those joints.


The pain that patients with this pathology experience comes from the strain on the muscle that begins to put tension on the hamstring tendon. Depending on the location, there will either be strain on the proximal tendon in our sit bones or pain in the distal tendon at the knee. The tension put on these tendons from overuse is what causes the pain.


The important point to note is that it is tendon that gets irritated.  Usually these problems are due to overloading of the tendon.  The tendon hasn’t been stressed correctly during your training and it doesn’t have the resilience to tolerate the running you’re doing.  This usually occurs at that proximal hamstring tendon site and we refer to it as a proximal hamstring tendinopathy (PHT) or tendinosis.  This is not your common tendonitis where it’s an inflamed tendon but more of a degenerative condition that if left untreated with continued symptoms for years of running will eventually lead to a hamstring tendon tear.  Before you go and seek out an orthopedic surgeon to either get an injection or surgery, please read these actionable tips that is a compilation on how we treat tendons differently than we did 20 years ago!


How Do I Get Rid Of Hamstring Tendonitis?


Treatment of this injury is going to depend on the severity of the injury and how long you have had this pain.

Most of the runners I see with this condition have already tried hamstring stretching and it does not help.  The reason is because it is not that your hamstring muscle length is restricted or you have tight hamstrings, the root cause of the problem is usually a weakness issue and a lack of ability for your hamstring tendon to withstand load and the demands of running.

Below, I will outline the general treatment plan that has helped hundreds of runners get back running doing what they love without that stubborn pain in the butt.  Keep in mind this is a generalized plan that will help 75% of you reading this if you do in fact have hamstring tendinopathy.  However, there is no substitute for a personalized evaluation to get properly diagnosed and working 1-on-1 with a medical professional who has a ton of experience treating runners with this condition to help guide you on timing and specific prescription of when to implement these treatments.  Overall, if I had to share 1 golden nugget tip that will give you the most bang for your buck in overcoming this condition it is to start loading the tendon with strengthening to make sure your hamstrings are strong! This will be pivotal in preventing hamstring tendonitis and helping you get back to running as healthy as you can!


4 (NEW AND IMPROVED) PHT Treatment Tips:


  1. Don’t use sitting to determine when you should run!


Pain with sitting as a guide on whether or not you should run or not run is not reliable or predictive in my experience and is one of the worst things you can do.  Inconsistency with running by starting and stopping every time you have pain with sitting will not help you get back to running.  

  1. Passive treatments won’t work!


Passive treatments whether injections or modalities are not going to be the fix for this treatment or this problem. Exercise with specific loading to the tendon is the key AND correcting muscle imbalances with the glutes!  I just posted a brand-new instructional video of the best activation exercise for the glutes…The Fire Hydrant Exercise with a mini band.  This has been a go to activation exercise for all my clients with PHT.



  1. Hills and Speed will be Last!


Both increase hip flexion and compression of tendon so you will want to add these in after you have established a nice consistent base level of running for 2-4 months.  



  1. Be patient…


The sitting pain will take longer, it could take up to a year, but you’ll be able to improve function and be able to run again so you can get those mental clearing miles in. Don’t be afraid if the pain with sitting is not going away initially.

In this blog, you learned What is High Hamstring Tendonitis (PHT) and What you need to do about it to fix it for good so you can run again


The HOW you get rid of it is done with proper structure, guidance, and support within our Healthy Runner Coaching Program!


If you have been struggling to overcome your Hamstring Pain and want the clarity and focus on how to overcome your stubborn PHT?

That is exactly what we do within our Spark Healthy Runner Coaching Program! We teach you how to grow as a runner to not only get you running consistent but also crush whatever running goal you have whether it is toyou’re your first 5k, half marathon, or marathon! Myself as your running PT and coach as well as our Healthy Runner coaching team act as your guide in mastering the six key steps of your running journey Mindset, Strength Training, Structured Run Plan, Nutrition, Recovery, Race Strategy


Learn how these runners got over PHT for good with Dr. Duane’s guidance!


Learn how Mary went from being depressed after she made the difficult decision to cancel running the Detroit Free Press marathon a day before the race because her pain was so bad that she could barely walk to finding the exact steps to safely get back to running and crushing her marathon debut in New York!


Learn how Lisa got her 18th Boston qualifying time after not running a marathon for 2 years due to injuries. She got guidance on the runner specific exercises her body needed to overcome her hamstring pain.


She was able to get to the start line healthy for the first time in 2 years and qualify for another Boston marathon.  




Steph, a client in our Healthy Runner Coaching Program shares her story of going from 6 years of frustration trying everything from physical therapy, manual therapy, prolotherapy, and all the self remedies she could research to now being able to run 10 mile long runs without hamstring pain following our 16 week program.



Courtney went from being a frustrated marathon runner due to struggling with proximal hamstring tendinopathy (PHT) for 2 years to feeling stronger and back to training for a marathon again!



Ken went from not being able to run to crushing his goal marathon race and getting a Boston marathon qualifying time.  You can too with the right strategies and physical therapist who is a run coach on your team!




In the latest UPDATED resource, I share with you the specific strategies to get back to running without proximal hamstring tendinopathy and keep it from coming back.  


These have been the tried, true, and tested strategies that have kept all of the runners I work with on a 1:1 basis running during their recovery and then finally saying goodbye to PHT pain for good!


Download your Proximal Hamstring Tendinopathy free ebook here!



Ready to get back on the road after proximal hamstring tendinopathy?


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Want to help a friend, client, or patient of yours get back into running the right way without setbacks?


Trying to get back into running after an injury is intimidating and scary…


The will provide you with the structure of exactly how much, how often, and the proper run/ walk progressions to allow your body to safely adapt to the demands of running without any setbacks!  


BONUS printed out calendar telling you exactly what to do each day of the week for the first 6 weeks!




✅ If you are currently injured and don’t have any red flags to not run (fracture, bone stress injury, nerve pain, pain levels greater than 5/10 with running) 


✅ After you rehab from an injury and have been discharged and released to “start running again”


✅ Following surgery (Meniscus, Hip arthroscopy, THR)


‍ After giving birth  


✅ After a long time off of running ( > 2 months )


✅ If you are out of shape and you want to start running again


✅ Have been walking consistently and want to try running


All you need to do is [] YOUR return to run plan to get back to doing what you love safely and effectively!


✅ Then, take action and implement the easy to follow plan I outlined for you 


Download here



Connect with Dr. Duane:

Dr. Duane Scotti, DPT, PhD, OCS is a running physical therapist, run coach, host of the Healthy Runner podcast, and founder of Spark Healthy Runner and has been a leader in the rehab and running community for 20+ years.


Duane initially started running as an adult, wanting to add some cardio to his gym sessions. After having a hip surgery, his doctor advised him to get off the treadmill and run outside. Without having fully recovered, Duane suffered a running-related hamstring tendon injury and many others as a novice runner.


As a coach, he has guided thousands of athletes back to running, finishing their first marathon, crushing a personal best, and even the elusive Boston Marathon qualifying time.


He is truly living his passion educating the running community that they don’t need to stop running to get over a running injury.  Through his signature 1:1 coaching program, weekly videos, and podcast episodes, he empowers runners to get stronger, run faster, and enjoy lifelong injury free running.  Dr. Duane truly believes that anyone can run and that all runners should be treated differently when recovering from an injury.  He is on a mission to change the traditional thinking that running causes “overuse injuries” or “your body is just not meant to run” and you must “take a break” to get better.  Through strength and run specific training you can grow a strong mind, strong body, and just keep running!


Duane received his Bachelor of Health Science degree and Master of Physical Therapy degree from Quinnipiac University in 2001 and 2003. He then went on to receive a clinical Doctor of Physical Therapy and a Ph.D. in Physical Therapy from Nova Southeastern University in 2017. Duane is a board-certified Orthopaedic Clinical Specialist, RRCA Certified Running Coach, Certified Mulligan Practitioner, certified in dry needling and has advanced training in spinal manipulation and rehabilitation for runners.


As an athlete, Duane is an adult-onset runner, avid half marathoner, 4x marathoner, and enjoys challenging himself to learn and grow in his personal running journey!


A native New Yorker from Long Island, Duane currently lives in Cheshire, Connecticut with his wife Deb and his two teenage daughters who are competitive volleyball players.  They all love to explore new beaches along the east coast.




Get weekly running tips on the Healthy Runner Podcast…available wherever you get your podcasts!


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“I don’t have enough words to express my gratitude towards Duane Scotti and the Spark Healthy Runner program. When I started working with Duane, I had been dealing with chronic shin splints/posterior tibialis tendinitis for almost a year.

I had worked with multiple other coaches and physical therapists with little success and was at the point of almost giving up on my love for running. Duane is so kind, thoughtful and knowledgeable as both a physical therapist and running coach. Our first virtual meeting lasted two hours because he was so meticulous in his assessment. His strength and running program is progressive and created so that you can continue to build strength and mileage as you heal. His strength program is unique, effective, and fun.

Additionally, his warm-up routine is awesome and includes drills that over time have made me a more efficient runner. His training platform is easy to use, and he is always readily available to chat when problems or questions arise.

Over four months of working with Duane, I have built back to five days a week of running and am almost back up to my pre-injury weekly mileage and long run distance. Whenever I have flare ups or setbacks, Duane reassures me and makes necessary adjustments so that I can continue to progress in my running journey. I have had so much success with him so far that I have signed on for four more months so that he can help me to continue getting stronger as I train for the Dopey challenge in Disney World.

If you are struggling with a running injury and are feeling hopeless, you have to reach out to Duane Scotti. Of course, you will have to put in a lot of hard work, but with Duane by your side, you will be able to achieve your goals and more. Thank you Spark Healthy Runner for bringing the spark back to my running!”

Dipti Pandya

You can teach an old dog new tricks!!!  I have never considered myself a runner and I knew I needed to be smart about it because I am no spring chicken. Spark preached getting strong and healthy to be injury free and they practice what they preach.  I am soooo glad I made the investment in me!  I finished my half marathon last weekend and couldn’t be any happier!  The program fed me all the steps I needed to essentially learn how to run long distance, build strength, nutrition help, a forum of other runners and probably most important was the 1:1 coaching.  I had no idea how to tackle training for a 1/2 marathon and this program broke all of it down, had it individualized for me and we tweaked as we went to make sure I was staying healthy and strong.  I had so many questions the week prior to my race and Coach Cat was always there for me and answering all the questions and issues I had-and believe me there were a lot!  The biggest benefit I think I got was the strength. I am strong and fit. But most important was what I gained emotionally.  I built confidence and strength I didn’t know I had, even at my age.  Honestly could not have done this without Spark Healthy Runners!

Gina J.

My Healthy Runner journey started after I had battled bilateral achilles pain for a few months and was frustrated how it affected my running. As soon as I talked to Duane I knew I had made the right decision. His positivity, enthusiasm and genuine care are infectious. The training plan that was tailored to me included specific exercises to rehab my injury and I was so excited that I didn’t have to stop running. It took patience to only run slow for a few weeks but I trusted the process and it got me me to where I am now: running pain free. We made adjustments to the plan throughout whenever needed having someone in your corner that is always there with guidance and support throughout the process was invaluable.

I just ran my second half marathon, both with Duane’s coaching, and PR’d by over 9 minutes! I got all choked up in the last mile when I realized that I felt strong and could still kick it up a notch.

I’m so thankful for the Healthy Runner program, community and the entire coaching team for all the support!

Katja L.

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