If you are like most, it’s no uncommon thing to get that sudden PAIN in the butt.

Am I right? Especially you runners out there. You train your tails off, and you suddenly come to a daunting stop when you feel that hamstring pain is creeping up.

What gives? You strength train, do the occasional bridge and feel as if you have strong legs.

So Am I Still Hurting?

Too often, we fail to realize just how our body truly works. Our hamstrings are essential muscles. They are a group of three muscles: the biceps femoris (long head), semimembranosus, and semitendinosus.

All three posterior thigh muscles originate from the ischial tuberosity (sit bone) of the hip and insert into either the tibia or fibula at the knee. The hamstrings flex the knee and extend the hip; thus, you must do the opposite actions: extend the knee and flex the hip to stretch the hamstrings.

Hamstring injuries are one of the most common for athletes, which is why I want to take a second to give you some insight as to why your “rehab” isn’t working. Your hamstrings are typically tight because other muscles are not doing their job. The body has tiny muscles inside the hip. When they get tight they pull on the pelvis which can add a lot of compression to the lower back. Additionally, suppose you have ever heard of the term reciprocal inhibition, well. In that case, it could be the very reason why your passive stretching routine isn’t working.

In many cases, this phenomenon is where the quads being overly active dips the pelvis into a slight anterior tilt, which can add to your excessive stretch of the hamstring. The leg that pushes us off the ground is in knee flexion and hip extension when we run. Both of these positions maximally lengthen the quadriceps. Suppose the quadriceps (specifically the rectus femoris) have limited flexibility. In that case, it can pull the pelvis into that anterior pelvic tilt which can be a bad end result for the hamstrings to be constantly “pulled upon” during daily activities.

What’s worse, stretching statically a tendon that is already over-stretched(the culprit of a tear) is a recipe for disaster. You don’t want to over-stretch the region, which is where reciprocal inhibition comes in. It describes the neurologic process of muscles on one side of a joint relaxing to accommodate a muscle contraction on the other side of that joint. In this case, the hamstrings are relaxing when the quads are doing the work. Like I mentioned earlier, this can put your low back and pelvis into places it shouldn’t, which will excessively burden the normal length of the hamstrings. This can be even more problematic for females, who have less rigid ligamentous restraints (more congenital laxity) to protect them.

The Result = MORE Pain

So losing stability and extensibility in the muscle is never a good thing, so excessively stretching them is not always the best course of action. Now, when stretching, if you feel a stretch in your lower leg, you may be dealing with more of a nerve-related issue coming from the sciatic region. It is the largest and longest nerve in the body and unlike muscles, nerves do not like to be stretched or tensioned. Instead, nerves are supposed to glide or slide within soft tissue nerve beds so this could be an issue outside of your normal care. The key to improving nerve pain is increasing blood flow, but that is for another post.

Think about one KEY thing when stretching them….ankle dorsiflexion! You want to be moving, gliding, and pointing your toes up in some situations to co-activate the hamstrings.

So What Should You Do?

Eccentric Training for Hamstrings

Researchers have determined through isokinetic testing (via high-tech research laboratory equipment) that a strength imbalance ratio of > 20% between eccentric hamstring force production and concentric quadriceps force production resulted in a 4X increase in the risk of a hamstring injury compared to a normal strength profile ratio!

This means that the hamstrings must be strong enough to eccentrically control and offset the concentric action of the quadriceps during the push-off while running.

A unique adaptation occurs within the muscle due to eccentric training where sarcomeres are added in series (lengthways), increasing the muscle fascicle length. Increasing the fascicle length does two things:

1. Increases the contractile velocity of the muscle
2. Shifts the optimum length-tension relationship to longer muscle lengths

This means there is an optimal length at which there is peak tension. If the muscle length goes past this point of tension, problems arise for the hamstrings. Research has suggested that those who produce peak tension at shorter muscle lengths are more susceptible to hamstring injuries.

By implementing eccentric hamstring training, we can shift this optimum length further to the right, allowing the hamstrings to produce peak torque at longer muscle lengths.

Once this is done, we can build stability in synergists to the hamstrings in the posterior pelvic tilt. In other words, there’s a heavy emphasis on glute activation and anterior core recruitment in exercise selection once stiffness is down.

So What Exercises Should I Do?

Start by working on getting more extensibility back into the hamstring with a few of these:

KB Loaded Hamstring Stretch

Extender Stretch

Hip Flexor Stretch

Bench Stretch

Then Work Into Your Eccentrics:

Eccentric Nordic Curl

(Two variations shown)

GHR Version

Anchored Version

Slider Leg Curl Eccentric

Swiss Ball Eccentric Leg Curl

So don’t let a pain in your tush be a reason to stop. Eliminating all activity is never the way to treat tears and tendon injuries. I hope this helps shed some light on a few things you can do to get yourself back to full strength.

What About Those Who Have A History Of Hamstring Injuries?

One thing to also note is the effect of previous hamstring injuries. This can be well-warranted for future strains and is something all athletes need to take into consideration. If you look at the hamstring itself, you will see that we sit on our proximal hamstrings attachments, which isn’t exactly good for blood flow and tissue regeneration. So a good indicator of an athlete who will need to stay on manual therapy and mobility or tissue work would be one with a previous history. This can even be hinted at from research done.

If you are an athlete and don’t spend time on your hamstrings, well, get to it! Remember living in anterior tilt all day can make your hour of training the reduce stiffness much harder, so work to correct posture and the possible poor tendencies that might be causing it.

Once you begin to train, be slow in progressing back to movements and exercises that combine hip flexion and knee extension. That will be putting the most stress on the region. Stick to hill sprints over regular sprints, front squats over back squats, and slowly work in your eccentrics.

References:

McGuigan MR, Wright GA, Fleck SJ. Strength training for athletes: does it really help sports performance? Int J Sports Physiol Perform. 2012;7:2–5.

ASKLING, C., J. KARLSSON, and A. THORSTENSSON. Hamstring injury occurrence in elite soccer players after preseason strength training with eccentric overload. Scand. J. Med. Sci. Sports. 13:244–250, 2003.