There are many tissues that mimic hamstring pain, which may be why your
hamstring injury never seems to get better. Runners, triathletes, yogis, soccer
players and many other athletes suffer from pain in the posterior thigh. Many of the
athletes we see in our practice have pain in their posterior thigh that is referred
from somewhere other than the hamstrings. First, you must correctly identify the
source of your pain in order to truly treat it.
The hamstrings are located in the posterior (back) of the thigh. The hamstring is
made up of three muscles: semimembranosis, semitendonosis and biceps femoris.
Together, they flex or bend the knee, adduct the thigh and help to extend the hip.
They attach at the ischial tuberosity or sit bone and cross the backside of the knee.
Hamstring pain presents in the posterior aspect of the thigh. It will typically be more
painful with running up hill, with faster running, with bending forward,
straightening or bending the knee and walking.
If your symptoms are truly from the hamstring, do not overstretch the muscle; this
could make it worse. This is more difficult for our yogis, but you may have to avoid
poses that require forward bending or stretching the hamstring with a strap. One
way to continue practicing is to offload the hamstring by bending your knees more.
Runners and triathletes, your running form may also be a culprit of your ongoing
symptoms. A runner’s foot strikes the ground 800-1500x/mile. If you are landing
with your foot too far from your center of mass and on the heel 1500x every mile or
bending forward from your hips, this could result in increased stress on the back,
nervous system and hamstring. Increasing your cadence by five percent or making
sure you are landing with your foot under your center of mass with less heel strike
Doing a dynamic warm up prior to running, cutting or sprinting will also be helpful
to improve metabolic factors that will positively affect the muscle, such as increased
heart rate, blood flow to the muscle and core temperature. Other studies have found
dynamic stretching to improve muscle compliance, nerve conduction and possibly
One of the most important things that can be done for chronic hamstring issues is
eccentric exercise. Add eccentric exercises, such as hamstring curls and kneeling
eccentric glute-hamstring raises, to your regular strength routine to better prepare
your hamstrings for running, sprinting, cutting and many yoga poses.
What if I have been treating my hamstrings and nothing is helping?
Then the issue may be something else or a combination of your hamstring and
something else. Other tissues that refer to the posterior thigh include the lumbar
spine, particularly sacral or lumbar segments, the sciatic nerve, the obturator
internus muscle, the sacroiliac joint and more.
If you are experiencing pain with sitting, then it is likely the obturator internus is
involved in some way. The obturator internus is a pelvic floor muscle, and only 1/3
of it is exposed externally. This is often a factor for posterior thigh pain in women,
but can affect men as well. The easiest way to figure out if it is a factor is the
manually release the muscle. This muscle can be difficult to get to one your own, and
you may need help from a person that is trained to find it.
Neural tension in the sciatic nerve is another common factor in posterior thigh pain.
Nerves move about seven mm in each direction. They need movement, blood flow
and space in order to stay healthy. Over time, the sciatic nerve (or any other nerve!)
can get stuck because of muscle or fascial tightness, trauma or injury to the area or
to the areas above and below it. Neural mobility exercises can improve the
movement, blood flow and space around a nerve. However, be careful to not do too
many neural mobility exercises at first, or your symptoms could flare up. Nerves are
more sensitive than muscles, so more is not better!
Ultimately, the important thing to remember is pain in the posterior thigh may or
may not be a hamstring injury. If you are not getting better with typical treatment,
then be sure you are being treated for the correct issue!
Dr. Kate Mihevc Edwards is a board certified orthopedic specialist, a specialist is running and endurance medicine and the owner/CEO of Precision Performance & Physical Therapy.