Common musculoskeletal injuries such as piriformis syndrome, plantar fascitis, and high hamstring tendinopathy affect a growing number of runners and triathletes. It’s been my experience that female runners tend to experience high hamstring tendinopathy more than men. Perhaps it’s hormonal. Perhaps it’s structural. Unfortunately research is limited.

High hamstring tendinopathy is an overuse injury most often seen in middle- and long-distance runners. High hamstring tendinopathy is quite literally “a pain in the ass”. As an exercise physiologist and coach, I’ve worked with many runners who will typically complain of a deep buttock or upper hamstring pain brought on during acceleration and at faster speeds. Some will even complain of sciatic and buttock pain while seated.

The Physician and Sportsmedicine, a peer-reviewed journal, published an excellent article in the May 2005 issue. I’d like to share a few exercises that might be of benefit. The following information is from this article and is available on-line.

HAMSTRING BIOMECHANICS DURING RUNNING
During running, the hamstrings have three main functions. First, they decelerate the knee extension at the end of the forward swing of the gait cycle. This action helps provide dynamic stabilization to the weight-bearing knee. Second, at foot strike, the hamstrings elongate to facilitate hip extension, again stabilizing the leg for weight bearing. Third, the hamstrings assist the calf muscles in extending the knee during the takeoff phase of the running cycle.

TREATMENT OPTIONS AND REHABILITATION
After an initial evaluation and diagnosis by a health care professional, several treatment options are available for relieving high hamstring pain, preventing its recurrence, and getting the athlete back into running.

Treatment typically includes:
• Pain control. Ice works wonders.
• Pelvic alignment if necessary. I would recommend a sports chiropractor who has experience working with athletes.
• Soft-tissue mobilization. Breaking up adhesions or scar tissue will help realign muscle fibers. I would recommend a health care professional who specializes in deep tissue massage, myofascial release or muscle energy techniques.
• Progressive hamstring flexibility. An appropriate stretching regime for both legs to ensure a balanced structure.
• Core-strengthening program. I’ve included snapshots of two very effective exercises. These are not as easy as they look and should be performed with someone supervising them. It’s quite easy to think that you’re aligned when doing them, but that’s not usually the case. One side will typically be weaker than the other and there will be a tendency to compensate and use other muscles which might lead to injury.

Exercise 1 - Prone plank with hip extension
Keeping your head level with the floor, support your body weight on your forearms (elbows bent at 90 degrees) and toes. Maintain a neutral spine while maintaining position. Each leg is lifted and held for 5 secs. Repeat 5-10 times per side alternating legs.

Exercise 2 - Bridge on ball with ball curl
These two pictures are part of a series of stability movements. Hips are raised until the knees, hips and shoulders are in a straight line. It’s important to keep your back in a neutral mid-range position. The bridge position is maintained as you push the ball forward and back. The goal is to be able to do this with both legs and then progress to single leg as shown.

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Dorothy Hamburg, M.S., Exercise Physiologist is a USA Triathlon Level II Expert Coach, an ACSM Clinical Exercise Specialist and Health Fitness Instructor, ACE Personal Trainer and TrainingBible Coach & Manager. Dorothy has recently launched TriSportsTraining.com, a site dedicated to women specific triathlon training & coaching. Dorothy is a two-time Ironman finisher, a SOS survivor as well as an ultra-distance trail runner and XTERRA regional champion. Dorothy can be reached at dhamburg@TrainingBible.com.