Proximal hamstring tendon pain is frustrating...period.
Runners of all distances dread this injury because it sinks its teeth in and sticks around for a long time if not managed properly. If you, or a runner you know, has ever battled a chronic hamstring tendon issue you understand how difficult it can be to beat it and run pain free.
Plus, if you comb the internet for information you will find conflicting advice...
Some say rest, some stretch, some strengthen, some injections, maybe even surgery is recommended...this wide array of options and lack of cohesiveness among medical professionals leaves you without a solid answer as to how to run again pain free.
Lack of a plan or direction of treatment just adds to the frustration of having a nagging hamstring issue....
Why Proximal Hamstring Tendon Pain Occurs
Let me try to "clear the confusion" about proximal hamstring tendon treatment based on current understanding and research.
First, proximal hamstring injuries occur secondary to tendon overuse. There are a variety of factors that influence overuse including running intensity, volume, and progression of running mileage week to week.
What I am going to mention here are the biomechanical reasons for hamstring tendon overuse.
1. Anterior Pelvic Tilt---When there is increased rounding of the lower back and a forward tilted pelvis, the hamstring is put on "stretch" due to the pelvic bone being lifted upwards.
2. Pelvic Drop--- During your run, when your affected leg is on the ground, if your opposite side pelvis drops it will also add "strain" to the hamstring tendon
3. Poor Gluteus Strength--- If your gluteus maximus and medius muscles are weak you will have difficulty controlling your pelvis while running which will result in the form changes noted above.
4. Poor Eccentric Hamstring Strength--- As you extend your knee and leg in front of you during the swing phase of running, your hamstring stretches and needs strength to control the velocity of leg motion to get it back to the ground for the next step. This is the most common movement where the hamstring tendon is injured.
So, we now know the risk factors for what causes hamstring tendon pain and the question remains how to fix it...
Clearing The Fog On Chronic Hamstring Tendon Pain Treatment
"I have been stretching my hamstring like crazy but the pain has not changed!"
Stretching is usually what most runners will try first to help alleviate hamstring tendon pain. Yes, this may provide some temporary relief and will "feel" like the stretch is doing some good...yet over time there will be minimal change.
Stretching alone is not enough stimulus to improve tendon tissue quality.
Basically the hamstring tendon is unable to tolerate the high forces placed upon it. That leaves two options. Take away the forces, through form correction and rest, or improve tendon "strength" enough to tolerate the loads.
Here are 2 proven ways to ease chronic hamstring tendon pain naturally...without cortisone or PRP injections.
1. Eccentric Hamstring Exercises
As noted before, the hamstring tendon is most affected during the end of swing phase while running. During this motion, the hamstring is performing an eccentric contraction. This means the muscle and tendon are working hard to slow down and stop motion versus creating motion (lengthening tissue versus contracting tissue)
In order to build up the tendon's tensile strength specific "eccentric" exercise needs to be performed.
First off, eccentric hamstring exercise is not ball curls, sitting on a machine and bending your knees against weight, or standing with an ankle weight and lifting your foot up towards your buttocks. These will all strengthen the hamstring but not in a "running specific" way.
So what does eccentric hamstring exercise look like? Just recently, the Journal of Orthopedic and Sports Physical Therapy published an article on how to using a treadmill for hamstring strengthening. You can check out the article in full here.
Standing facing backwards on the treadmill, with your affected hamstring side foot on the treadmill belt, try to resist the moving treadmill belt as it moves in front of you. Repeat this movement 2 times per day for 3 sets of 15 repetitions.
The article noted improvement in the case study subject within 2 weeks and full resolution of symptoms in 12 weeks. (This is similar healing time as the achilles tendon and patellar tendon, both of which responded favorably to eccentric training protocols)
Another way to perform eccentric hamstring exercise is through the use of an exercise band. This video will explain how its done.
#2 Improve Gluteus Strength To Control The Pelvis Biomechanical running errors are common in runners with chronic hamstring tendon pain. Pelvic drop, anterior pelvic tilt, and lack of hip extension all contribute to hamstring overuse.
To control these factors having strong gluteal muscles is crucial.
As in the eccentric protocol, it will take about 12-16 weeks to learn proper hip and pelvis control with running. It takes about 8 weeks to see real changes in gluteal muscle strength and another 1-2 months to learn proper motor control to use that strength with faster movements such as running.
It is important to isolate the gluteal muscles with proper activation exercises before jumping into weighted strengthening or single leg strengthening exercises. Usage of biofeedback such as muscle EMG, a sensor placed on your buttocks muscle that will provide visual feedback of the muscle contraction, drastically improves the ability to isolate the correct muscle and avoid wasting time by compensating.
Once your gluteal muscles are activated and strengthened you are ready to begin dynamic running specific strengthening and conditioning and running re-training with feedback.
2 Effective Chronic Hamstring Tendon Interventions
By improving your gluteal strength, pelvic control, and eccentric hamstring strength you can return to running without the nagging and frustrating hamstring pain you have been dealing with.
Don't waste anymore time resting thinking it is just going to get better. Take action today and start your journey to recovery!
Kevin Vandi, DPT, OCS, CSCS
Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.