{"id":2398,"date":"2016-05-25T18:59:02","date_gmt":"2016-05-26T01:59:02","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=2398"},"modified":"2016-05-25T19:02:17","modified_gmt":"2016-05-26T02:02:17","slug":"chronic-hamstring-pain","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=2398","title":{"rendered":"Chronic Hamstring Pain"},"content":{"rendered":"<p>Many people suffer from chronic hamstring pain.  The question is what is the root source the pain?  As a seasoned clinician, I see many patients who present with pain in the upper hamstring\/ischial region.  Referral sources can include the low back, hip, SI joint, proximal hamstrings, gluteals, piriformis, and ischial bursitis to name a few.  In some cases, the pain can be multi-factorial as I see some runners with low level discogenic (nerve) pain and proximal hamstring tendinopathy. \u00a0The sciatic nerve and its proximity with the hamstrings necessitates thoroughly vetting the symptoms and its pattern in each client. \u00a0Assessing SLR, slump test, reflexes, myotomes and dermatomes is a must.<\/p>\n<p>Determining what the exact source of can be difficult and requires a good subjective exam and objective testing.  For the purposes of this particular post, I am focusing on the proximal hamstrings themselves as the primary source of the pain, as I see so many who struggle with proximal tendinopathy who have seen many providers with little relief.<\/p>\n<p>I treat many runners and middle aged adults who experience this high hamstring or buttock pain that is often worse with:<\/p>\n<ul>\n<li>Sitting<\/li>\n<li>Forward bending<\/li>\n<li>Walking or running uphill<\/li>\n<\/ul>\n<p>As with traditional hamstring strains, eccentric strengthening is a must for this population. \u00a0However, we must consider the myofascial component and contributions to this pain as well. \u00a0In many cases, these patients have ischial tuberosity tenderness. Consider the referral pattern of the medial HS illustrated below:<\/p>\n<p><a rel=\"attachment wp-att-2400\" href=\"https:\/\/blog.brianschiff.com\/?attachment_id=2400\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-2400\" title=\"img_4157\" src=\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2016\/05\/img_4157-169x300.png\" alt=\"img_4157\" width=\"169\" height=\"300\" srcset=\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2016\/05\/img_4157-169x300.png 169w, https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2016\/05\/img_4157-576x1024.png 576w, https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2016\/05\/img_4157.png 640w\" sizes=\"auto, (max-width: 169px) 100vw, 169px\" \/><\/a><\/p>\n<p>I typically like to consider using hip and core strengthening, dry needling, IASTM, stretching and eccentric strengthening to address the pain. \u00a0If I feel the problem may include a sciatic nerve component and there is an extension bias, I will utilize some PA glides and extension exercises too. \u00a0In addressing this pain pattern, we must be thorough.<\/p>\n<p>A 2014 case study published in JOSPT looked at a case study with two runners (71 and 69 y\/o men) who were treated with eccentric exercises, trigger point dry needling and lumbopelvic stability exercises. \u00a0The rehab was phase based and the results are as follows:<\/p>\n<p>Patient 1 was treated in physical therapy for 9 visits over 8 weeks. At discharge, he had achieved his goal of running 8 to 10 km 5 times each week pain free. An e-mail received 6 months following discharge noted that he had remained symptom free with all activity and that he completed a triathlon symptom free.<\/p>\n<p>Patient 2 was seen in physical therapy for 8 visits over the course of 10 weeks and discharge were performed by the same therapist who performed the initial evaluations and oversaw each treatment. \u00a0He was discharged after running 30 km without symptoms and reporting significant decrease in hamstring pain. The patient was seen 6 months later in physical therapy for unrelated right shoulder subacromial impingement but reported no hamstring symptoms and that he had participated pain free in a marathon.<\/p>\n<p>In my practice, I have found dry needling, heat and soft tissue work to be very helpful along with stretching and strengthening. \u00a0I like to use eccentric PREs and hip stability work to resolve proximal hamstring pain.  Specifically, I have used the following two exercises with very good results:<\/p>\n<p>Single leg RDL<\/p>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/VXk281nEDXw\" frameborder=\"0\" allowfullscreen><\/iframe><\/p>\n<p>Supine reverse hamstring curls using gliding discs<\/p>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/RhCVjsqRd4s\" frameborder=\"0\" allowfullscreen><\/iframe><\/p>\n<p>Both of these exercises are effective in promoting eccentric hamstring strength, hip stability, and improved hamstring mobility.  Furthermore, they can be effectively used in rehab, rehab and training situations.  I routinely use them in all of the above.  For a more detailed explanation of the reverse curls, be sure to check out my upcoming Functionally Fit column at www.fit-pro.com.<\/p>\n<p>Keep in mind that hamstring pain can be caused by one or multiple sources.  It is best to seek a medical evaluation to determine the exact source of pain and address it safely and effectively.  Exercises such as the ones demonstrated in this post represent a few options for addressing hamstring strains\/tendinopathy.  Others may include Nordic hamstring curls, prone eccentric hamstring curls and hamstring walkouts.  Using manual interventions along with exercise is often effective in accelerating and optimizing full recovery.<\/p>\n<p>Reference<\/p>\n<p>Jayaseelan DJ, Moats N, Ricardo C. Rehabilitation of Proximal Hamstring Tendinopathy Utilizing Eccentric Training, Lumbopelvic Stabilization, and Trigger Point Dry Needling: 2 Case Reports. <em>J Orhtop Sports Phys Ther<\/em> 2014 (44)3:198-205.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Many people suffer from chronic hamstring pain. The question is what is the root source the pain? As a seasoned clinician, I see many patients who present with pain in the upper hamstring\/ischial region. Referral sources can include the low back, hip, SI joint, proximal hamstrings, gluteals, piriformis, and ischial bursitis to name a few. [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[188,3,43,7,31,8],"tags":[125,344,126],"class_list":["post-2398","post","type-post","status-publish","format-standard","hentry","category-acl-knee","category-fitness","category-hip","category-injury-prevention","category-knee","category-rehab","tag-hamstring-injury","tag-hamstring-pain","tag-hamstring-rehab"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.10 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Chronic Hamstring Pain - Brian Schiff&#039;s Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blog.brianschiff.com\/?p=2398\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Chronic Hamstring Pain - Brian Schiff&#039;s Blog\" \/>\n<meta property=\"og:description\" content=\"Many people suffer from chronic hamstring pain. The question is what is the root source the pain? As a seasoned clinician, I see many patients who present with pain in the upper hamstring\/ischial region. Referral sources can include the low back, hip, SI joint, proximal hamstrings, gluteals, piriformis, and ischial bursitis to name a few. 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