Upper Hamstring Pain

author : AMSSM

comments : 1

This article goes through some diagnosis and treatment options for upper hamstring pain.

Member question

I have had some pain in my left glute (mid butt cheek area) which goes down a few inches into my upper thigh area. This started a couple of weeks ago and it isnt' going away. The pain doesn't go to the knee or anything, but it's a constant sore point. I have tried some light stretching, etc., but nothing seems to help. Is this an upper hammy thing I need to watch out for? What is best course of action? I have not seen a doctor or anything yet. It hurts enought that I skipped my run this AM to rest it. I don't want this to get worse.

Answer from Steve Albrechta, MD
Member AMSSM 

Based on the description of where the pain is, it could possibly be an injury to your hamstring. Some more information that would be helpful is what you were doing when you first noticed the injury, as well as, what activities make the pain worse. The fact that you were unable to do your run in the morning after resting it makes me concerned for a hamstring injury. However, there are other muscles in the gluteus/upper hamstring area that could cause similar pain. This includes your hip abductors (buttock muscles or gluteus medius and gluteus minimus), and/or your hip external rotators (piriformis, quadratus femoris).

Other possibilities - sciatica

Sometimes the pain you feel in your hip or thigh may actually be radiating from your lower back. If one of the lumbar, or lower back, disks becomes injured or inflamed, it can press against nerve roots coming from the spinal cord. The herniation then can cause lower back pain which sometimes presents as hip pain. A common disk herniation injury seen in athletes is sciatica. This is when the sciatic nerve, which runs from the spinal, through the gluteus muscles and down the leg, becomes injured, inflamed or impinged. Many times this pain starts in the lower back and radiates down the back of the thigh.

Other possibilities -  sacroiliac joint dysfunction

Another injury that could also be causing your pain is sacroiliac joint dysfunction. The sacroiliac joint is the joint that connects the pelvis to the sacrum in your lower back. This joint can be injured from trauma or from overuse. It can become painful if you run on uneven surfaces or have a gait abnormality. You may feel pain in your lower back, buttock or hip pain. The area may be tender and without treatment can become a true nuisance when trying to return to activity.

Anatomy

The hamstring muscles are made up of the biceps femoris, semitendinosus and semimembranosus.  These muscles are responsible for flexing your knee and extending your hip. The biceps femoris also externally rotates your hip, or turns your leg outward, and your semimembranosus and semitendinosus also internally rotate your hip, or turn your leg inwards. In working together, these muscles are responsible for deceleration when you are walking or running. They also play a role in your kicking motion while swimming and pedaling while biking. They can become injured when you are running and start or stop too quickly, usually if you have not stretched or “warmed up” prior to your activity.

Diagnosis and Treatment

Hamstring injuries are one of the most common injuries in sports that involve running. They are graded differently based on the severity of muscle strain or tear. This could also be hamstring tendonitis or any tendinopathy of the muscles and tendons in that region. When any of these injuries occur, activity should be stopped. You will limit the swelling and pain by using the PRICE treatment. That is:

Protect the strained muscles from further injury
Rest the involved leg
Ice the painful area for 20 to 30 minutes every few hours
Compress the hamstring with an Ace wrap or compression sleeve to limit the swelling
Elevate the leg when able to

These measures will help alleviate some of the pain and swelling during the time right after the injury. You may also take anti-inflammatory medicines, if you are able to by your physician.

Healing and Rehabilitation

Most hamstring injuries heal with time. It generally takes two to six weeks to feel better. Once the pain from the injury is gone, you may start a program to be able to return to your activity. You should work your way up to full activity. This will help reduce your chance of reinjuring your hamstring. You should gradually increase the time you bike and/or swim, and should push yourself with each practice session to soreness but not to pain. Sharp pain may be an indication that you have pushed too hard and your injury may have reoccurred. When returning to running, you should start by mostly walking and doing a short light jog. After a few days of mostly walking and doing a short light jog, you can then increase how much you jog based on your symptoms. The slower you take to get back to your full activity level, the better healed your hamstring will be. You should not run during this rehab period on consecutive days while you are progressing to your baseline before your injury.

Prevention

The best way to prevent hamstring injuries, or glute injuries, is to stretch your muscles prior to and after activity. One key thing to remember, though, is that these injuries can be further injured if you over stretch the muscles. Recent evidence also shows that massaging sore areas after you exercise can help to quicken tissue recovery, meaning a quicker return to full activity. Your risk for hamstring injuries is higher if you do not stretch prior to exercise. If you are able to increase your flexibility, you will help to lower your risk of hamstring injuries. If at any time your pain becomes worse or you have not improved with a rehab program, you should seek medical advice from a sports medicine physician. You may require further treatment and care including physical therapy, a bike fitting and gait analysis.

Steve Albrechta, MD
The Ohio State University
Family Medicine Residency Program, PGY-1
Rardin Family Practice Center

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date: April 30, 2013