Question: I am a seasoned runner, although over the last year I have not been able to run as much as I wanted (previously 4 -5 times a week, 25-30 miles a week, now down to once a week if I’m lucky!). Anyway, I am now starting to increase the training again but am noticing a pain in the very top of my hamstrings. It comes on about 20 minutes into a run and gets gradually worse throughout. However, I can’t find a sore spot anywhere in the muscle and It doesn’t seem to be tight. Any ideas?
The Sports Injury Clinic Answered: Have you thought that your problem may not be coming from your hamstrings and that maybe the pain is being referred there? Generally, if it were a hamstring injury you would be able to find a tender point, or the muscle would hurt to either stretch or contract. If none of these are the case then it is definately worth looking elsewhere.
Pain in the hamstring region which doesn’t appear to be coming from the hamstrings themselves is often sciatic pain – called sciatica. The sciatic nerve passes from the lower spine, through the buttock and down the back of the leg. Any damage to this nerve or obstruction of the nerve can refer pain further down the leg. Therefore, if we are looking at pain in the top of the hamstring, the buttock and lower back should be investigated.
Do you ever feel lower back pain or have you had a previous back injury? If not, then I would look closely at the buttock. If you have, then I would advise you visit a health professional to assess your back.
A common cause of sciatic pain is the piriformis muscle. This is a muscle within the buttock under which the sciatic nerve passes (in fact in some people, the nerve even passes through the muscle!). If the piriformis muscle becomes very tight then this can impinge on the sciatic nerve, causing pain to refer into the leg. The piriformis muscle can tighten up for a number of reasons and you should always conside the cause of an injury to fully treat it:
- Tight adductor (groin) muscles
- Weak hip abductor muscles
- Sudden increase in training
- Overpronation of the foot
- Suddenly sitting for long periods
So make sure that if any of these causes may apply to you, try to correct it before returning to training. If your feet overpronate (roll inwards and the arch flattens) too much when you run, this causes an increase in inward rotation which travels up to the knee where this is corrected by excessive external rotation of the thigh – caused by muscles including piriformis, therefore making them work too hard! Make sure you have the right kind of running shoes for your foot type! Get a gait analysis if you are unsure.
Treating the muscle spasm and associated weaknesses can be achieved with a thorough rehab programme, aimed at stretching the piriformis muscle and adductors as well as strengthening the hip abductors and external rotators.
For more information on treating piriformis syndrome visit www.sportsinjuryclinic.net
