Member Case Study: Hamstring Pain

author : AMSSM

comments : 1

This is a “hip-butt” injury, which describes the location of the insertion of the hamstring tendon at the base of the pelvis on the ischial tuberosity very well. They are difficult to treat.

Question from Ed Movic
Everything was going along just fine. Then one morning I could not get into the pool in a timely fashion so I jumped on the elliptical trainer. Low impact...what could it hurt? (I have a rule; Never get on the moving equipment. Go outside no matter what the weather.) I broke my rule got on the machine and began the march for about 40 minutes. Got off felt okay. It was the next couple of days when the right hamstring was really sore. Limping sore. Iced it, heating padded it, rested it but not enough apparently, hot tubbed it, ibuprophened it. This all started about 6 weeks ago.

Now I have a nagging injury. Swimming and biking do not seem to bother it. If I run slow and steady on the level for a few miles I’m okay. But it’s there. Sometimes low level aches other times it's pop-you-in-the-air hurt. I know what a hamstring does. I’m sure my quads have over-powered that little muscle. This week I’m off the running, going to a masseuse, starting back on the Advil all cause it doesn’t hurt as bad.

Sincerely,
Ed Movic

Answer by Grant Morrison MD

Member AMSSM
Many questions about your injury come to mind; the first being - where do you live? Here in Minnesota, going “outside no matter what the weather” can be a life threatening, especially at 20 below zero Fahrenheit. Nevertheless, you appear to have pinpointed the source of your injury as the hamstring, and to be more specific the “high” or proximal hamstring tendon. Without more details regarding your training I am not certain how you got there. My running friends call this a “hip-butt” injury, which describes the location of the insertion of the hamstring tendon at the base of the pelvis on the ischial tuberosity very well.

In my experience, they are notoriously difficult to treat, and virtually all of my patients come in describing your symptoms, with incredibly extensive stretching efforts. To me, this indicates that stretching is not going to help. First thing I recommend is to stop stretching the hamstring – stretching might relieve pain temporarily, but in the same way a repeatedly stretched rubber band will eventually wear thin and snap, I fear persistent stretching is likely to cause more severe injury. Secondly, I will work with runners and/or their physical therapists to enhance other hip muscles especially the glutes to take up some of the work of pulling or extending the leg back, relieving the strain from the hamstring. Additional treatments include eccentric hamstring strengthening, irritant therapies such as Active Release Therapy or prolotherapy and others to stimulate tendon healing.

Running on flat surfaces at a gentle pace seems to be ok, but hill training, speed work, and increasing mileage all seem to prolong or prevent healing time. Fortunately, with triathlon training, there is always something else to work on. Good luck with your efforts, and be patient!

Grant Morrison MD
Family and Sports Medicine
Edina Sports, Health and Wellness

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date: April 11, 2007