The hamstrings are three muscles that originate at the ischial tuberosity (your sit bones) and run along the back of the leg until they connect on each side with bone just below the knee. When you run, your hamstrings work to extend your hips and flex your knees.
Hamstring strains are common in runners. Chronic hamstring tightness can easily arise in people who spend a lot of time sitting, as is common for people with desk jobs and commutes.
- Long and weak or short and tight hamstrings all pose injury risks. Also, muscle imbalances with over-powering quadriceps can create problems.
- The hamstring is a ‘two-joint muscles’ which works hardest driving up hills, and during power/sprint
- Strain or Tear
- An acute injury that usually occurs during dynamic running activities: sprinting, jumping, fast stop/starts, striding with a straight leg
- Tendinopathy
- Overuse/overloading of the muscle-tendon attachment at the origin of the Hamstring on the ischial tuberosity (your sit bone) deep in your buttocks.
Symptoms of a Hamstring Injury:
- Sudden onset of pain whilst running
- Sharp, stabbing, possibly even a snap or pop sound
- Bruising on back of the thigh
- Swelling
- Can have associated back and buttock pain
- In Grade 2 or 3 injuries may have difficulty walking
Some tips:
Acute phase:
- R.I.C.E. – rest, ice, compression, elevation
- Physical therapy to promote tissue healing reduce scar tissue
- Massage and manual therapy to release tight surrounding structures Exercise therapy – slow and progressive over stages depending on the severity of the initial tear
Rehab:
- Strengthen pelvis and core including the gluts (buttock) muscles as they work together with the hamstrings.
- Manage any muscle imbalances in weakness or flexibility through exercise correction
- Neural mobilisation stretches
- Progression to full leg strengthening exercises, squats, dead-lifts etc and finally ECCENTRIC strengthening of the hamstring.
Hamstring Tendinopathy
- History of increased load, more hill running, increased speed work, unaccustomed deep lunges, yoga and dead-lifts.
- Tendon is poorly perfused (blood flow) which makes healing and recovery slow.
Symptoms:
- Buttock pain, point specific pain on or just below the ischial tuberosity (sit bone)
- Chronic stiffness
- Aggravated by periods of sitting and driving, deep lunges, hamstring stretches and running at high speeds and uphill
- Stiffness or soreness first thin in the morning followed by a ‘warming up period’ where the pain disappears
- Following exercise, pain may be delayed by 24-48 hours.
Hamstring Tendinopathy Management
Early stages:
- Icing regularly through the day
- Stop stretching
- Sit as little as possible, use soft roll under your buttock to relieve pressure on tendon
- Physiotherapy to mobilise tight structures and promote tissue healing using massage, acupuncture and other modalities
- Isometric exercises 2-3 x week especially if still painful
Rehab:
- Load modification.
- Manage muscle imbalances in weakness and flexibility through exercises.
- Strengthen the core, pelvis and glute (buttock) muscles
- Neural mobilisation stretches
- ECCENTRIC strengthening in latter stages of rehab
Hamstring Injury Training
- Complete rest depending on severity of injury OR reduce intensity and training volume
- Avoid speed and hill work
- Find a comfortable pace and distance that elicits no pain and stick to that 3 x week with a day rest in between
- Train on softer surfaces like grass and dirt roads
- Cross Train with cycling, water running, swimming, elliptical trainer
- Address underlying contributing factors like biomechanics (do you need orthotics for your arches?), leg length discrepancy.
Prevention:
- Strengthening hamstrings, back, glutes and core
- Good flexibility and neural mobility
- Regular massage to maintain healthy tissue and pick up any tight niggles early
- Compression tights during or after running to aid blood flow and recovery
- Treat underlying back problem by a physical therapist
- ECCENTRIC strengthening 2-3 x week
- Warm-up before a run
- Graduate training load and intensity
- Physiotherapy: A proper general assessment, followed bio-mechanical assessments, gait and running analysis strengthening and stretching exercises will help to solve the hamstring problem. In addition, specific exercise plan, strapping, massage, deep frictions, electrotherapy can help to reduce the pain.
- Untreated injuries can increase the risk of suffering of a chronic problem and chronic pain and reduce the pleasure of running and even walking.
At Swissphysio we have helped many people to be pain free and many athletes from different backgrounds to get back to their optimal performance level.