High Hamstring Injuries- What A Pain in the @$$!


Pain in the high hamstring area is one of the most common (and most frustrating!) athletic injuries. It hurts when you run, when you bike, when you sit, drive, tie your shoes, brush your teeth... it just hurts ALL OF THE TIME. Chances are if you have ever suffered from a hamstring injury even reading this first paragraph will make you a little queasy; they can be a notoriously persistent and long lasting issue. I still maintain that, given a choice, I would pick a stress fracture over a hamstring injury any day. When a bone heals, it heals. It stops hurting and you can start running. A soft tissue/hamstring problem can wax and wane seemingly without any reason and can certainly outlast your optimistic attitude. Allow me to be a little dramatic- it can squash your season and your soul. 

So why does the hamstring take so long to heal, and why is it essential to seek treatment sooner rather than later? Let us consider...


The hamstring crosses two major joints in the body, and is responsible for both hip extension and knee flexion. This places the hamstring at even more risk for injurious forces and can increase the necessary recovery time. Recovery can be further delayed by misdiagnosis of the actual injury and failure to correct poor movement patterns and postures which caused the injury in the first place.

The hamstring is not a single muscle, but a group of three (arguably four) muscles which originate at the ischial tuberosity (read: sit bone) and attach below the knee on both sides. The infamous sciatic nerve innervates (read: feeds, makes work) the hamstring. The relationship between the sciatic nerve and the hamstring is significant                       and will be further explained below. 

To effectively treat hamstring pain, there must be an understanding of its root cause. WHY was the tissue injured in the first place? Why the hamstring, and why one side verses the other? This leads us to...


  • A hamstring sprain, strain, or pull- is a result of a micro trauma to the muscle fibers. Pain can be felt near the buttock, near the back of the knee, or anywhere along the length of the muscle belly. The injury can come on gradually or suddenly (as in during a sprint or a kicking motion) and can sometimes be accompanied with bruising or swelling in the back of the thigh.
  • Hamstring tendonitis or tendonosis- Tendonitis (an inflammatory response within the tendon) or tendonosis (degradation and disorganization of the tendon fibers) of the hamstring is a common           and frustrating injury. Pain is typically felt at the top of the thigh and gluteal area and will be worse with prolonged sitting, running hilly terrain, or doing speed work. 
  • Neural tension with or without low back contribution- A nerve may be restricted at multiple points along its path: where it exits the spine, where it dives under specific muscles, and/or where it bends around boney prominences. If the sciatic nerve doesn't glide and slide like it should (ie. "neural tension") it may mimic a feeling of extreme hamstring tightness. Furthermore, if there is neural tension in the sciatic nerve, the hamstrings are unable to work at their full capacity. This means that they are more likely to be overused, strained, and injured. 
  • Form and posture deficits- Poor movement patterns which overuse or overstretch the hamstring-muscle tendon complex put the tissue at risk for injury. This can include: weak abdominals, inactive gluteal muscles, unstable hips, overactive quadriceps and shortened hip flexors. These are intrinsic factors, or factors that are specific to an individual’s body.


  • Extrinsic Causes- Extrinsic factors can also contribute to hamstring injury. An extrinsic factor is an "oops, that was stupid" or "probably shouldn't have done that" factor. Examples include a drastic increase in training intensity and/or volume. It could also be a sudden change in training activity (hot boxing 6x a week starting tomorrow anyone? YEYYYYY) or footwear. Weather can even be an extrinsic factor, like very very cold temperatures. 


Full rehabilitation and return to activity is certainly possible after a hamstring insult. I don't want you to think that your athletic life is over and that you should expand you scrapbooking skills. However, a thorough evaluation and specific recovery program is typically necessary.

  • Manual therapy- techniques such as ASTYM, joint mobilization, trigger point dry needling, and soft tissue work is extremely beneficial in reducing immediate symptoms and allowing return of normal movement patterns.
  • Progressive strength program- a specific program to strengthen the hamstring tendon, muscle, and supporting muscles is a must. The program should not provoke lasting symptoms, but also needs to be challenging enough to produce strength gains and changes in tendon health. Just "resting it" is not always the answer and can actually delay recovery in certain circumstances. 
  • Assessment of form- running form, bike fit, standing posture, etc in order to ensure that you are not moving repetitively in a pattern that continues to irritate your hamstring with every step, peddle stroke, and passing minute. 

I always joke about starting a Nashville-Female-Endurance-Athletes-Suffering-Or-Having-Suffered-From-Hamstring-Insult support group. I'm only 10% kidding. It's real people. 

Link to MY physical therapist's blog and my own personal experience HERE

Don't let your hamstring injury be a pain in the, I'm gonna say it...ready? ASS! Don't let it be a huge pain in the ass! Consult with your physical therapist today.