Perhaps the hardest part about discussing the topic of High Hamstring Tendinopathy (HHT) is resisting the urge to begin the conversation with a bad pun, but it is difficult to describe the affliction any way other than "a pain in the butt." HHT is a crippling injury that feels like a deep tightness or pain in one or both buttocks.
Typically, the pain is caused by a thickening or scarring of tissue at the connection of the hamstring to the ischial tuberosity (the sitting bones). This scar tissue was formed by the body in an attempt to heal soft tissue damage, though it inadvertently created extra tissue, forming trigger points of pain. It should be noted that the research on tendinopathy in the upper hamstring specifically is fairly limited (though much research has been completed on tendinopathies in general).
This means much of the knowledge about treatment for High Hamstring Tendinopathy comes from a 2005 study completed by Fredericson et al. This study can be found here. Fredericson found that there are 3 keys to curing HHT:
- Soft tissue mobilization
- Stretching
- Progressive eccentric hamstring strengthening
Let's start with a discussion of soft tissue mobilization. This procedure is often confused with a massage, which is simply the rubbing of muscles with hands with the goal of relieving tension. Any person could give any other person a massage. Soft tissue mobilization is a much more specific technique that must be done by a physical therapist. It aims to break up adhesions and scar tissue, thus relieving pain and increasing range of motion.
The next tool Fredericson found beneficial when attempting to cure HHT was stretching. Everyone knows what stretching is. Back in gym class we all had a loud instructor demanding that we "touch our toes." That is not exactly the form of stretching I am going to recommend here. There are many different forms of stretching that people find useful.
I recommend dynamic stretching before each run. Dynamic stretching is essentially stretching while moving rather than just reaching for your toes and holding that position for 30 seconds. Dynamic stretching more effectively warms up the legs, increases blood flow and allows the muscles to loosen up. When stretching, the goal is to not only stretch the muscle that is tight (in this case the hamstring), but rather to work out every muscle so your legs are entirely loose and nothing is tugging on anything else. Here is a sample warm-up stretching routine:
- Forward leg swings while walking- each step swing one straight leg out forward to stretch your hamstring, then the next step do the other leg. Do 10 reps on each leg.
- Knee tugs- Each step pull one knee toward your chest to stretch your quad and glute. Do 10 tugs on each knee.
- Butt kickers- Bring the back of your heel to your butt each step. Do 10 reps on each leg.
- Toe walks- Walk up on your tippy toes for 20-30 steps to work the calves.
- Lunges- Work the upper legs by doing lunges. Do 5 reps on each leg forward then do 5 reps on each leg backward.
- Glute Bridge- Lie on your back with your feet flat on ground so your knees rise and form an upside-down 'V.' Raise your butt off the ground. Hold for 2 seconds then lower yourself. Repeat 10-20 times. You will feel this in your glutes and hamstrings.
- Squats- Make sure to focus
on squeezing your butt and get power out of your glutes. Do 2 sets of 10
squats.
- Leg curl on exercise ball-
Lie on your back with your feet on top of a big exercise ball (calves against
the top of the ball). Roll your feet backwards until you are in a bridge position,
then return to the original position. Do 2 sets of 5-10 repeats.