Hamstring Pain in Runners
How to Prevent & Treat Hamstring Symptoms

By: John Fiore, PT
Sapphire Physical Therapy

The hamstring is a complex muscle group which has a dual identity.  Unlike most muscles in the human body, the hamstring crosses two joints and plays a role in two distinct movements.  The hamstring’s primary function is to flex or bend the knee.  If your knee bends, you can thank your hamstring for its work.  The hamstring’s secondary function is to aid in extending the hip.  Because the hamstring crosses both the hip joint and the knee joint, it is a key muscle in the running stride.  Understanding the hamstring is the first step in preventing and treating hamstring related running injuries.

The hamstring is comprised of three muscles. All three hamstring muscles originate on the ischial tuberosity of the pelvis.  The semimembranosus and semitendinosus muscles attach on the medial side of the lower leg (tibia) below the knee.  The biceps femoris attaches on the lateral side of the lower leg (tibia) below the knee.  The hamstring muscle group works in opposition to the quadriceps muscles.  When you are flying down a hill at full speed, quads pounding and quads burning, the hamstrings act as the “brakes” to prevent knee hyperextension and to initiate the push-off phase of running.

Many runners become “quad dominant.”
Our quad strength increases as we run further, faster, and up and down steeper hills.  In contrast, our hamstrings often pay the price and are unable to keep pace with the power of our quadriceps.  A muscle imbalance between the quadriceps (agonist muscle) and the hamstrings (antagonist muscle) is created which may result in a hamstring overuse injury.  Simple standing, sitting, and supine hamstring stretches often miss the multi-faceted hamstring musculature.  The problem often lies in increase resting tone or tension in the overworked hamstring.  A qualified physical therapist performing deep tissue massage, muscle energy techniques, and contract-relax techniques can address pain and tightness in the hamstring secondary to overuse.

Decreasing pain is only one component of hamstring injury treatment.
Strengthening the hamstring in a manner consistent with running is key in preventing injury recurrence.  You can go to the gym five days a week and do hamstring curls to strengthen your hamstrings but still have pain while running.  The treatment secret is to understand the hamstring’s role during running.  Strengthening the hamstring in a lengthened state (eccentric) versus a shortened state (concentric) will result in hamstrings which are stronger and more prepared to check the power of the quadriceps while running.  Running fast and racing often results in a longer running stride which further stresses the hamstring and makes eccentric strength training necessary.

Remember to include gluteus maximus strengthening as well.
The gluteus maximus is the primary hip extensor in our body.  The “overachieving” hamstring often tries to steal the role of main hip extensor and becomes further stressed.  A very similar battle for dominance exists between the tensor fascia latae (TFL) muscle and the gluteus medius muscle.  The take home message is this:  Don’t forget to role, release, and eccentrically strengthen your hamstrings, and see a qualified physical therapist to rule out underlying injuries or referred pain to enable you to resolve your injury and return to the joy of pain-free running!

John Fiore, PT