Why Does My Buttock Hurt When I Sit or Run? A Physical Therapist Answers

By Nova Physical Therapy | North Hollywood, CA

October 19, 2026

You sit down to work, drive across Los Angeles, or relax after a run. Within minutes, an uncomfortable ache develops deep in the lower part of one buttock—almost directly on the bone you sit on. Standing may ease it, but running uphill, taking a long stride, or bending forward can bring it back.

Some people call this “sitting-bone pain.” Others wonder whether they have sciatica, a pulled hamstring, piriformis syndrome, or a problem with the hip. One possible explanation is proximal hamstring tendinopathy, but buttock pain has several potential causes and should not be diagnosed from its location alone.

At Nova Physical Therapy in North Hollywood, our role is to evaluate movement, muscle performance, activity tolerance, functional limitations, and findings that may require medical referral. This article explains how physical therapy may fit into an individualized plan.

Patient Question

“I get a deep ache at the bottom of my buttock when I sit for a long time, especially in the car. It also hurts when I run uphill or stretch my hamstring. Could it be a hamstring tendon problem, and can physical therapy help?”

The Short Answer

Pain concentrated near the sitting bone, especially during prolonged sitting, running, lunging, or other activities that load the hamstrings, can occur with proximal hamstring tendinopathy (PHT). The proximal hamstring tendons attach near the ischial tuberosity, the bony prominence commonly called the sitting bone. Direct pressure from sitting and certain hip positions may aggravate a sensitive tendon in some people. NHS patient guidance describes this pattern in active and less-active individuals.

However, pain in this region can also be associated with lumbar spine-related symptoms, sciatic nerve irritation, deep gluteal pain presentations, a hamstring strain, ischial bursitis, hip conditions, or other medical problems. A physical therapy examination helps identify relevant impairments and determine whether rehabilitation is appropriate or medical evaluation is needed.

A randomized trial published online November 16, 2025, compared individualized physiotherapy with shockwave therapy in 100 people with proximal hamstring tendinopathy. Neither approach was significantly superior on the primary improvement and function measures through 52 weeks. That is a reason to make treatment decisions based on the whole clinical picture—not a promise that one intervention will work for everyone. Read the randomized trial

Where Is the “Sitting Bone,” and Why Can It Hurt?

The sitting bone is part of the pelvis. Several hamstring muscles originate near this area before traveling down the back of the thigh. Their tendons transmit forces during walking, running, stair climbing, bending, and lifting. Sitting can place pressure directly over the attachment region, while hip-flexed activities can change the combination of tension and compression experienced by the tendon.

If the area is sensitive, the same person may tolerate easy walking but struggle with a hard chair, a long commute, a deep lunge, or fast uphill running. That variation does not mean the tendon is being newly damaged each time it hurts. Pain is influenced by multiple factors, including current loading, sensitivity, recovery, and the individual clinical presentation.

What Is Proximal Hamstring Tendinopathy?

Proximal hamstring tendinopathy is a clinical term used for a painful presentation involving the upper hamstring tendon region near the pelvis. It can develop gradually and is often reported by runners, field-sport athletes, and people who spend substantial time sitting. It can also occur in people who do not participate in organized sports.

Typical complaints may include a deep, localized lower-buttock ache, discomfort with sitting on a firm surface, pain during faster or uphill running, or sensitivity during certain loaded hip-flexion movements. These features are suggestive, not diagnostic. The 2025 clinical commentary on PHT emphasizes individualized assessment and graded exercise rather than a one-size-fits-all protocol. 2025 clinical commentary

Why Does Sitting Make the Pain Worse?

Sitting puts body weight through the pelvis. A hard seat may increase local pressure around the hamstring attachment, while prolonged sitting can keep the hip flexed for an extended period. For some people with a sensitive proximal hamstring region, this combination is uncomfortable.

Temporary strategies may include changing positions periodically, standing for short movement breaks, or trying a pressure-dispersing cushion. These are ways to manage a provocative activity while you work on longer-term function; they are not cures or substitutes for an examination when symptoms persist. If the pain is accompanied by spreading numbness, neurological changes, or other unusual symptoms, further assessment is particularly important.

Why Can Running Uphill, Sprinting, or Taking Long Strides Hurt?

Running requires the hamstrings to help control and produce movement around the hip and knee. Faster speeds, hills, acceleration, and changes in training volume can alter the demands placed on the muscle-tendon complex. For a person with a sensitive proximal hamstring region, those changes may exceed current tolerance.

A rehabilitation plan may temporarily modify hill work, speed sessions, running volume, or stride-related demands while maintaining tolerable activity. The goal is not to label running as harmful. It is to match activity to current capacity and progressively restore the demands needed for work, recreation, or sport. There is no single mileage rule that prevents tendon pain for every runner.

Is It a Hamstring Tendon Problem, Sciatica, or Piriformis Syndrome?

These labels are not interchangeable. A person with localized pain near the sitting bone during loading may have a different presentation from someone with pain traveling from the back or buttock down the leg, altered sensation, or neurological weakness. Likewise, a sudden hamstring injury after sprinting is different from a gradual ache that has developed over months.

Clinicians consider the history, pain location, onset, response to positions and movements, muscle performance, neurological findings when indicated, and the patient's functional limitations. No single home test reliably distinguishes all causes of buttock pain. A physical therapist should refer for medical assessment when the presentation suggests a condition outside the scope of physical therapy or when progress is not occurring as expected.

Should I Stretch My Hamstring If It Hurts Near the Sitting Bone?

Not automatically. Aggressive hamstring stretching places the hip and knee in positions that may increase tendon tension and compression near the pelvis. In some patients with suspected proximal hamstring tendinopathy, repeatedly forcing a deep stretch can aggravate symptoms rather than improve them.

That does not mean hamstring stretching is always wrong or that flexibility is unimportant. It means mobility work should be chosen according to the examination, symptom irritability, functional needs, and response over time. A person whose symptoms increase after prolonged stretching may initially benefit more from appropriately dosed strengthening and changes in aggravating activities than from more intense stretching. Rehabilitation commentary

Does Pain Mean My Hamstring Tendon Is Torn?

No. Pain alone cannot establish a tear, and structural findings on imaging do not always explain how much pain a person feels. Sudden sharp pain during a sprint, a popping sensation, substantial bruising, or a major new loss of strength after an injury is a different situation from gradual sitting-related discomfort. Significant acute injuries deserve timely medical assessment.

Imaging is not automatically necessary for every person with buttock pain. A physician may consider imaging when the history, examination, trauma, persistent symptoms, or other findings suggest it could change management. Physical therapists can help determine when referral for further medical assessment is appropriate.

Can Physical Therapy Help?

When the examination suggests a musculoskeletal presentation appropriate for rehabilitation, physical therapy may help improve hamstring and hip muscle performance, graded loading tolerance, functional movement, and confidence returning to meaningful activities. For a person with suspected PHT, treatment may involve patient education, temporary activity adjustments, progressive resistance exercise, and eventual reintroduction of tasks that require more hip flexion or higher-speed movement.

Depending on the patient, a plan may address hamstring strength and endurance, hip extension performance, lower-extremity strength, movement control, walking or running tolerance, and the demands of sitting, lifting, work, or sport. A home exercise program can support progress between appointments. Hands-on care may sometimes be used as an adjunct for relevant symptoms or mobility restrictions, but passive treatment alone should not be assumed to restore the physical capacity needed for daily life.

For example, a runner hoping to return to hills may eventually need a different progression from an office worker whose primary goal is to sit comfortably during a commute. Both goals matter. Exercise selection and progression should reflect the person's examination and response rather than a fixed list of exercises copied from the internet.

What Does Research Say?

2025 Randomized Trial: Physiotherapy Versus Shockwave Therapy

A randomized controlled trial published online on November 16, 2025, in the American Journal of Sports Medicine enrolled 100 adults with proximal hamstring tendinopathy. Participants received either individualized physiotherapy or shockwave therapy, with standardized advice and education provided to both groups. Outcomes were assessed at 4, 12, 26, and 52 weeks.

There were no statistically significant between-group differences in the primary measures of perceived improvement or hamstring-related function at any follow-up. Some secondary satisfaction outcomes favored shockwave therapy at particular time points, but this did not establish superior functional recovery. The trial supports discussing options without claiming that shockwave therapy is a guaranteed solution or that it consistently outperforms individualized rehabilitation. 2025 trial abstract and details

2025 Clinical Commentary: Education and Progressive Loading

A June 2025 clinical commentary in the International Journal of Sports Physical Therapy outlined a staged, individualized approach including symptom education, hamstring loading, lower-extremity strengthening, gradual exposure to compressive positions, and return to sport when appropriate. This is useful clinical guidance, but a commentary is not the same as a high-certainty trial proving that one specific protocol is best. 2025 clinical commentary

Systematic Review: Evidence for One Best Treatment Remains Limited

A systematic review published in 2021 examined interventions for proximal hamstring tendinopathy and concluded that the evidence was insufficient to recommend one intervention over all others. Its findings should be read alongside newer trials, including the 2025 comparison of individualized physiotherapy and shockwave therapy. This illustrates why research-backed care means updating recommendations when better evidence becomes available. 2021 systematic review

2026 Review: Rehabilitation After Tendon Procedures Is Not Yet Standardized

A June 17, 2026 systematic review of rehabilitation protocols following percutaneous tendon procedures included studies involving proximal hamstring, gluteal, and patellar tendinopathies. The authors found substantial variation in post-procedure restrictions and exercise progressions. Importantly, this review concerns rehabilitation after procedures, not proof that those procedures are necessary or superior for ordinary sitting-related buttock pain. 2026 review

The practical takeaway: education, individualized loading, and functional rehabilitation are reasonable considerations when the examination supports a proximal hamstring presentation. The evidence does not justify promising a fixed recovery time, diagnosing PHT from symptoms alone, or recommending shockwave therapy as the automatic first choice.

What Happens During a Physical Therapy Evaluation?

At Nova Physical Therapy, the evaluation starts with a conversation about the patient's symptoms and goals. A physical therapist may ask when the pain began, whether there was an injury, exactly where it is felt, whether sitting or running changes it, and how the symptoms behave later that day or the following morning.

Depending on the presentation, the examination may include:

• Assessment of hip, knee, and lumbar spine movement when relevant.
• Hamstring and hip muscle-performance testing, within the patient's tolerance.
• Observation of walking, squatting, step tasks, or running-related movement when appropriate.
• Assessment of functional sitting, lifting, and activity tolerance.
• Neurological screening when symptoms suggest possible nerve involvement.
• Review of training changes, work demands, prior injuries, and relevant health history.
• Screening for findings that require medical referral rather than routine rehabilitation.

The plan of care should connect examination findings to measurable functional goals. For one patient, the goal may be to tolerate a longer commute. For another, it may be returning to recreational running, hiking, or a field sport. California's Physical Therapy Board describes physical therapists as licensed professionals who evaluate physical status, establish plans of care, and provide treatment focused on movement and function. PTBC consumer guidance

When Should You Seek Medical Attention?

Seek prompt medical evaluation if buttock or upper-hamstring pain follows significant trauma, a sudden pop, marked bruising, a major loss of strength, or an inability to bear weight. Medical assessment is also appropriate for unexplained worsening pain, fever, significant swelling, persistent pain at rest, or symptoms that do not improve as expected.

Seek emergency care for new loss of bladder or bowel control, numbness in the saddle region, rapidly progressive leg weakness, or other serious neurological symptoms. New severe leg swelling, chest pain, or shortness of breath also requires urgent medical attention. These symptoms should not be managed as routine hamstring tendinopathy.

Physical therapy is not a substitute for medical evaluation when red flags are present. A licensed physical therapist should refer when findings suggest a problem requiring assessment beyond the scope of physical therapy. PTBC

Why Patients Choose Nova Physical Therapy

We Care.

At Nova Physical Therapy, we understand that “buttock pain” can mean different things to different patients. One person may struggle with sitting through a workday. Another may have pain only after hill running. Another may describe numbness that travels down the leg. Those situations should not automatically receive the same exercise plan or treatment.

Our North Hollywood clinic emphasizes individualized physical therapy evaluation, patient education, progressive strengthening when appropriate, reassessment of functional progress, and communication about when additional medical assessment may be needed. We want to understand not only where the pain is, but what it prevents you from doing.

Nova Physical Therapy serves North Hollywood and surrounding communities including Burbank, Toluca Lake, Studio City, Valley Village, and nearby Los Angeles neighborhoods. Learn more about our physical therapy services, including orthopedic and sports rehabilitation.

Frequently Asked Questions

1. Why does my buttock hurt when I sit?

Pressure near the sitting bone can aggravate several musculoskeletal presentations, including proximal hamstring tendinopathy. Spine-related and other causes are also possible, so persistent symptoms deserve an appropriate evaluation.

2. What is proximal hamstring tendinopathy?

It is a painful clinical presentation involving the upper hamstring tendon region near its attachment to the pelvis. It may be associated with prolonged sitting, running, squatting, or other loading activities.

3. Is sitting-bone pain the same as sciatica?

No. Sciatica describes a pattern of nerve-related leg pain, while localized sitting-bone discomfort may involve different structures. The symptoms can overlap, and an examination is important.

4. Can sitting on a hard chair make hamstring tendon pain worse?

It can for some people. Direct pressure and prolonged hip flexion may aggravate a sensitive proximal hamstring region. Changing positions or trying a pressure-dispersing cushion may help manage symptoms.

5. Should I stop running?

Not automatically. Running may need temporary adjustments in distance, speed, hills, or frequency depending on the symptoms and examination. Significant worsening or concerning findings may require stopping and seeking medical assessment.

6. Why does running uphill make the pain worse?

Hills can increase the demand on the hip and hamstring complex. If that demand exceeds current tolerance, symptoms may become more noticeable.

7. Should I stretch my hamstring every day?

Not necessarily. Aggressive stretching can aggravate some proximal hamstring presentations. The appropriate mobility and strengthening plan depends on individual findings.

8. Can physical therapy help with sitting-bone pain?

When the symptoms are associated with an appropriate musculoskeletal presentation, physical therapy may help address muscle performance, movement tolerance, activity management, and functional goals.

9. Is shockwave therapy better than physical therapy for proximal hamstring tendinopathy?

A 2025 randomized trial of 100 participants did not find a significant difference between individualized physiotherapy and shockwave therapy in its primary improvement and function outcomes through 52 weeks. Treatment choice requires individual assessment. Study

10. How long does proximal hamstring tendinopathy take to improve?

Recovery varies according to symptom duration, functional demands, health factors, and response to treatment. No fixed timeline or guaranteed outcome applies to everyone.

11. Do I need an MRI for pain near my sitting bone?

Not automatically. A physician may consider imaging when trauma, persistent symptoms, suspected significant injury, or other examination findings make it appropriate.

12. When should I worry about buttock pain?

Seek medical care for significant trauma, sudden weakness, unexplained systemic symptoms, or progressive neurological changes. New bowel or bladder dysfunction or saddle numbness requires emergency assessment.

Schedule an Evaluation

If discomfort near your sitting bone is interfering with sitting, driving, walking, exercise, running, or daily activities, Nova Physical Therapy can assess relevant movement and functional limitations and discuss whether physical therapy is appropriate. Our goal is to help patients understand their options and work toward meaningful, measurable improvements without promising a particular diagnosis or outcome.

Request a Physical Therapy Evaluation or explore our contact page. Nova Physical Therapy is located at 4795 Vineland Ave, Suite E, North Hollywood, CA 91602. Phone: (818) 639-3402.

Disclaimer

This article provides general educational information and is not a diagnosis, individualized treatment plan, or substitute for an examination by an appropriate licensed health care professional. Symptoms can have multiple causes. Physical therapy evaluation and treatment in California must remain within the Physical Therapy Practice Act and applicable referral requirements. Research findings describe studied populations and do not guarantee individual results. If you have concerning or rapidly worsening symptoms, seek medical attention.

References

1. Rich A, Ford J, Cook J, Hahne A. Physiotherapy Compared With Shockwave Therapy for the Treatment of Proximal Hamstring Tendinopathy: A Randomized Controlled Trial. American Journal of Sports Medicine. Published online November 16, 2025;53(14):3396–3407. DOI: 10.1177/03635465251391134. PubMed.
2. Rich A, Cook J, Hahne A, Ford J. Treatment of Proximal Hamstring Tendinopathy with Individualized Physiotherapy: A Clinical Commentary. International Journal of Sports Physical Therapy. June 1, 2025;20(6):892–910. DOI: 10.26603/001c.138308. Full article.
3. Proximal Hamstring Tendinopathy: A Systematic Review of Interventions. International Journal of Sports Physical Therapy. 2021. Review.
4. Buttinger JN, et al. A Systematic Review of Post-Procedural Rehabilitation Protocols following Percutaneous Needle Tenotomy and Ultrasonic Debridement for Gluteal, Proximal Hamstring, and Patellar Tendinopathy. Published June 17, 2026. DOI: 10.1097/PHM.0000000000003031. PubMed.
5. Calderdale and Huddersfield NHS Foundation Trust. Proximal Hamstring Tendinopathy: Patient Information. NHS guidance.
6. Physical Therapy Board of California. Consumer FAQ and Physical Therapy Practice Information. PTBC guidance.
7. American Physical Therapy Association. Clinical Practice Guidelines Library (general evidence-based practice resource; not a condition-specific PHT guideline). APTA.