Tips for sitting with high hamstring tendinopathy

Sitting, something we rarely think about, becomes difficult with high hamstring tendinopathy. The pain can feel relentless, but it’s important to know that this usually isn’t a sign of serious injury. Learn how to balance sitting – not too much, not too little – to reduce pain and support your recovery. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.

This article contains affiliate links. We might earn a small commission on sales at no extra cost to you.

In this article:

1. Pain does not indicate how bad your injury is

2. Finding the Goldilocks zone for sitting

3. Tips to make sitting less painful

4. How we can help

We’ve also made a video about this:

👉 Read more about other aspects of high hamstring tendinopathy here.

Recovering from a high hamstring tendinopathy has the added challenge that sitting is often painful, and the more you sit, the more painful it gets. Which means that many aspects of your life become complicated: working (if you’re doing a desk job), commuting and travelling, socialising, and just relaxing at home.

Pain does not indicate how bad your injury is

When you have a high hamstring tendinopathy, the pain can vary from just being a niggly pain – uncomfortable when you've sat for an hour or so – to an excruciating pain that means you can't sit for more than five to ten minutes before you have to get up.

We used to think that the worse your pain is, the worse your injury is. But research, using MRI scans, has now shown that there’s not always a correlation between the amount of pain and how bad the tissue damage is.

Some people can have a very bad injury and little pain, whereas others might have severe pain while the scan shows that the injury is not very serious or has indeed healed completely.

💡 This is important for how to approach high hamstring tendinopathy and sitting. I've previously explained in detail why pain levels can vary so much and often doesn't match the injury state.

Finding the Goldilocks zone for sitting

First, you should know that painful sitting is not going to make your tendon injury worse as such. However, if you aggravate the pain, the pain becomes a bigger problem than the injury itself, because this is now what is ruling and ruining your life.

⚖️ Sitting too much is just as detrimental as avoiding it at all cost.

Sitting too much 👎

If you try to ignore it and “sit through the pain”, your body’s alarm system will go into overdrive and create even more pain, which means your pain threshold becomes lower and you can sit for shorter and shorter periods of time with increasing pain.

It’s like constantly prodding a bruise – you’re not going to make the  injury worse, but the sensitivity will increase if you keep on doing it. Learn how this works here.

Sitting too little is just as unhelpful as sitting too much

Sitting too little 👎

However, our alarm systems (which live in our subconscious minds) also respond to emotions like stress and fear and the stories we tell ourselves. So, if you’re fearful of sitting and start avoiding it while telling yourself it’s bad for you, your alarm system will also get dialled up, and even the slightest amount of sitting can trigger the pain.

On a physical level, your injured tendon needs to get used to getting sat on again … but gradually.

Also, standing for most of the day when you’re not used to it might affect other areas of your body negatively – back pain and foot injuries like plantar fasciitis might rear their heads.

So, what to do?

Sitting should be a part of your rehab 👍

The ultimate aim is to restore your sitting tolerance.

With this in mind, we advise our patients to sit when they can sit, for as long as is comfortable. So, they don't force themselves to sit for longer and sit through pain, but they also don't avoid it fully.

We also encourage them to test different surfaces and habits (see tips below) to find the ideal mix that allows them to sit for as long as possible in a day. And then we get them to slowly build it from there, just like with the rest of their rehab.

This is a dynamic situation. If you get the Goldilocks zone right, you will find that you are able to sit for longer periods. This is because your tendon would have been getting better thanks to the rehab programme you’re following and because your pain system is getting back to normal and not constantly being irritated  because you’re sitting for too long.

💡 It's normal to find that, depending on what else you do in your day, your tolerance to sitting varies, e.g. you might find that your tendons want you to take more regular breaks after you've done a harder workout. The best approach is to listen to your body and adapt it accordingly.

Tips to make sitting less painful

🪑 Surfaces

Soft but firm is the way to go. A memory foam or gel cushion can be useful if your current sitting surfaces are too hard.

It works for some people to move the cushion slightly forward so that it supports their thighs but there’s no direct pressure on their sit-bones.

These cushions are designed to reduce the pressure when you sit:

🧘 Positions

The general guideline is that your hips should be higher than your knees. Sitting with your hips lower than your knees stretches the injured tendon over your sit bone, which might increase your pain.

For example, avoid sitting in soft, deep, easy chairs or couches. When you drive or sit in a car, see whether you can lift your hips somewhat by using a memory foam cushion.

Another position that will stretch your tendon over your sit bone is sitting upright in bed or with your feet on a footstool or Ottoman with your legs straight out in front of you.

Going out with friends? Perching on a high stool can often be most comfortable – you can also try just having one buttock on it at a time.

Sitting with your hips lower than your knees increases the angle at your hips, which causes a mild stretch on the upper hamstring tendons.

🕜 Take regular breaks from sitting

If you have to sit a lot during the day (e.g. you’re chained to your desk) it’s a good idea to get up every so often even before the pain kicks in. 

By getting up before the pain system is significantly triggered, you can often avoid it getting super painful. This can  increase your “total sitting time” for the day.

Try doing some light exercise during your breaks (maybe your rehab exercises or even just a short walk) – this will increase the circulation to your injured tendon and can help to “reset” your alarm system.

How much pain before you get up? This is not an exact science, but you want to get up before it feels like a significant increase above your normal non-sitting pain levels.

👉 The ultimate aim is that, by the end of the day, your tendon is only a bit more uncomfortable than normal and this “extra” discomfort should ideally settle back down to your normal levels by the next morning.

Here’s our article with more detail on how to take regular breaks from sitting.

✍️ Keep a sitting diary

Keeping a “sitting diary” can be useful to establish the right amount of sitting and make you aware of what you can actually do.

I've often have patients say "I can't sit", only to come back in the next follow-up appointment and report, that actually, they can sit for x amount of time. They weren't trying to exaggerate before — they've just been experiencing pain so often that their subconscious had created a (not very accurate) story that they started to believe about sitting.

A sitting diary forces you to pay attention to the actual reality and helps to restore perspective.

The diary is not just for logging how long you’re sitting, you can also add what surfaces you’re sitting on and in what positions before you have to get up due to increased pain.

It’s also a great tool to help you see progress over time. High hamstring pain can take a very long time to recover and you will have days when it feels like you’ve not made any progress. When this happens, it can be useful to look at your diary and see how far you’ve come.

How we can help

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.

References

1. Butler, D. and Mosely, L. (2013) “Explain Pain” Noigroup Publications: Adelaide, Australia.

2. Hanlon, S.L. et al. (2021) “Beyond the Diagnosis: Using Patient Characteristics and Domains of Tendon Health to Identify Latent Subgroups of Achilles Tendinopathy” J Orthop Sports Phys Ther 51(9): 440-448.