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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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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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!Read More
“I went to see Duane early into my marathon training with hamstring pain. At that time, I was barely able to run 3 miles and was in pain. After a thorough exam and analysis of my running, he was able to diagnose and start treatment that day. Duane provided me with exercises to strengthen my hamstring and surrounding running muscles, all while slowly building my mileage back up. He was honest with me about setting realistic goals for my race and helped me to meet those goals. With his help, I was able to run the New York City Marathon.”
“I first went to Duane prior to training for my first full marathon because I had some aches and pains from running that I wanted to sort out. Duane was able to diagnose the problems immediately and I went home pain free. The exercises he prescribed were personalized to my needs and within a few weeks, I felt stronger and pain free while running so I could get to healthy training! It’s great to have a physical therapist who understands athletes and encourages people to continue to stay active. I highly recommend Duane to any person who is looking to stay healthy while maintaining an active lifestyle!”
SPARK Physical Therapy was instrumental in my recovery of from achilles tendinitis. I visited a podiatrist who said I would need surgery to shave down a bone spur and Haglund’s Deformity. The recovery would be at least 8 weeks and at the time I was 24 weeks from running the NYC Marathon. Duane evaluated me and said I needed to work on my calf muscle and flexibility. We started treatment with dry needling and specific exercises that I could do on my own. The pain subsided and even after some long runs everything was starting to feel better. I will tell you that I ran and finished the NYC Marathon without pain or issues from my achilles. Had I not met Duane about a week after my podiatrist appointment I would have needed to defer my marathon and probably would still be recovering from the surgery. I was able to run through my injury safely and achieve my goal. The refreshing thing about SPARK Physical Therapy is they do not push for ton of session. I met my running goals in 10 sessions spread out over 3-4 months. Big Thank you to Duane and I highly recommend seeing him for any running injury you may have!
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