MIHP Think Tank Brainstorms… Movement Training Specialists

High Hamstring

I first want to congratulate all of our patients, clients and friends who reached their goal in the numerous marathons last weekend.  Whether it was the full, 1/2, or a relay leg.  You set a goal and you reached it! We are proud!

Now that the muscle soreness is wearing off, I have been receiving numerous emails regarding this "pain in the butt". It is described as a "dull ache" in the low butt, or high hamstring region.  It is often felt through out the day but feels worse with running, jumping or bending forward.  

This pain is a tendonitis of the hamstring (the proximal insertion).  It is felt at the insertion on the ischial tuberosity (the sitt bones). The hamstring muscle is prone to injury because it crosses two large joints, the hip and knee.  When running, this muscle is required to decelerate hip flexion and knee extension simultaneously during stride.  It is also required to do this task at a very rapid speed,  yet I still watch runners prior to a race stretching their hamstring in a slow passive fashion. Remember... we need to train the body the way we are going to use it.  So how does this injury occur?

Possible Causes:

•  A functional leg length discrepancy, causing a rotation of the pelvis.
• Lack of dorsiflexion or hip extension on the non-injured side.
•  Reduced rotation at the hip or thoracic spine on the injured side.
• Frontal plane tightness (IT band or quadratus lumborum) on the injured side. 
• A tight subtalar joint on the injured side.
• Over pronation of the uninjured side.

The Fix: 

This is not a pain that I recommend running through.  Reducing inflammation at the tendon is the immediate goal but chasing down the cause of this problem will assist in both the healing and prevention of it happening again.  If you are going to run, shortening your stride  and avoiding any speed training during this recovery process is recommended.  Focus on the push off phase the back leg, and keep your runs short or add walk breaks into you run until the pain is gone. During this healing process consider the following: 

• Increase hip extension and dorsiflexion on the uninjured side to assist in push off phase.  
• Do not stretch the hamstring (you are pulling on an already inflamed tendon insertion)
• Improve mobility of the hip joint in the rotational plane and frontal plane.  Avoid exercises or stretches in the sagital plane (straight forward/backward motion). Check the MIHP website for a daily dozen that will assist you in choosing these exercises.
• Roll the IT band on the injured side.
• Increase subtalar joint mobility on the injured side.

By chasing down the true cause of your injury and not just treating a tight hamstring, you will prevent future injury and find yourself back to running pain-free in no time.  

-Tracy Ryckaert