Running Hamstring Pain: Causes, Treatment and Prevention Plan

Do you have tight hamstrings or is it the start of a running hamstring injury?

It’s always a fine line to figure out when we’re going from normal running discomfort to the edge pushing things farther than we should and especially with our hamstrings.

This is because many runners become quad dominant, and this results in tight hamstrings.

Tight hamstrings are uncomfortable, so we start stretching and stretching, and….well that doesn’t fix the issue, but it can lead us straight into an injury!

Hamstring strains are unfortunately one of the most common running injuries. Even a low-grade tear can leave a runner sidelined for weeks, even months.

If not dealt with properly, the frustrating injury can linger on and on.

But with the right care, gradual introduction back to running, and a proper warm-up and strength routine, the hamstring can stay healthy for a long time.

In this article, you’ll learn everything there is to that hamstring pain you’re feeling, what might have caused it, and how to fully recover to avoid re-injury during your next run.

Where is Your Hamstring?

Stay with me for a second as we go through the science, so that you know what you’re dealing with. The hamstring is made up of three different muscles located at the back of the thigh:

Semitendinosus
Semimembranosus
Biceps femoris

They start at the bottom of the pelvis at a place called the ischial tuberosity. Unlike most other muscles in the body, the hamstring muscle group crosses two joints, the knee, and the hip.

This means it plays a crucial role in two key running movements: bending the knee and extending at the hips.

Within these movements, the hamstring has three roles:

Acting as a braking system by gradually slowing down the front leg as it nears the ground, especially during downhill efforts
Extending the hip to propel the body forward
Assisting the calf muscle to help the knee bend (flexion)

Altogether, this makes the hamstring an essential component to the running stride.

What Causes Running Hamstring Pain?

Hamstring injuries occur when you strain, pull, or tear one of your hamstring muscles. This typically occurs during sports and activities that involve sprinting with sudden stops and starts, as well as sudden bursts of speed.

For this reason, you’re more likely to experience hamstring pain and injury if you’re a runner or are an athlete that plays sports such as soccer, football, basketball, or tennis.

That’s why you often see a sprinter suddenly grab the back of their leg with a look of horror on their face!

Distance runners are more prone to what is called tendinopathy, or inflammation of the hamstring tendon. This results like most inflammation from some kind of weakness or overuse.

Common causes of running hamstring pain are:

1. Muscle Tightness

Tight muscles are one of the most common causes of hamstring pain or injury. Tightness makes the muscles vulnerable to strain.

When the quads are too tight, they pull the pelvis forward, which then tightens the hamstring. This is why it’s incredibly important to always warm up before a run to counteract poor flexibility.

2. Muscle Imbalance

If one group of muscles is stronger than its opposing muscle group, it causes an imbalance that can lead to a strain.

When it comes to the hamstrings, this is commonly seen when we have weak glutes since glutes and hamstrings work together.

This makes the hamstrings work even harder and that leads to overuse and, therefore, pain or injury.

3. Muscle Overload

A hamstring strain generally occurs as a result of muscle overload. While running this occurs when your leg is fully stretched out just before your foot strikes the ground.

When your foot strikes the ground and all your weight is on it, the muscles can get stretched too far and they may start to tear. Having a proper running form can help avoid this particular issue.

4. Sudden Increase in Activity

Suddenly increasing how long or fast you run can put extra pressure on your muscles, including your hamstrings. Sudden increases in intensity can also lend to this.

So when a runner suddenly introduces speed or hill workouts before you’re ready, they increase their chances of having a hamstring injury.

5. Muscle Fatigue

Pushing yourself harder to build endurance is a common running goal, but it’s important to do it right.

When you’re not taking the necessary precautions, fatigue reduces the energy-absorbing capabilities of muscles which makes them more susceptible to injury.

How to Correctly Identify Hamstring Pain or Injury

Let’s decide if you have a strain, a little tightness, or just a bad day!

You’ll know you have a hamstring injury because they’re a pain in the ass. (but not the same pain in the ass as Piriformis Syndrome)

Literally.

Pain in the back of the thigh or lower butt is a telltale sign of a hamstring injury.

Common Symptoms of Hamstring Injury

Other symptoms and indications of a hamstring injury include:

Sudden, sharp pain during exercise
A snapping or popping sound
Swelling or tenderness
Pain while walking
Bruising or discoloration along the back of your leg

Source

Is it Really My Hamstrings That Hurts?

Here are a few things you can do to figure out if it really is your hamstring that hurts:

The “shoe test.” Take off the shoe of your injured leg using your healthy foot. If you feel pain when you pull up and out of your shoe, that’s a sign.
Extend your injured leg to a surface at hip height. Hinge at the hip to reach for your toes, as though you were stretching. If the pain exceeds beyond your normal stretching pain, then that’s your hamstring.
Press down on a surface with the heel of the injured leg. This could be done during the previous exercise while sitting on the floor with both legs extended in front of you, or on a Swiss ball while doing hamstring curls. Pain in the back of the leg means hamstring injury.

Identifying the Level of Severity of Your Hamstring Pain and Injury

There are three levels or ‘grades’ of hamstring injury:

Grade 1: A Mild Muscle Pull or Strain

This grade would be classified as a mild hamstring strain. It will usually cause sudden pain and tenderness at the back of your thigh.

If this is your level of hamstring injury, it may be painful to move your leg, but the strength of the muscle should not be affected.

Grade 2: A Partial Muscle Tear

This grade would be classified as a partial hamstring tear and are usually more painful and tender. You might also notice some swelling and bruising at the back of your thigh, and you may have lost some strength in your leg.

Grade 3: A Complete Muscle Tear

This grade would be classified as a severe hamstring tear, ranging from more than half of the fibers ruptured to complete rupture of the muscle. It will usually be very painful and tender.

In the most severe hamstring injuries, the tendon tears completely away from the bone

This will grade of injury there will be noticeable swelling and bruising, making it difficult to walk and stand. There may have been a ‘popping’ sensation at the time of the injury, and you’ll be unable to use the affected leg.

White Bay Physical Therapy provided this great chart to help understand what recovery time could look like.

How Is Hamstring Injury Diagnosed?

Mild hamstring strains can be treated at home (more on that later).

However, you should see a doctor if you can’t bear any weight on your injured leg or if you can’t walk more than four steps without significant pain. In severe cases, you may require surgery and several months of rest, and physical therapy.

You should also head to the doctor if your hamstring injury is not healing, or your symptoms are getting worse.

In most cases of moderate or severe hamstring injury, the doctor will be able to diagnose you by asking how the injury occurred and performing a physical examination of the area.

In case the medical practitioner isn’t too sure, he or she may ask for medical imaging to exclude all other possibilities. Two main types are usually used:

An X-ray can show your doctor whether you have a hamstring tendon avulsion. This is when the injured tendon has pulled away from a small piece of bone.
Magnetic Resonance Imaging (MRI) can create better images of soft tissues like the hamstring muscles. It can help your doctor determine the degree of your injury accurately.

Is It Ok to Run with Hamstring Pain?

Those with low-grade pain can try to continue running, but if the pain increases, then it’s time to stop.

Basically, if you can walk normally, but have pain in certain positions, go ahead and try an easy run to see how you feel afterward. If the injury is bad enough to alter your gait, then rest is in order.

The longer you run with hamstring tendinopathy, the worse it will get. If you can still continue running, put the speed workouts and hill repeats on hold for a bit. Other high-intensity workouts are out, as well.

Recovery can take a long time, depending on the severity of the injury.

Don’t return to previous level of physical activity until you can:

Move your injured leg as well as your healthy one
Feel as strong in your affected leg as in your healthy one
Feel zero pain when you graduate from walking, jogging, sprinting, and finally jumping over time.

If you start training before the injury is fully healed, you run the risk of prolonging the injury.

How to Loosen Tight Hamstrings and Prevent Injury

Hamstring strains have a notoriously high re-injury rate due to improper rehabilitation process. Over 60% of runners that strain their hamstring will do so again within the first year.

Yikes.

Let’s make sure that doesn’t happen and more importantly let’s take care of those tight hamstrings right now with some of my favorite things…pre-hab!!

Hamstring Strength Training

The best way to stop injury before it starts is to add strength to your training plan. To mitigate hamstring injuries, focusing on our glutes, core, and hips will go a long way (feels like I say this about 99% of running injuries).

Luckily for you, I have a whole host of resources for you to get those glutes and hips into tip top shape, this will help to keep your pelvis in proper alignment and reduce hamstring tightness:

Dynamic Warm Ups

I know I sound like a broken record at this point, but you must do a dynamic warm up.

Skipping the warm up is easy, especially when you’re already waking up at the crack of dawn to get your run in before you have to dash off to work.

I get it.

But your warm up matters.

Taking the time to do a proper warm up transitions your body from rest to activity by stimulating blood flow to the muscles that will do the work. A glute activation warm up will keep you injury-free long term.

Which is worse: waking up 10 minutes earlier or being sidelined due to a totally preventable injury?

At-Home Treatment for Mild Hamstring Injury

If you’re past the point of running with a tight hamstring and have moved on to a full blow injury, first up checkout these mental tips for recovery because that’s often the hardest part!

Next, it’s good to know many hamstring injuries can be managed at home, however severe cases should seek physical therapy to help with a more structured treatment plan dedicated to correcting the exact problem.

RICE

After digging deep into the research, I no longer recommend the traditional RICE method (rest, ice, compression, elevation). However, there are instances when components of RICE make sense.

If you felt the injury happen, apply ice immediately afterward for up to 72 hours. After that time frame, switch to heat. Physical Therapists now rely on a process called PEACE and LOVE, so I’m not just making up this no more RICE.

Compression

If you can tolerate easy running with the injury you have, then consider wearing a compression pants on your thigh during or after your run.

They work by helping to stabilize the muscle and support the quad and hamstring muscles.

Foam Rolling

Try rolling before and after your run to break down the connective tissue.

If you can’t run at all, then daily rolling for 10-15 minutes will help increase oxygen flow to the area, but ONLY if it’s not painful. You can’t massage a bruise to make it better.

Foam rolling the hamstrings is fairly straightforward. This post explains how to do so safely.

Rest

If running without pain is impossible, then you’ll have to rest. Take the opportunity to start doing yoga for runners like you’ve always wanted.

Or switch to a cross training activity, like swimming or cycling, as long as it doesn’t cause pain.

NSAIDs

You might be prescribed non steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) or other pain killers such as acetaminophen (Tylenol) that may help with pain and swelling.

It’s important to note that these medications should only be taken in the short term unless advised by a licensed medical practitioner, as long-term use can result in side effects.

Hamstring Recovery Exercises

Physical therapists recommend focusing on eccentric rather than concentric strengthening, which will result in hamstrings that are strong and can work in conjunction with the quad.

Eccentric exercises are those in which the muscle is in a lengthened state versus a shortened state.

Lengthening the muscles helps realign them and also strengthens the tendons and ligaments, which decrease the risk of injury. Further, eccentric contractions result in increased mobility.

A progressive treatment plan is essential for full recovery from hamstring injuries. What this means is gradually adding targeted hamstring exercises that focus specifically on strengthening the core, hips, and glutes.

Here’s a great video from my friends at The Run Experience with some exercises:

Additionally, small loop resistance bands and a stability ball are great for recovery strength.

They allow for resistance without straining the muscle from using too much weight before the hamstring is ready.

The exercise routines below use both tools and will help build the core, glute, hip, and hamstring power you need to get healthy again.

Core strength using the stability ball
Hip stability workout
Glute bridge – can be done without without a band or stability ball
This quick resistance band workout will make a significant impact on hip and glute strength.

Hopefully this gave you some ideas on what to look out for and what you can do at home if you have a mild issue of running hamstring pain. As always it comes back to working on our hips, glutes and abs! That core power for lasting pre-hab.

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