Why do runners get hamstring tendinopathy? Few runners that I work with who run greater than 3 miles complain of hamstring soreness after a long run. Typically, their most common offenders are their quads and calves. However, there is a growing body of research about the prevalence of proximal hamstring tendinopathy (PHT) in middle and long distance runners.
Before we get into why, how do you know if you have proximal hamstring tendinopathy?
Symptoms and common findings:
Pain near the junction between the back of the thigh and the glute that can also radiate into the glute and low back
Pain decreases slightly within the first few minutes of a warm up, then feels worse after exercising
Pain with prolonged sitting, especially on a hard surfaces
Pain or stiffness with deep hip flexion i.e. deep squats, rear leg elevated split squats, certain yoga positions
Pain typically improves within 24 hours of the offending activity but returns with provocative activities.
The hamstring muscles run from the ischial tuberosities (bony part of the butt) to the tibia and fibular head. Because they cross the hip and knee joint, they can both flex the knee and extend the hip. When running on flat ground, the hamstrings are relatively inactive compared to the quadriceps, and gastroc/soleus. See below for a visualization of muscular contributions during the running gait cycle from Hamner and Delp. (1)
So why do runners develop proximal hamstring tendinopathy when the hamstrings are not working that hard comparatively during the running gait cycle?
When running on an incline or at faster speeds, the hamstrings have to work harder to extend the hip from a flexed position. Runners that start to incorporate more speed work or hill work that haven't been specifically training their hamstrings might be at risk for hamstring injuries because their usual flat ground training doesn't load the hamstrings very much. Especially if they incorporate those changes abruptly! If you are experiencing a few of the symptoms above and have recently increased your running pace or increased the volume of your hill running, you may be dealing with some PHT.
What to do about it
As with most tendinopathies, PHT responds well to a combination of the following:
Relative Rest
This doesn’t mean do nothing! Relative rest means that you decrease your overall workload, especially of the offending sport or activity. For example, if you are training for a marathon, you should decrease your overall mileage or intensity of your running to allow for ample recovery to occur.
Progressive Loading
Tendons respond well to heavy slow resistance. This can sometimes cause some discomfort during the exercise, but pain should return to baseline within 24 hours. I often spend a lot of time tweaking and modifying this programming for my clients to ensure that they are progressing optimally.
Addressing suboptimal body mechanics
Things like coordination between glute and hamstring muscles or stride length can affect how much work the hamstring muscles have to do. Making small changes to your body mechanics and strengthening surrounding muscles can help support the healing structures by distributing loads across other muscle groups.
Here is an example of a general exercise progression that can be used to start to load the hamstring tendon. Pain levels should stay under 5/10 with all of these exercises, and should return to baseline within 24 hours. (2)
At Alterra, we specialize in helping runners resolve any and all of their injuries that limit their running ability or performance. If you're a local runner in Boston's Back Bay and are dealing with proximal hamstring tendinopathy, we'd love to help you eliminate it for good! Book a free discovery call to chat with a therapist today.
Disclaimer: The information in our blog posts is not a substitute for professional medical advice. Consult a healthcare provider before making decisions related to your health. Use our content at your own risk.
Sources
Hamner SR, Delp SL. Muscle contributions to fore-aft and vertical body mass center accelerations over a range of running speeds. J Biomech. 2013;46(4):780-787. doi:10.1016/j.jbiomech.2012.11.024
Radovanović, G., Bohm, S., Peper, K.K. et al. Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. Sports Med - Open 8, 149 (2022). https://doi.org/10.1186/s40798-022-00545-5
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