The spot at the top of the hamstring where the buttock ends can be the site of much pain or tightness. It’s often difficult to tie down what the problem is and thus it is also challenging to know how to treat it. There are, however, several common causes:
1. Tear or strain of the hamstring
2. Tendinopathy of the hamstring
3. Gluteal strain (not common)
4. Nerve irritation
5. Sacroiliac joint dysfunction
A strain of the muscle usually has a sudden onset, for example during a run, but not always.
Tendinopathy of the hamstring is more difficult to assess yourself. There is rarely pain on stress tests, but there is a tender spot just down from the bone that you sit on. The tendon feels thicker and stringier than the other side.
The history is of a gradual onset of pain and is often associated with pelvic dysfunctions as described later. The presentation is of more of a dull ache and stiffness in the hamstring when running which warms up a
bit, but generally is just there! All the above can be associated with sciatic nerve irritation but also tendon issues.
So treatment involves sorting out the sciatic nerve, the pelvis, the low back and the hamstring tendon. Lots of loading of the tendon, gradually increasing and involving weights and other gym equipment is the answer. It has to be carefully assessed and a program put in place. The local treatment involves much manual therapy and shockwave as well as spinal mobilisation and sacro-iliac work.