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Runners Series: High Hamstring Pain

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Posted by Eric J. Kropf, MD

Runners can experience pain and injury from their choice of activity at many levels: feet, shins, calf, knee, thigh, hip, and back. In our Runners Series of blog posts, we will cover a variety of injuries that can affect runners/joggers of all levels.

Frequently, runners are susceptible to injury when starting a new running program, returning to running following an injury, or when increasing the distance or speed at which you run. Factors such as training and shoe choice can often be controlled to help minimize these risks, but there are some anatomical contributors that can also affect your running health. Our runners series will aim to identify the factors you can control to keep you involved and enjoy your running program as long as possible.

Hamstring Injuries

One issue runners may often experience is hamstring pain or tightness. While not always debilitating, high hamstring pain, or pain that occurs near the origin of the hamstring muscles, can sometimes lead to chronic issues – including problems with sitting or even numbness or tingling down the back of the leg. When hamstring pain and injury becomes chronic, the door is also opened to multiple other problems that can inhibit your progress – sometimes presenting in hip flexor pain/tightness, IT band issues, and back pain that can throw off your training routine.

Hamstring injuries can range from tightness and mild strain to a complete rupture with fiber disruption. These types of injuries can vary from acute in nature, related to a single action or movement, to chronic issues such as muscular fatigue or overuse tendinopathies.

Factors contributing to the susceptibility of hamstring injuries include age, muscular tightness, muscular fatigue, muscular imbalances, insufficient warm up and previous injuries. Lack of flexibility is often named a contributing factor to hamstring injury, but can also occur as a result of acute injury. In addition, hip flexor tightness may also contribute to higher risk of hamstring injuries.

The challenge in managing and avoiding reinjury of the hamstrings is frequently related to the timing of returning to activities and adhering to a good maintenance program for maintaining both strength and flexibility. Returning to full activity too soon after a hamstring injury can place you at risk of not only recurrent injury but possible more extensive injury as well.

Treating High Hamstring Pain 

The non-surgical treatment of hamstring injuries usually begins with basic principles of rest, ice, compression and elevation to treat the acute inflammation. The goal here is to minimize pain and further injury to the area. It may be necessary to refrain from running following the onset of hamstring pain until your symptoms improve.

The use of non-steroidal anti-inflammatories (NSAIDs) is also often recommended for symptom control and for tendinitis-type injuries. However, long term use of NSAIDs can lead to other problems so it is important to monitor and use as directed.

Once the acute inflammation can be controlled, the treatment goals should shift to preventing muscular atrophy and promoting healing. Early pain-free active motion is essential to minimizing adhesion within the connective tissue, but should not be forced.

Hamstring strengthening exercises should be initiated - with knee flexion and hip extension based exercises such as hamstring curls, hip extension, hip bridges, etc. It is also important to address any related or contributing factors such as core weakness, gluteus inhibition, hip flexor/psoas tightness, iliotibial band (IT band) - in an effort to prevent possible future injury prevention and improve your all around running health.

Once pain free motion and strengthening is achieved, the next phase of rehabilitation is returning to your prior level of activity - without reinjuring the hamstring. The balance and timing of this phase can be difficult. The goal is to restore your strength and flexibility while advancing to a jogging progression that will return you to your prior level of distance/speed safely.

Following the return to your normal mileage and pace, a maintenance program encompassing stretching, strengthening and a global hip and core program are essential to avoiding reinjury.

Additional Options

In addition to the treatment procedure outlined above, your physician may recommend other interventions including corticosteroid injections. While these are still used in some cases, there are potential risks of tendon rupture and infection. There is also evidence that corticosteroid can sometime interfere with muscle regeneration.

There is also the availability of minimally invasive treatments such as autologous conditioned plasma or platelet rich plasma (ACP/PRP), dry needling, and acupuncture. These treatments may be beneficial in treating some chronic injuries, but should be discussed with a sports medicine professional if you are interested in pursuing these options.

In cases where symptoms begin to interfere with daily activities such as walking and sitting surgical intervention may be discussed to address the “chronic hamstring syndrome.” Proximal hamstring surgery is a specialized procedure and you should seek out the professional opinion of an experienced orthopaedic surgeon to discuss surgical intervention and the post operative recovery.

The information on this Site is for informational purposes only and is not intended as a substitute for medical professional help, advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions that you have regarding your medical care. For more information, see our Terms of Use.

Eric J. Kropf, MD

Dr. Kropf is an orthopedic surgeon and sports medicine specialist. He is Director of Sports Medicine, and Chair and Associate Professor of Orthopaedic Surgery, at the Lewis Katz School of Medicine at Temple University. His major clinical and research interests include evaluation and treatment of sports-related injuries in all age groups, specifically arthroscopic and minimally invasive surgery of the shoulder, elbow, knee, ankle and proximal hamstring repairs. In addition to having several publications to his credit, Dr. Kropf has given many presentations, both nationally and internationally, and is a member of the Arthroscopy Association of North America as well as the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports.

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