Hamstrung: Hamstring Strains and Posterior-Thigh Pain in Runners

Stay the CourseWhere do ideas for Stay The Course come from? Unfortunately, I don’t have a giant hopper filled with topics that I pluck from each month (though perhaps we might create such a hopper from questions from iRunFar readers someday soon). Instead, topics come from salient issues or concepts I come across – either in the clinic or on the trail.

This month’s is no different. As a clinician, it is common to “get runs.” (No, not those “runs,” or those “other runs!”) To clarify: a clinician’s “run” is a cluster or succession of patients who have a similar issue.

The injury du jour? Hamstring pain!

Hamstring – or posterior-thigh pain – is less common than, say, lower leg or knee pain, but it is a frequent issue for many runners. And it’s an issue we tend to see in the summer, perhaps when we’re starting to run faster and farther, and in the winter, when cooler temperatures make tissue flexibility more challenging.

But what is it, really? Why does it happen? And how do we recover from and prevent it?

Posterior-Thigh Pain: Differential Diagnosis

Hamstring strains are over-diagnosed nearly as frequently as plantar fasciitis. In fact, until recently, I didn’t believe distance runners ever truly had hamstring strains.

There are three primary causes of posterior-thigh pain: hamstring strain, referred sacroiliac-joint pain, and “sciatica”, or peripheral nerve tension referral.

Hamstring Strain
Yes, to strain a hamstring as a distance or long trail runner is possible, even if one avoids fast running. Signs of a true hamstring strain include:

  • Range of motion loss in the hamstring (both straight-knee and bent-knee raise testing)
  • Palpable soreness somewhere along the length of the muscle-tendon
  • Pain with end-range stretching and/or resisted testing, i.e. it hurts to stretch it or strengthen it

Referred Sacroiliac-Joint Pain
Referred sacroiliac (SI) joint pain is a substantial and frequent cause of posterior-thigh pain. In fact, the common referral pattern of SI pain closely mimics that of hamstring pain. Signs of SI joint pain include:

  • Pain with applied pressure to the SI joint (the “bumps” just below the waist band in the posterior pelvis); this is usually described as the “starting point” of the pain.
  • Sometimes a range of motion loss with a straight-leg raise, but often an absence of pain with bent-knee testing.
  • A general lack of “a sore spot” in the hamstring, or posterior-thigh tissue, i.e. you poke around but can’t seem to find it

“Sciatica,” or Peripheral Nerve Tension Referral
Referred nerve-tension pain closely mimics hamstring-muscle pain; and often, it accompanies it. If the sciatic nerve is either adhered or compressed in its travels from the spine to the leg, it can cause pain anywhere along the length of that nerve (as we discussed in the Achilles pain column). The posterior pelvis, buttock, and thigh are common areas of sciatic nerve referral. Signs of nerve pain include:

  • Pain with straight-leg raise testing (but significantly less with bent-knee hamstring stretching)
  • Usually (but not always) a lack of tenderness in the posterior thigh
  • Usually a lack of pain with resisted testing, i.e. strengthening the muscle doesn’t hurt
  • Nerve-like symptoms, including ache at rest, buzzing, tingling, or any other “electrical” sensations

Neither SI joint nor sciatic-nerve pain in the posterior thigh will be discussed in this column. However, many of the recommendations for relieving hamstring pain will result in decreased pain in these areas, as well.

Why the Hamstring?

The hamstring has three primary actions in the running stride:

  • It helps extend the hip (but weakly, unless you’re sprinting) in push-off.
  • It helps lift the leg upward in the drive phase.
  • It helps slow the foot at and before initial contact.

There are two primary reasons for hamstring tightness and dysfunction in athletes: compensatory overuse and over-lengthening.

Compensatory Overuse
At my new clinic, we have a variety of interesting toys, high-technology diagnostics and biofeedback instruments that are extremely useful in identifying how people move. One useful tool is electromyography (EMG), using surface electrodes to measure the relative activation of muscles during functional movements.

What we frequently find clinically in patients with hamstring pain is excessive hamstring firing to compensate for deficient activation of the gluts. The gluteal muscles are the strongest hip movers; the glut max is one of the strongest muscles in the body, and it is primarily responsible for extending the hip. And since hip extension comprises half of the gait cycle, this is an important action!

But when the gluts fail to powerfully activate, the hamstring, a weak hip extender, tries to help out. And when this imbalance occurs, what we see are sky-high EMG values for the hamstring, and relatively little for the gluts with hip-extension testing.

In non-endurance athletes, such as sprinters and weightlifters, we tend to see a weak glut on the same side as the painful hamstring. Makes sense: glut’s not doing its share, so the hammy kicks in. But with distance runners in particular, what we see in folks with hamstring pain is the weaker glut is on the opposite side!

But why?

Recall The Three Injury Rules: For every injury action, there is an equal and opposite reaction.

If you believe the run stride is two actions: one leg pushes beneath and behind, and the other leg drives upward and forward, then a deficient push (hip extension, glut muscle action) on one side will result in overstress of the drive (hip flexion, hamstring curl) of the opposite leg.

We saw this plainly in a recent EMG study of one of my hamstring-pain runners: she had left-hamstring pain, and a nearly nonexistent right glut activation. To reiterate, if you have a push problem on one side, you’ll create a pull problem on the other side. In this runner’s case, her lack of glut activation (and overall push-off) on the right was a major factor in her left-sided hamstring pain.

Regardless of which side is weak, heavy emphasis on selective glut activation is important for both performance and pain relief.

Over-Lengthening

This is arguably a more common cause of chronic tightness and pain in distance runners. The hamstring plays a substantial role in “slowing down” the foot at the end of the swing phase, as it readies to contact the ground. If the stride is, for some reason, too long, or if the stride has inadequate hip flexion and the hamstring is “stuck” in a constantly lengthened state, the hamstring gets over-stretched and over-worked with each stride.

Initial Treatment Strategies

Conventional sports-medicine strategies are important for the initial treatment of hamstring pain. If acute, RICE is required. If it is sub-acute or chronic, the following basic strategies are helpful for initial treatment:

  • Soft tissue mobilization – either self-mobilizing with a ball or roller, or from a licensed massage therapist.
  • Gentle range of motion – restore normal length with passive and active stretching. But avoid over-stretching, as strains, by true definition, are tissues that have been excessively stretched.
  • General strengthening – low-intensity, general hamstring strength exercises emphasizing both concentric and eccentric exercise are helpful in the initial stages so long as it does not increase pain beyond the exercise bout.

However, to perform conventional sports medicine alone will only result in temporary relief. More specific strategies are required for sustained relief and recovery.

Run-Specific Treatment Strategies

To fully recover from hamstring pain and prevent recurrences, it is paramount to do the following:

  • Restore full strength and range of motion to the hamstring itself.
  • Restore normal muscle-activation patterns. Namely, activate the gluts!
  • Restore efficient gait mechanics to prevent over-use or over-lengthening stresses.

1. Combined Hamstring Plus Glut Strengthening
The following are two of the more effective, evidence-based hamstring – and glut – strengthening exercises, specific to running:

A. Chair Bridges

Position yourself on the floor beside a chair, couch, or table, with heels resting on the edge. To achieve some glut activation, flatten the back into the floor, then preemptively squeeze the gluts. Then, slowly lift the pelvis. This is a powerful activator of the hamstrings, yet you should also feel the gluts working hard.

Chair Bridge Start

Chair Bridge Start

Chair Bridge Double Up

Chair Bridge Double Up

It is important to keep the back flat, as a common muscle imbalance is over-use of the lumbar extensors to extend the hip, which causes both hamstring and low-back pain.

To make this exercise more challenging, perform with a single leg.

Chair Bridge Single Up

Chair Bridge Single Up

Hold 3 to 6 seconds. Perform two to three sets of ten reps, once or twice daily.

B. Bridge Walk-Outs

Position yourself flat on the floor, with knees bent and feet flat. Flatten your back, pinch the gluts firmly, and boost up the pelvis 4 to 6 inches. Then slowly “walk-out” each heel until the legs are nearly straight. Slowly return. A typical repetition involves 4 to 5 “steps” with each leg. Emphasize pelvic stability by keeping it level throughout the exercise.

Bridge Walkout Start Up

Bridge Walkout Start Up

Bridge Walkout Extended

Bridge Walkout Extended

To make this exercise more challenging, when the legs are nearly fully extended, lift one leg straight upward about a foot. With the other leg, “reach long” with the heel, pushing it into the floor. Alternate, then return.

Bridge Walkout SLR

Bridge Walkout SLR

Perform two to three sets of 10 reps, once or twice daily.

2. Selective Glut Activation – The Running Pattern

This next exercise is extremely important in selectively activating the glut muscles – as well as the abdominals – within the running pattern.

Recall The Power Position from “The Fall Guy” column last November:

Power Position BOTH

The “Power Position,” demonstrating the prolonged holding of both the push-off (lengthened) and driving (shortened) leg positions.

This represents a prolonged hold of The Running Pattern, which emphasizes the push-off and the drive phase of the running gait.

Emphasizing the trunk elongation (as noted by the downward tilting pelvis) on the stance leg effectively facilitates glut firing. A normal activation pattern involves the runner “feeling” the glut begin to “burn” within 1 to 2 seconds of holding this position. If you do not feel the glut working, hold the position until you do, or as long as you can.

Once the glut firing (signified by that burn) is effectively and quickly perceived, hold this position for six seconds, repeating the same side in succession, 4 to 6 times. Perform this exercise once or twice daily, including before a run.

3. Restoring Efficient Gait Mechanics

Once the hamstring is strengthened, and the gluts turned on, it is time to address stride efficiency.

To be certain the glut is the prime mover in push-off, and the hamstring is not being over-lengthened in initial contact, it is important that the stride be both powerful and compact.

Performing marching and skipping drills, emphasizing The Running Pattern – namely the strong, compact upward and downward action of the hips – will facilitate the gluts to push off. Equally important, this compact pattern will ensure that the foot lands directly beneath the trunk at initial contact, sparing any over-lengthening stresses.

Perform this drill for 3 to 4 bouts of 10 to 15 seconds, immediately before running as part of your warm-up.

In Conclusion

Hamstring strains and pain yet again require the trifecta of treatment strategies for full recovery:

  • What is it, really? As always, find out for sure what it is. Never assume, until all other factors are ruled out. Treating a SI problem with hamstring exercises will keep most people off the roads and trails, far longer than necessary.
  • Pain control. Restore normalcy to the tissue. Any injury requires adequate pain control. Sometimes this is literally no off-time; it’s simply correcting the dysfunction, be it neuromuscular or motor control. But often, it takes significant rest and a well-balanced rehab approach. Be patient!
  • Get to the bottom! What is it about your stride that causes this? The vast majority of running injuries are inefficiency issues. What’s yours, and how can you correct it to relieve the stress and pain?

And lastly, the good news about treating all running injuries, the elusive Fourth Law of Running Injuries:

Any treatment approach that fully and sustainably resolves pain will invariably make you faster (The Efficiency Law).

You run more efficiently, and you run faster and hurt less. It’s that easy, right? Win-Win!

Good luck!

Call for Comments (from Meghan)

  • Who has experienced a diagnosed hamstring strain from endurance running? How did the injury originate for you?
  • For those who have worked through the recovery for a hamstring strain, what among Joe’s suggested exercises/treatments worked well for you? Are there other exercises/treatments that worked for you and that aren’t mentioned here?
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 40 comments

  1. Sammy Kim

    Good running-specific recommendations for adjusting gait mechanics in this post. I think some readers may find this blog really helpful too: http://www.athletestreatingathletes.com. Click on 'Blog' for info about treatment of specific injuries. Disclosure: I have no relation the with the writer of the aforementioned site or her clinic.

  2. Will Musto

    Hey Joe, I wanted to share our researcher John Davis' post about hamstring injuries/rehab:

    runnersconnect.net/running-injury-prevention/high-hamstring-tendinopathy-injuries-a-pain-in-the-butt/

    (If this is against any of your policies, definitely feel free to remove this comment!)

    1. OOJ

      Will-

      Thanks for the link – very thorough, evidence-based post!

      My critique – and it's the same for 99% of sports medicine content – is that motor control (both running and walk stride) is not addressed (MY belief is that it is VERY difficult to research motor control – too many variables – and since many practitioners are "married" to evidence-only approaches, they fail to recognize its importance).

      Therefore, the posted return to run protocol is unreliable. If you continue to run with "pathological mechanics" (e.g. a stride that continues to strain the hamstring anywhere in its length), any return to running will be tenuous and slow. Whereas properly addressing and correcting mechanics can result in immediate pain relief and full resumption of training, often with shocking immediacy.

      1. Will Musto

        You make a great point, Joe. And your emphasis on the stride correction is key, in my opinion. I've had too many teammates/friends/athletes that I coach who face consistent hamstring issues who are unwilling to investigate changing their stride, and it's always seemed so obvious to me. Thanks for including that part in your post!

  3. Emmanuel

    Thanks for sharing your findings with us Joe. I have been reading your articles this past week for the following reason. Last week i videotaped myself running on the treadmill and saw how my left foot, especially my heal, crosses the middle imaginary line completely. It seems like it just needs to go there. I know for a fact i have weak gluts and core and now i realized i have a lot of work to do. This might also explain why my hamstrings are so tight all the time and painful to stretch.

    Great article.

    ~Emmanuel.

    1. OOJ

      Emmanuel-

      Refer to my previous post on stride width (http://www.irunfar.com/2013/03/going-wide-the-role-of-stride-width-in-running-injury-and-economy.html).

      ALSO: look at your trunk alignment in that video. Is it "listing" or shifted to the narrow (L) side? If so, you may have a trunk/lumbopelvic proprioceptive issue that's causing overload on that side. A shifted trunk makes the hamstring work harder to lift, and causes increased landing/eccentric forces through the hamstring…

      1. Emmanuel

        Thanks Joe, it looks like there is a slight shift to the left. What was more shocking to see was the (significantly) lower left shoulder when i did the power position on the mirror. I played around by trying to straighten/lifting it up but noticed how it wanted to go down, my left shoulder that is.

  4. Kat

    Thanks for the suggestions! I have been struggling with hamstring issues for the past year, and while the pain has improved tremendously, my range of motion has been severely affected. I mostly run slowly and on flat ground for the time being. Initially what helped me were exercises for strengthening hips/glutes as well as eccentric hamstring exercises, notably the Nordic hamstring curl. I suffer from pain at the sit bone where the tendon connects, as well as pain deep in the middle of the left thigh. Anterior pelvic tilt seems to be another issue that has caused my hamstring problems. Any suggestions for correcting this in conjunction with the strengthening mentioned above?

  5. Alex

    Fantastic post. I am going to add these glut exercises immediately. My (partially rehabbed) upper left hamstring tendinopathy is definitely linked to sprinting + weak left glute firing (same side in my case) and these look like great ways to address that.

    Thanks very much for another great column.

  6. Andy Snyder

    Nice post Joe, but you need to change "glut" to "glute". As a fellow PT I wanted you to have the correct spelling in your post.

    Keep up the good work!

  7. Jeremy

    Joe,

    I said it out on Pucker Point and I'll say it again…thank you for sharing your knowledge in such a well thought out and clear way. Your column is the finest info on the web for a runner looking to stay healthy. You give coach-less hacks like me a fighting chance at getting to the starting line healthy. Please keep it coming.

    Best regards,

    Jer

    1. OOJ

      Jeremy-

      Thanks for the feedback! I won't soon forget that quality time spent on Pucker Point: I was cramping like crazy!

      Let's hope that American fire doesn't completely take out what is the most beautiful and enjoyable section of the WS Trail!

    1. Kat

      Thanks for the suggestion. I tried the stretch and it felt "easy," but I definitely noticed a difference between the left (bad) side and right side. I will work on that and read the nerve pain article! Thanks for your input.

      Kat

  8. Bryan

    I'm curious…would soreness/pain at the very top of the hamstring (right where it meets your glutes) fall into this category? From time to time, I deal with balled up muscles and soreness at that spot on both legs, and I'm unsure what I'm doing or not doing to cause it, or what I can do to fix the issue.

    1. OOJ

      Bryan-

      Yes, it would. The hamstring originates on the ishial tuberosity (or the "sit bone"), very close to where gluts run.

      Proximal hamstring pain is more commonly an issue of poor glut firing (and typically accompanied by too much lumbar extension, or "running too tall"). This makes the low back and hamstring muscles try to do the glut's job.

        1. ashell8785

          Hi Bryan,

          I know this post is pretty dated, but have you had any relief with your high hamstring issues? Were you still able to run with this problem?

  9. Stephane

    I actually have hamstring pain, mostly surfacing during fast races or speed workout (at least fast for me, so around 6:30-7:30 min / mile). It is happening on my left leg, which is the one where a few years ago I lost mostly all strength for more than 3 months following a sciatica (it probably lasted a month where I could not stand on my toes on the left side for a month and it gradually came back within the following 2 months).

    I'm mostly unable to do the Bridge Walkout SLR on the left side because I just don't have enough strength while it is no problem on the right side.

    My stride on the left side has changed significantly since the accident, at least based on the wear of my shoes. Right now it feels mostly like a lazy leg.

  10. Amanda

    What a clear and well-written explanation! I'd love to get some help with my hamstring/glut issues, but I live in Bend, OR. Do you have anyone you would recommend here to help me out with this?

    Thanks so much for your article!

  11. OOJ

    Amanda-

    Thanks for the feedback!

    I don't know any specific PTs in the Bend area, but I do know that Rebound is the "giant" in that community – may want to check them out, and possibly reference this article as a starting point for your treatment! Good luck!

  12. sharon

    After I strained my hamstring over 3 years ago I could not walk upstairs. My leg simply did not work going up. That got better, and I have been working on strengthening, and stretching my hamstrings since then. I am now pretty darn good at uphills, but sometimes my hamstrings will start cramping badly on downhills, while they recover on uphills. I thought that this was not reasonable since I use my hamstrings going up, and quads going down, but it has happened several times, well twice.

    Then today, I read Anton Krupicka's UTMB blog, and there he writes that his hamstring injury was really painful on the downhills, and he passed people on the uphills. I thought WOW, I am not the only one, and that this must make sense in a way. But how can a hamstring be strong for uphills, but be useless in downhills. And how do I fix this?

    1. OOJ

      Hi Sharon-

      What you say makes 100% sense if you consider that "over-lengthening" creates chronic stress and overload on the hamstring. To review:

      "Over-Lengthening

      This is arguably a more common cause of chronic tightness and pain in distance runners. The hamstring plays a substantial role in “slowing down” the foot at the end of the swing phase, as it readies to contact the ground. If the stride is, for some reason, too long, or if the stride has inadequate hip flexion and the hamstring is “stuck” in a constantly lengthened state, the hamstring gets over-stretched and over-worked with each stride."

      If you fail to adequately flex the hip/drive the knee upward, the foot stays low, the leg long and the hamstring over-lengthened and over-worked. This is more likely to be exacerbated on downhills (where it would be even longer as it has longer to reach the downgrade), and better on uphills, where the upgrade will shorten the stride and require more hip flexion.

      It does not surprise me that Anton Krupicka deals with this issue, as his stride is characteristically "low" on hip flexion.

      My advice: strengthen the hamstring, but then work on hip flexion (via the exercises and drills noted above) and be sure you're getting a bit more "lift" from your hips/knees in your stride.

  13. sharon

    OK, thanks!! Making 100% sense is good. This implies that I can make it better. I will definitely start working on hip flexion along with my hamstrings. :-)

      1. Anonymous

        Oh dear, rule nummer 2.

        Was it, in fact, my stiff left ankle which caused the sciatica/piriformis on my right side, which caused the hamstring strain on my left side, and so on, and so on……. I can't begin to come to the original cause of my problems. But I have learned WHY one does not run or train while in pain, or until an injury is no longer causing compensation.

        As for the drill, I had to watch it 7 times before I realized it was simply skipping with high knees. Then I tried it. It felt very wrong, but looked OK as I skipped quickly past the mirror. Most of all, it was fun! And fun is something I will do often. Thank you!!!

  14. Katerina Claiborne

    Yes! Rule #2 is sooooo important!

    Here's what I've been doing to get my glutes and hip flexors to become more involved in the running process, and I have been feeling better than I have in a long time. When I run (and when I walk too), with each step, I squeeze my butt to "pull" my foot/leg back further behind me. It seems to take a lot of pressure off of my poor hamstrings and I don't have the soreness/fatigue that I used to experience. It's a bit of a pain to consciously activate my glutes, but it's worth it.

  15. Terry

    I'm so excited that I found this article! And it's only a month old!! I'm 51 and fairly new to running (4-5 years now) and a 4:34 marathoner (I've done one!). Next one is in 2 weeks and I'd like to get a sub-4:30 but it's a different and possibly more challenging course so I don't have my hopes set too high at the moment.

    I will be implementing the recommended exercises immediately into my regimen. I have sore hamstrings on long runs (over 10 miles) and by 20 miles, I want to quit. Thankfully, we don't go further than that in training. But I want to make my marathon experiences more enjoyable with less hamstring soreness and I think your exercises and information is spot on for my condition and improving it.

    Thanks again!

  16. ashell8785

    Hi Joe,

    I have been dealing with some strange, mild irritation in the back of my right leg for about a week now. I can't really pinpoint what the issue is. It does feel tight and achy at the top of my hamstring where it meets my glute. And it only presents when I do linear leg swings when I swing my leg out in front of me. But then it starts to loosen after a few times of doing that. It doesn't hurt when I prop my foot up on a waist-high surface and stretch my hamstring (which has been pinpointed as a test to check for high hamstring tendinopathy). It is a little sore when I lay on my back and cross my affected leg in a straightened fashion over my body and stretch the area. I am afraid it may be high/proximal hamstring tendinopathy because of where the irritation is, but it does not hurt when I sit, nor does it hurt when I press on the area where the tendon and ischial tuberosity. It also doesn't really hurt or ache when I run. If I feel anything, it isn't really anything more than what feels like muscle soreness. While I did mention I'm afraid of high/proximal hamstring tendinopathy due to where the irritation is, these other things I've outlined don't really seem indicative of the condition. I can also produce a little bit of irritation when foam rolling my glute in the area where I believe the piriformis muscle is…the irritation isn't up in the piriformis area, though. I feel it high in my hamstring where it meets the glute muscle. It almost feels like a nerve sensation. So I also feel like it may be something with the sciatic nerve in my right leg. I know this is a bit long-winded, but does anyone have an opinion on what I'm feeling? I've still been running regularly for the last week and it has not grown worse, nor does it really bother me when I'm actually running…as I mentioned above, it more so just feels like a little bit of muscle soreness while running. Any input would be greatly appreciated!

  17. RLaPoint

    I injured my achilles in October at a 100 mile race. Rest, rehab, massage, in a nutshell, continued to run and 3 months later was totally pain free. Most of my running was on a banked 1/9th mile banked track, and around the time my achilles cleared up, i started getting pain in my glute/hip. The pain was/is in the rear, near the bottom of my glute/top of my hamstring. Seemed to cause me to "ride" over that leg while running. Running fast doesn't bother it too much, but long slow runs are where it hurts the most. I can pretty much do any other intense workouts (stairs, cycle) and not only is the pain not noticable, it actually goes away the more I do non-running activities.

    1. RLaPoint

      I have tried strengthening, rolling, massage, NSAID's, and making sure my running form was balanced and efficient. I made sure my beard was large and bushy. In my mind, it was either the speedy track workouts and/or the achilles injury that caused this, so returning to a normal routine on roads and soft trails with an otherwise healthy body should let the pain fix itself, right? The pain WHILE running is near the bottom of my glute, but the following soreness is more alonmg the middle/upper glute, almost to the lower back. Don't think it's sciatica, as there is no leg or back pain, and no numbness or tingling anywhere. Thought it might be piriformis, but the fact that I can do any other activity at full intensity with a reduction of pain suggests otherwise. Any suggestions would be greatly appreciated!

  18. s207268

    Hi Joe,

    New reader here! This was a great article, very informative.

    I strained my hamstring recently and just wanted to get your advice re: if I can continue to run on it. I've only been running for about a year, 3-5 miles every day, nothing even remotely impressive, but I've become somewhat addicted to my routine nonetheless.

    I felt pain/tightness a few weeks ago, but thought nothing of it really, though I did start to stretch a little bit more comprehensively. I have been running outside during this pretty awful East Coast winter and I do have to admit that my stretching regimen has been lacking. The temperature has been all over the place recently – up and down – which may be relevant? In the past few days, the pain has worsened significantly. I took a few runs earlier this week – when I thought I was feeling better – and was so tight and sore afterward, I could barely walk.

    My doctor said it's a strained hamstring, but he was relatively unhelpful with any further advice, other than prescribing me an anti-inflammatory and giving me a packet of stretches to do. So what I want to know is if this is something I can and should run through. Because I'm a pretty inexperienced runner, I don't know if this is a pain that others feel regularly and just power through while I'm being a total wimp! I'm sure you're hesitant to make generalizations, but is there a general rule of thumb when it comes to returning to running with a strained hamstring?

    Any advice would be great! Thanks so much!

  19. James Dunne

    A little late to the party here guys!

    100% agree with the earlier comments in this thread about the importance of assessing and correcting pathological running biomechanics, to help improve long term rehab outcomes.

    I want share this great post from running physio, Tom Goom: http://www.running-physio.com/pht-gait/ He describes his experience with running gait retraining for high hamstring tendinopathy.

    Also, a few months ago I uploaded a video on high hamstring tendinopathy rehab for runners. Here’s a link to the video and accompanying article: http://www.kinetic-revolution.com/proximal-hamstring-tendinopathy-a-real-pain-in-the-butt-for-runners/

    Please feel free to remove links if against your comments policy :)

  20. Colin

    This is a great article! Good to see such in-depth discussion and recommendations beyond just “stretch more”. I love all the suggestions here and will be linking back to this in my own article! For some additional reading, here’s my article discussing hamstring tightness… it covers 6 different potential causes and fixes for them. There’s a bit of overlap with the info here but some good alternatives as well! http://bit.ly/28TfkLc

  21. Emma

    THANK YOU! I have had low level right hamstring niggly ‘feelings’ (not quite pain) for months. I just googled it and your article came up. I had a total ‘AHA’ moment when you mentioned that it could be a weak glute on the opposite side. That glute IS weaker. I have had degenerative disc disease for years and my left leg is weaker in general because of it. I know now that I need to work harder on my running form and glute strengthening. At least I now have a plan of action :)

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