Many runners take exceptional care of their bodies: they are diligent about doing all the right things, fine tuning their running performance. That said small deviations in joint alignment or poor muscle activation can contribute to pain and decreased running efficiency. How? The repetitive strain of training, racing etc. means high reps, sometimes at high intensity over a long period of time. This process can eventual lead to a breakdown in soft tissues. Diligent stretching, foam roller work, strength training, diet/nutrition and rest are all good injury preventative habits for runners. What do you do when you still have recurrent hamstring pain even when you do diligent prehab?
Hamstring pain is a common complaint of runners. They typically come into my office saying their hamstrings are “tight”, they’ve been stretching but the pain persists. There are several reasons why anyone would have hamstring pain, the big red flag is sciatica and lumbar spine dysfunction, sacroiliac dysfunction is another red flag injury. Ruling these out is an important first step in the assessment process.
Muscle “tightness” is not a predictor of pain, in fact I prefer to see some hamstring stiffness in runners, too much hamstring mobility is not good for long distance runners. A range of motion test is more than measuring angles: I listen to knee/hip joint, nerve and soft tissue movement with my hands. If movement of all these tissues is adequate then it’s onto other tests to determine muscle function.
Muscles work in concert to produce movement, individual muscles can be injured (strain) and individual muscles can be weak as well, it all depends on what muscle: what does it do and where in the body is it located. The hamstrings are a group of three muscles, they span both the hip and knee joint contributing to hip extension and knee flexion. They work in concert with the gluteus maximus to to produce hip extension (leg goes behind body). They work with the gastrocnemius (calf) muscle to flex the knee. The hamstrings also slow down the forward swing of the leg. Sprinting can be hard on the hamstrings: the rapid, forceful forward swing of sprinting is typically when and how the hamstrings are torn or spasm.
Since the hamstrings work in concert with these other muscles it is important to assess muscle firing (contraction) patterns. With certain cases of hamstring pain it is not uncommon to find that the gluteus maximus is not firing in conjunction with the hamstrings to produce hip extension. In these cases the hamstrings will often cramp with exercise since they are bearing a heavier movement load. In other words the gluteus maximus should be helping the hamstrings and they aren’t.
In the cases where I find an under active gluteus maximus the focus shifts from addressing pain to re educating the gluteus maximus to fire appropriately in conjunction with the hamstrings. Specific “reactivation” exercises combined with gait re – training is usually very successful in reducing pain/cramping. In the process of activating the gluteus maximus the runner will improve their running mechanics and stride. Hill running will be much more efficient with stronger glutes.
Changing how someone activates their muscles or changing how they run is not an easy task however. Some athletes are better than others at listening to their body, doing the exercises and making mechanical corrections. It takes focus and discipline to listen to the body and turn switches on that were previously shut off.