Do you get that stubborn pain at the top of your hamstring right where it connects to your “sit bone” and you are wondering if it is ok to run with hamstring pain? This could be a dull achy pain that gets worse after your runs or sitting for a long period of time during your work day. Do you dread long car rides? Like so many of you, I have suffered from proximal hamstring tendinopathy (PHT) when I started running and thought to myself…will it ever go away?
I have helped several runners overcome this stubborn chronic condition that is literally a pain in the butt and wanted to share the best tips and hamstring injury exercises that I have learned over my 17 year career as a physical therapist and running coach. Everyone responds slightly differently but the strategies I will outline in this article will set you up for success in utilizing the most evidence informed treatment we have on this somewhat mythical condition. If you are a frustrated runner who has already been to physical therapy that included no running, heat, ice, massage and hamstring stretching and you are considering injections or surgery, please keep reading, listening, and watching the tons of valuable content in this resource. As you will soon find out, the best way to get you back to running and get rid of this butt pain forever looks much different than what you have been told and experienced in the past. Here is a teaser…you don’t have tight hamstrings…and if you do it is not the reason why you have hamstring pain!
In episodes 23 and 24 of the Healthy Runner Podcast and in this article, SPARK Physical Therapy wanted to help you as a runner become stronger with specific tips on how to deal with hamstring pain. In this article, we will take a deep dive and discuss what hamstring tendonitis (or butt pain) is in runners. We will share treatment as well as the best exercises for your hamstrings to help your body be more resilient with your running and to prevent any future hamstring injuries!
During episode 23, I was fortunate enough to be a guest on the Strength Running Podcast podcast with Jason Fitzgerald to share my knowledge on hamstring tendon pain.
Click the audio file above to listen to our conversation in which we got down to the root cause of hamstring injuries, how to strengthen your hamstrings, prevention advice, as well as dispel some common myths about rehabbing hamstring injuries.
Click the video below to watch the LIVE training I did on this topic within the Healthy Runner Facebook Group
The hamstrings are a group of muscles on the back of the leg. The hamstrings include the biceps femoris, semimembranosus, and semitendinosus. These muscles work together to bend the knee and extend the hip. The hamstrings are powerful muscles and can become very tight and cause pain when being used consistently. The hamstrings originate at the ischial tuberosity, which is a bony landmark on the back of the pelvic bone. In a more general explanation, the hamstrings start high up on the thigh, or in the middle of our butt cheek. They run along the back of our thigh and insert on the tibia and fibula.
Hamstring tendonitis occurs due to overuse and/or inflammation of the hamstring tendon. The inflammation can cause damage to the tissue in the form of microtears, which is what causes the pain. There is also the possibility that the hamstring will pull on the origin site at the bone, therefore causing pain in the upper thigh.
Click the audio file below to hear my detailed explanation of hamstring pain and how to overcome this condition in EPISODE 24 of the Healthy Runner Podcast
The symptoms associated with hamstring tendonitis can either be proximal, near the upper thigh, or distal with pain closer to the knee.
The most common symptom is pain or burning higher up in the butt or down lower at the knee. There can also be swelling in the back part of the knee as well. Generally, with hamstring tendonitis, the pain will get worse with repetitive exercise and with putting pressure on it (sitting during your work day after you go for a run). Perhaps the pain will go away when you’re resting, but in the middle of your long run you start to feel the pain. The pain can either be sharp, achy, or a burning sensation.
OVERUSE, OVERUSE, OVERUSE. Hamstring Tendonitis is an overuse injury! This happens due to the hamstring experiences continuous load and tension on it through activity. When you’re running (especially the long runs), every time you push off and land your hamstring is absorbing some of the force. Running requires repetitive bending of the knee and extension of the hip, meaning the hamstrings are also constantly being forced to contract and relax to move those joints.
The pain that patients with this pathology experience comes from the strain on the muscle that begins to put tension on the hamstring tendon. Depending on the location, there will either be strain on the proximal tendon in our sit bones or pain in the distal tendon at the knee. The tension put on these tendons from overuse is what causes the pain.
The important point to note is that it is tendon that gets irritated. Usually these problems are due to overloading of the tendon. The tendon hasn’t been stressed correctly during your training and it doesn’t have the resilience to tolerate the running you’re doing. This usually occurs at that proximal hamstring tendon site and we refer to it as a proximal hamstring tendinopathy (PHT) or tendinosis. This is not your common tendonitis where it’s an inflamed tendon but more of a degenerative condition that if left untreated with continued symptoms for years of running will eventually lead to a hamstring tendon tear. Before you go and seek out an orthopedic surgeon to either get an injection or surgery, please read these actionable tips that is a compilation on how we treat tendons differently than we did 20 years ago!
Treatment of this injury is going to depend on the severity of the injury and how long you have had this pain.
Most of the runners I see with this condition have already tried hamstring stretching and it does not help. The reason is because it is not that your hamstring muscle length is restricted or you have tight hamstrings, the root cause of the problem is usually a weakness issue and a lack of ability for your hamstring tendon to withstand load and the demands of running.
Below, I will outline the general treatment plan that has helped hundreds of runners get back running doing what they love without that stubborn pain in the butt. Keep in mind this is a generalized plan that will help 75% of you reading this if you do in fact have hamstring tendinopathy. However, there is no substitute for a personalized evaluation to get properly diagnosed and working 1-on-1 with a medical professional who has a ton of experience treating runners with this condition to help guide you on timing and specific prescription of when to implement these treatments. Overall, if I had to share 1 golden nugget tip that will give you the most bang for your buck in overcoming this condition it is to start loading the tendon with strengthening to make sure your hamstrings are strong! This will be pivotal in preventing hamstring tendonitis and helping you get back to running as healthy as you can!
This will help release and loosen up the soft tissue. In general we see hamstring dominance in the actual hamstring muscle meaning the muscle is contracting and firing too much so the gluteus maximus is not doing as much work, causing the hamstrings to feel “tight”. Foam rolling is a great self treatment technique that you can do on your own that will help to desensitize this area and loosen up the tissue. To learn more about soft tissue care for runners (my 4th tip to healthy running) click this Link from a previous blog post I did on this topic.
Click the YouTube video below to learn how to foam roll your hamstring properly by isolating either the outside muscle or the 2 inside muscles. This video actually shows my top 5 foam roller exercises for runners but the second exercise in this video is amazing for the hamstring! This is important to do to help loosen up tissue and increase mobility in the muscle.
At SPARK Physical Therapy, I like to compliment self foam rolling techniques with instrument assisted soft tissue massage (IASTM). You may be a runner who can benefit from seeing a massage therapist who can “work out” that hamstring muscle. To learn more about IASTM, click this video on my YouTube channel.
The other soft tissue treatment option that can be beneficial for treating the hamstring pain in runners is trigger point dry needling. Dry needling is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments. To learn if dry needling is the same as accupuncture click the video below to find out. If you are wondering what dry needling looks like and how it is performed for the calf muscle especially if you have tight calves or chronic achilles pain, plantar fasciitis, and shin splints.
Notice how I did not say “stretch your hamstrings” before a run? That is because we know better nowadays and what your dad did back in the day does not help today! In order to get our muscles ready for running we need to prime the muscles with movement based exercises as opposed to trying to hold and stretch our muscles. In this video, I explain why you should be stretching dynamically and then I demonstrate and share my favorite hamstring specific exercises that I include in the program of the runners I work with as part of their movement prep before running or hitting the gym.
If you are a creature of habit and you must statically stretch your hamstrings, please do it AFTER your run! Click THIS LINK to watch a simple video I created during my run to show you how to stretch your hamstrings if you get back pain.
Glute activation is essential for running to provide proper propulsion forward to decrease the stress to the hamstrings, knee and ankle soft tissue structures. Research supports including exercises that target your glutes for treatment and prevention of common running injuries such as hamstring, patellar, and achilles tendinopathy. Glute inactivation (or sleepy glutes) can come from either muscle weakness or poor running form.
Here is how to use your glutes with every step you take during your running:
🔹 Head looking straight forward
🔹 Shoulders back
🔹 Slight bend at the hips and NOT the trunk
🔹 Drive through the hips activating the glute to propel yourself forward
Many of the runners I work with have dominant hamstrings meaning they are overusing the hamstrings instead of using the bigger more powerful muscle…the Gluteus Maximus!
This is especially apparent with hill running as your glutes are the prime muscle to power you up that hill and sometimes the top part of the hamstring becomes the prime mover trying to extend your hip and get you up that hill. The hamstrings need more help and that is where some good old fashioned glute isolation exercises can be very helpful. I know you may be saying to yourself, but I am already doing squats, deadlifts, and lunges in the gym…doesn’t that mean I have strong glutes?
I have seen many runners who are doing they great compound movements using mainly their quads as well as their hamstrings. Check out the video series below that I start my runners with to teach their body how to use their glutes! This is a first step prior to advancing to more complex and running specific exercises. These exercises are great for activating the glutes before a run!
For a great progression once your glutes are turned on…give this explosive lunge exercise a try to focus on what we call triple extension (at the ankle, knee, and hip joints). Really push down into your heel and then drive through activating that glute in a nice run specific manner!
I can not emphasize this enough that the best thing you can do for your hamstring muscle to load it to facilitate healing with strengthening exercises. Eccentric exercises are fantastic for strengthening muscles and specifically helping tendons heal. An eccentric exercise is when the muscle is lengthened under tension. These types of exercises are good for increasing the force production of a muscle and loading the tendon to allow for remolding and healing. In fact, these are the KEY to getting over stubborn chronic hamstring tendon pain! Trust me, I have been there personally and I have seen these work for hundreds of runners I help.
CAUTION! You need to make sure that you do not have pain greater than a 3/10 (on a 1-10 pain scale) when performing these. Also, please be sure to start with lower reps (6-8 reps) for 1-2 sets and then building up eventually to 3 sets of 10 reps. These require more force production from both your muscle and your tendon and you can easily do too much too soon or suffer from delayed onset muscle soreness (DOMS)
I have 5 great eccentric hamstring exercises to help you stay strong!
Listen in to see what one of our runner’s had to say about the help he got with stubborn hamstring pain below!
Do you want to know more about our SPARK Physical Therapy running injury clinic to help you with your hamstring pain or learn more about our healthy runner evaluation to get you on a specific plan to PREVENT any running related injuries so you can continue hitting the pavement doing what you love?
Here is what it looks like when I help you overcome hamstring tendinopathy virtually and what you will feel only after a couple of sessions!
Thank you (running friends) for taking the time to read and I hope you enjoy the podcast episode!
Stay active, stay healthy, and just keep running!
Duane Scotti, PT, DPT, PhD, OCS
Do you get that stubborn pain in the bottom of your foot especially when you take that first step out of bed in the morning? Are you wondering, why do my feet hurt when I run? Like so many of you, I have suffered from plantar fasciitis with running and thought to myself…can I run with heel pain?
Foot and ankle injuries can perhaps be some of the most debilitating injuries. Not only do they shut you down from running, they also can shut you down from being able to function in your regular daily activities. They can also take a long time to get over, as you have likely experienced…
But, here’s the great news…They don’t have to!!!⠀⠀
Many runners use “band-aids” as their fix for foot and ankle injuries – change shoes, purchase orthotics, ice, stretching, and all sorts of other fads out there.
And if they have done some strengthening, it often hasn’t worked either…because they are likely strengthening the wrong areas.
Does this sound familiar to your story?
Click THIS LINK to to help you as a runner become stronger with specific strength training on how to fix foot pain for good!
Do you get stubborn pain on the outside of your knee with running especially going up hills? This could be sharp at times and may even cause you to walk during your run. Have you thought… will IT band syndrome ever go away? Have you tried rest, ice, and stopping running but every time you try and go back that pain just comes back and stops you in your tracks?
Click THIS LINK to to help you as a runner become stronger with specific strength training on how to fix iliotibial band syndrome (IT band syndrome). In this resource, I will share with you the causes, symptoms, treatment, and prevention to help with iliotibial band syndrome in runners. Following these running tips and exercises will help build up your body to be more resilient with your running and prevent future injuries.
⚡️ SPARK Physical Therapy and the Healthy Runner Podcast Helping Active Adults Be Able To Run Without Aches and Pains So You Can Feel Good About Yourself Again…
[Even If You Don’t Think You Are A Runner]
If you are a runner and frustrated with your nagging aches and pains and have been told to stop running, we can help you.
Have you had a challenging year in 2020? Unless you predicted the coronavirus and knew you wouldn’t run many races this year, this year has been a crazy and unexpected roller coaster ride for you too! In this episode, I am going to share the lessons I learned during this crazy year that… View ArticleRead More
In this article we will be discussing the one test your doctor must order for you when you are in pain as well as what to expect during your first physical therapy appointment. You could be a runner, dancer, gymnast, or an aerial circus artist who is having pain in your knee, foot, or shoulder. … View ArticleRead More
Does the heat and humidity prevent you from running? Do your race goals suffer if you have a hot weather day? In this article we’re going to be covering 7 tips to help beat the heat and actually go for your run even when the weather is hot and humid! In excessively hot weather,… View ArticleRead More
“I developed IT band syndrome during my first marathon training cycle last year and ended up in physical therapy for about 3 months. I was told not to run if I had any pain at all. I lost so much time “recovering” that I ended up deferring my registration to the next year. I spent the next summer training for the same marathon when about 6 weeks out, that familiar IT band pain returned. I could barely finish a mile. I didn’t want to go back to my physical therapist because I knew what he was going to tell me. Stop running. I was so frustrated and started to feel like marathons weren’t for me. I stumbled upon the healthy runner podcast and learned that I don’t have to stop running in order to recover from injury! I was skeptical about an online physical therapy session. But I reached out to Dr. Scotti and he was able to give me the tools to mitigate my pain within the first session! I was able to complete my training cycle and made it to the finish line of my first marathon with his help! I highly recommend!”
“I’d been dealing with Proximal Hamstring Tendinopathy (PHT) for about 4 years and had been doing PT, but still had lingering pains. I just figured I’d have to suck it up and deal with it because that was as good as I was going to get. But then, I came across a podcast of Duane being interviewed by Jason Fitzgerald on PHT and how he overcame the injury, and my curiosity was piqued. I met with him virtually and he has been a GODSEND! I’m able to sit as I type this! I can bend over and get in and out of cars without pain! And, I’m RUNNING again!!! It is amazing to be able to do things that I haven’t been able to do without pain since 2016!!! Thank you so much Duane for being an incredible PT!!”
“I suffered from IT band syndrome for four years before seeing Dr. Scotti in April 2020. Before then, I couldn’t run more than about 10 minutes without stabbing pain near my left knee. I’d seen various orthopedists, physical therapists, and chiropractors looking for some relief. My career needed me to run a mile and a half within a certain amount of time, and it was impossible to do so with the knee pain. I saw Dr. Scotti and he immediately got to work! That first visit, he helped me understand the anatomy and underlying cause of my knee pain (aka IT Band syndrome). Once I understood what was happening, the course of treatment made so much sense. Not only did he have online videos of all the recommended exercises to treat the problem, his “healthy runner” Facebook group, Podcast, and YouTube videos held a wealth of information and supplemented my plan. I soon understood that running wasn’t just a casual hobby – it’s a sport and one that deserves dedication and focus. Without his dedication to the sport and his community, I wouldn’t have realized this! Over the next few months, I had many ups and downs – victories and failures – and even some tears! Two steps forward and one step back. Dr. Scotti always checked in between appointments and tweaked my plan if needed. By August, I was regularly running 3-4 miles with barely any pain! If I did get pain, it was because my dedication and focus were lacking – and I quickly picked it back up and overcame. I’m so thankful I took another chance at having my knee looked at and trusted someone else. I run regularly now and am really enjoying it. I can’t thank Dr. Scotti enough and would highly recommend him to anyone having trouble.”