A pain in the backside: High Hamstring Tendinopathy by Tracy Hannigan

Tracy Hannigan

So you've been running down hills a lot, or maybe more than you are used to...or you're doing sprints or interval training....and you start to get this pain in your backside...right at the top of the back of your thigh and into your buttock. It is a deep pain, and can be intense if you press into that difficult to reach spot. You feel it when you do static stretches of your hamstrings, when you start to run, and especially when you get out of the bed in the morning - and you really feel it when driving. You don't know anyone else who's had it, because it's not as common as other recreational running injuries (like shin splints).

What is high hamstring tendinopathy?

Otherwise known as proximal hamstring tendinopathy, this problem is caused is an inflammation of the hamstring tendon insertion. There are three hamstring muscles, and they all attach in the same place: at the ischial tuberosity (the base of your sitting bones). High hamstring tendinopathy is an overuse syndrome. Eccentric pull on the hamstring tendon, which happens when we do things like run on hills, can sometimes create unusual strain and stress at the tendon origin. This can cause inflammation which, if not managed well, can develop into debilitating pain.

What can I do about it?

Once you have been fully assessed by a qualified professional and know you have a high hamstring tendinopathy, you will need to do the impossible for a short while: stop running. Not forever - but until you no longer have pain when you are sitting or standing, and when you can do something like a gentle lunge with the bad leg and have no pain. They key to returning to running is to go slowly, be guided by your body (not your 'time' and not your 'distance' goal)! Slowly run down the street (short street, and don't worry about reaching the 'end'!) It may be a little uncomfortable to run - very mild discomfort that doesn't impede your jog is usually acceptable. If it's more than that, you should stop because you may risk a flare up.

The key part of working back up to your normal running routine is to see how you are a day or two afterwards. If you have no pain throughout that 48 hours, you can very (!) slowly increase the amount you are running. When you increase to the point of more than mild pain during your run - OR - pain returning during that 48 hours after the run, you may want to consider lowering your distance back to where you had no pain. Very slowly you will be able to work up to where you were before for easy flat distances. You will want to wait some time before adding hills and sprints back into your running as these cause significantly more strain on the tendon than normal running.

Part of your rehab should often be to do some general strength and conditioning exercises of the hamstrings, but be sure to leave enough time for tendon recovery - at least a day between strength exercise and running.

Remember: pain is never normal and this kind of pain can have several different causes. Always see a qualified professional for diagnosis and support in your recovery.

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