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Fixing stubborn hamstring pain in runners and athletes:

Top 10 findings in my research/experience with treating these injuries

1. Eccentric strength of hamstrings are typically weak in runners that develop hamstring pain

Eccentric strength, most easily put, is the strength needed to control a movement during the opposite action that the muscle performs when activated. For example the hamstrings are responsible for bending the knee (concentrically) and controlling extension of the knee (eccentrically). If you do not have good eccentric strength of the hamstrings you will not be able to control extension of the knee during your running stride effectively, and can lead to injury over time.

2. Concentric hip extensor strength is often weak

Weak glutes often contribute to hamstring pain. The hamstrings are not only responsible for knee flexion (as mentioned above) but aid in hip extension. The glutes are the primary hip extensors and if they are weak they are not assisting the hamstrings appropriately. I’ll keep this simple- go do some weighted squats!

3. Hamstring flexibility is usually decreased on the leg with hamstring pain vs the other leg

Yes this means we need to stretch the hamstrings, but before you do WAIT! Overstretching an injured hamstring can cause more damage. If you have any bruising or swelling currently do not stretch it yourself and contact a professional to make sure you do not further injure it.

4. Scar build up from injury often contributes to pain and needs to be addressed

With injury often comes scarring. When tissues scar down it affects the mobility of those tissues and sometimes the surrounding nerves. All of these things can be contributors to hamstring and posterior leg pain. The good news is scar and surrounding tissue mobility can be improved with the right techniques. I often use deep tissue mobilization techniques with tools to help with this.

5. Physical therapy techniques including dry needling, scar tissue mobilization, and corrective exercise are effective for treatment

Dry needling is similar to acupuncture and uses microfilament needles to target taught bands of tissue within muscles. I have found this to be very effective with chronic hamstring pain and also fairly effective with acute hamstring injuries.

6. The sciatic nerve can be contributing to the pain and should be assessed

The sciatic nerve begins in the lumbar spine (lower back) and travels down the back

of the leg coursing by the hamstrings. Two branches of the sciatic nerve are responsible for sending the electrical signal to make the hamstrings work. With that said, it only makes sense that scar tissue build up or problems of the sciatic nerve will affect how the hamstrings work and feel.

7. Temporary training intensity modification may be necessary

Yes you may have to back off on running mileage or even stop running TEMPORARILY when correcting your hamstring injury/pain. The key here is temporary-least amount of time possible while making sure the hamstrings can heal.

8. Lumbar and pelvic manipulation can be effective for treatment

A tight back can contribute to excessive stress on hamstrings or hip flexor muscles so getting

the back to move better is an effective way to take some stress off. Also it can calm irritated nerves (such as the sciatic nerve) that can directly affect the hamstrings. I often use the technique below with good results!

9. Progressive loading of hamstrings is needed for rehabilitation

Yes the hamstrings need to be worked to recover! The key is progressing at the right rate and intensity. This can be a delicate balance and is why I recommend having a professional assist with progressive loading; too much load can cause more damage but not enough load won’t stimulate healing.

10. Lumbopelvic stabilization/control exercise is effective for preventing injury and hamstring rehab

A lot of times we group the hip and stomach muscles and refer to them as the “core”. Good core control while exercising, lifting, running, and most daily activities helps prevent injury. It can also help prevent hamstring injuries so work your core!

I hope this has been helpful to anyone who has been dealing with hamstring pain. If any of the following describes you then reach out to me for extra guidance and help:

- You have already had some form of treatment that did not get you all the way better

- You have tried to rehabilitate your injury yourself but it still hurts

- You are not able to participate in the activities that you love

- You have been dealing with the injury/pain for a long time

- You are thinking "I just don't think it's ever going to get back to normal"

- You would like to to get your injury/pain fixed faster

- You're ready for expert treatment

Author: Dr. Silem (Sal) Gomez-Gould PT, DPT, COMT, CCI


Jessica Kersten
Jessica Kersten
Jul 21, 2021

Great read, thank you for sharing! I've recently started running again and will use the tips you suggested to strengthen my body. I didn't know there were so many contributing factors that could lead to hamstring pain and what you could do to prevent it from happening. On #3 - Hamstring flexibility is usually decreased on the leg with hamstring pain vs the other leg, do you happen to have some stetches that you could recommend to help with my hamstring flexibility?

Sal Gomez
Sal Gomez
Sep 04, 2021
Replying to

Yes I do! I typically recommend dynamic hamstring stretches as a warmup prior to working out rather than static stretches. Here's a link to a good dynamic hamstring stretch warmup.

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