Chronic Hamstring Soreness

author : AMSSM
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Member Question

I'm sort of at a loss. I have a dull ache in the very center of my hamstring, generally throughout the day. "Flexing" / Tensing the muscle exaggerates the ache a little. Stretching, general movement and any exertion for the most part does nothing to help/hurt the situation. Running (when I was) relieved all pain "during" the run, but brought on a deeper ache afterwards.

I went to a sports specific doctor, he did his tests, told me I had possibly strained / pulled it, and told me to take 3 weeks off running.  After 5 weeks, I ran Monday night (5' total, 1' intervals at a 10min/mi pace - easy for me) and then yesterday was in the same feeling/shape I was in a month ago.

I really don't want to go back and blow another $800-$1000 for a 15' consultation and to be told "wait longer," but I suppose I will if I must. Any advice please?

Answer by Chris Koutures, MD, FAAP
Member AMSSM

Pain in the hamstring region can be very frustrating and challenging for triathletes- healing may take several weeks and there are many factors that may complicate the eventual outcome.  If there is a tear in the mid-portion of the hamstring, playing the waiting game to allow appropriate time for muscle repair may be part of the recovery process, but there are several other more active recovery aspects to consider.

Hamstrings work to extend the hip and flex(bend) the knee.  Several structures compliment hamstring function, including the gluteal muscles (namely the gluteus maximus), Iliotibial band, and gastrocnemius muscles.   In particular, gluteus maximus weakness may create a “hamstring dominant” individual where the hamstrings are in a constant state of relative overuse.  A properly designed gluteus activation and strengthening program can reduce demand on the hamstring muscles.

The hamstring muscles attach to the lower aspect of the pelvic, so imbalances of the pelvic region, including dysfunctional movement of the sacroiliac joints or a forward tilting of the pelvis, can also put undue pressure on the hamstring muscles. Correcting these imbalances and increasing motion at the sacroiliac joints is often essential for healing of a hamstring injury and to reduce risk of recurrences.

While relative rest is a key to a hamstring muscle tear, more active rehabilitation techniques can also be quite helpful. Eccentric exercises (slow, lengthening activation of the hamstring muscles) have been shown to enhance recovery, while friction or direct massage techniques can reduce restrictive scar formation.

Other injuries that mimic a hamstring injury.  Now if hamstring injuries weren’t frustrating enough, injuries to the spine/pelvic bones or to the sciatic nerves that come from the lower back into the buttocks area can mimic the pain of hamstring injuries, but may require different rehabilitation methods.

How to put this all together? Start with finding a sports medicine physician (check out the American Medical Society for Sports Medicine website) who can perform a complete physical evaluation, confirm the proper diagnosis and mechanical issues, and then make appropriate recommendations about a comprehensive active recovery program along with cross training activities that can be done during the healing period. You will also benefit greatly from a skilled sports-oriented physical therapist or athletic trainer who can focus on correcting the biomechanical issues commonly found in triathletes with hamstring region pain.

Good luck- hope this is helpful.

Chris Koutures, MD, FAAP
AMSSM Member and Sports Medicine Specialist
Anaheim Hills, CA

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date: January 17, 2012

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AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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