Do you have pain in the back part of your upper thigh or near your butt right on your “sit bone”? Is this pain preventing you from running? In this article we’re going to discuss ways to stop this pain in its tracks to get you back on the road doing what you love as well as to prevent it from coming back!
If you are more of the visual and auditory learner just click the YouTube video below outlining everything that is in this article!
The pain we are talking about today is pain in your butt or back of the top part of your thigh. This pain hurts mainly with running and also while you are sitting for a an extended period of time. You would be sitting at your desk or sitting during a long car ride and you’re starting to get that pain in your upper thigh or butt area right on your “sit bones” or your ischial tuberosity. This is actually your hamstring tendon connecting to the bone!
The tendon is what gets irritated and this is the pain generator. 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 is proximal hamstring tendon pain, so we call it a tendinopathy 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. Below, I will share 3 golden nuggets to help this tendon heal and make you feel better.
This will loosen up the tissues. This will help release 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 really tighten up. Foam rolling will help to loosen up the tissue and reset the area. For more information on why we treat soft tissue click THIS LINK to see 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.
Foam rolling before and after your run can be extremely beneficial so give this a try!
We want to re-educate how to strengthen the glutes. Using the contraction of the glutes will help to alleviate the stress on the hamstring tendon. The Gluteus Maximus muscle is a hip extensor so it helps extend your hip. Think about what you do running up a hill. You want to get a slight bend in the hip and get a forwar lean to contract your glutes to help you power up the hill. If you’re not contracting those glutes, all the stress is going to put on your hamstrings and the pain is going to start to occur at the bone attachment site in your butt!
Here are my top 4 exercises to activate the glutes in many of the runners I help. I hope these exercises help you!
We want to specifically load your hamstring muscle complex. How do we do this? Traditionally, we’ll do hamstrings curls. However, this is not necessarily how we want to strengthen. We want to think about strengthening from the hip joint. We want to strengthen from the hip joint as well as adding load. Think about those single leg exercises such as RDLS (russian dead lifts). We’re utilizing one leg nd we’re adding load.
We need to load the tendon to add resiliency. We have those chronic injuries of hamstring tendinopathy and Achilles tendinopathy in runners. We have two different protocol we can utilize to add resiliency to the tendon. The first way we can do this is to utilize an eccentric contraction. For example, an RDL exercise where we have weight in our hands, such as dumbells, and we lower down for 5 seconds and then come back up in 1 second. Lowering down slowly for 5 seconds and then coming back up quickly is what we call an eccentric contraction. This adds stress-strain to the tendon to allow it to start to heal. We know that tendons remodel and heal by adding stress to them. You may have some discomfort, but it will benefit you in strengthening the tendon. You don’t want to push yourself too far, so you shouldn’t have any pain above a 5 on 10 point scale, or even above a 3.
The second protocol we can use is what we call heavy slow resistance. For this protocol, it would be a 3 second lower as you pitch forward and then a 3 second raise. You would do this with added weight to have the resistance to add strength to the hamstring!
Finally, we can use a Nordic Hamstring curl! You’re going to fixate your feet, slowly lower forward and then push back up! That slow forward is going to be that eccentric contraction. There is a lot of research done on looking at soccer players utilizing this exercise to prevent hamstring strains when they perform it during their pre-season training. This nordic hamstring exercise really helps to add resiliency to the hamstrings! This exercise can really help to prevent and treat upper thigh or buttock hamstring pain! To see my top hamstring exercises that help add load and resiliency to your hamstrings click the video below! You will see the progression of the Nordic Hamstring Curl exercises going from easiest to hardest!
Keep in mind, these hamstring tendon problems will not be quick fixes. It’s going to take time. Your physical therapist can help you with some manual techniques such as dry needling or instrument assisted soft tissue mobilization (IASTM) to that area.
Some of these manual techniques may help to get you out of the pain a little bit earlier and then utilize progressive exercises to help the pain the long run. It’s also possible to see an SI joint discrepancy as a contributing factor to the hamstring pain. We want to address the contributing factors and discover what exactly is causing your pain!
Hamstring tendinopathy conditions are rarely muscle length issues. This is a common perception that individuals have. There is no research that shows that hamstring muscle length contributes to hamstring strains or tendon problems. Hamstring flexibility is something we can work on but it’s not one of those main contributing factors to the pain associated with the upper thigh/buttock pain we’re talking about. If we have tight hamstrings, it’s recommended to foam roll them then strengthen the glutes and load those hamstrings with the eccentric exercises.
To answer the question, one way you can self test if your hamstrings are tight is to simply lay on your back and pull your knee in towards your chest or you can kick your leg straight up. Your leg should reach about 90 degrees.
Perhaps you’ll be only be at 45 degrees (like the runner in the picture above). This is going to be something you really want to consider but not as important for our runners. However, for our dancers, gymnasts, and aerialists – they need that hamstring flexibility for their sport.
If you are a runner looking to stretch your hamstrings properly during your runs…check out this video below to properly stretch this muscle without putting strain on your lower back (especially if you have back pain with sitting and bending)
We hope this article helped to give you some insight on how to prevent and treat hamstring pain to keep you happy, healthy and running!
Check out all 5 of my healthy running tips in this previously posted blog article by clicking THIS LINK
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You could be an active adult starting out with a couch to 5k program or you may be an experienced marathoner!
The FREE Healthy Runner CT facebook group is your answer!
Our specialty here is prehab, rehab, recovery, and performance for all types of runners!
CLICK HERE to join our community http://bit.ly/HealthyRunnerGroup
Are you a runner that is trying to stay healthy but can’t train because pain is stopping you from meeting your goals?
Are you worried that an injury will limit you from doing what you love like working out and training?
Have you wondered what it will cost you in the long run if you continue to train through pain?
Have you seen other medical providers in the past that just tell you to stop your activity?
We have a unique treatment approach that focuses on solving these problems with our clients. We combine manual hands-on techniques with guided supervised exercises to help you get stronger, pain-free and perform at your peak level to get you back on the road doing what you love. Our goal is to help keep you active and on the road, while recovering from injury by guiding you in ways to modify your training, rather than eliminating running!
The SPARK Physical Therapy Commitment
No long waits or multiple trips to providers’ offices every week. We see you either onsite at a partnering gym or in the comfort of your home when it is convenient with your schedule.
One on one for a full hour with your doctor of physical therapy, every visit. We provide you with a customized plan specifically designed for you, based off your unique injury and goals.
Full transparency in what you pay. You will never get a bill from us a couple of months after your visit.
Access and availability to you! Have a question about your pain or exercise program? Get an answer from your therapist directly.
If you’re in the greater Hamden, CT area and are a runner that has been dealing with injuries we can help. We’d love to chat for a few minutes and see if you are a good fit for what we do. Fill in this CONTACT REQUEST LINK and we’ll set up a free-minute phone consultation with a doctor of physical therapy
Thank you for taking the time to read,
– Duane Scotti, PT, DPT, PhD, OCS
A special thanks goes out to Allie Eldridge, SPT for her contributions to this article
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Working with Duane has been a game-changer for my running. I’ve been in an endless cycle of injuries for the past five years and needed to make a change.
I connected with Duane through his Healthy Runner Facebook group, and then we began our virtual physical therapy visits. Virtual sessions work great for me because I’m constantly traveling and can access care wherever I reside. Even though I’m not in the clinic, I still receive the same quality of experience!
The best part is Duane is a physical therapist, runner, and coach, so he understands how important running is for our physical, mental, and emotional well-being! If you want to become a stronger, healthier, and faster runner, look no further!
In April, I was diagnosed with proximal hamstring tendinopathy, or PHT. If you haven’t heard of it or experienced it, let me tell you…it’s a real pain in the BUTT! Not only did it derail my training (I’m a runner/cyclist), simply sitting for more than 10 minutes at a time was unbearable. There’s very little research out there on this injury and finding credible information on how to effectively treat was difficult. The initial advice I got from my ortho was to stop running, rest, and stretch. This did absolutely nothing to improve my symptoms or help me get back to running. In fact, stretching made it worse! I also tried massage, dry needling, shockwave therapy…nada. In September, I stumbled on a podcast with Duane where he spoke in depth about his own experience with PHT and how he beat it, and how he helped others overcome this stubborn injury. I was also intrigued by his philosophy of not having to give up the sport you love while recovering from injury. I contacted Duane for a consult and have been working with him since October. After assessing and reaffirming my diagnosis, he put together a customized, structured rehab program focused on progressive loading of the hamstring tendon and supporting muscles WITHOUT giving up running! Gradually, my pain began to lessen and my strength has continued to increase. I am now running four days a week and am closer than at any point in the past 8 months to putting this injury in the rearview mirror for good. I’m looking forward to getting back to structured training and racing again in 2021…an unimaginable goal two months ago. Duane is awesome! His techniques and approach to injury rehab and prevention work. If you’re an athlete who has struggled with injuries that constantly disrupt your training, Duane is your guy!
“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!”