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No.4 Buttock/Hamstring Pain

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Buttock / Hamstring Pain  

What is Buttock / Hamstring Pain?

Buttock and / or upper hamstring pain are very common in distance runners and more commonly seen in females than males. The pain is deep in the side of your hip or around the upper hamstring origin where it attaches to your pelvis. Both can result in pain when sitting not to mention running. Most commonly they are related to tendon pathology. Pain over the outside aspect of the hip can be extremely uncomfortable, cause a lot of night pain, and result in a significant loss of function and lifestyle. This pain has various potential causes, but “Gluteal Tendinopathy” is the most common. The program below is critical to the rehabilitation of your gluteus medius problem, and gives the greatest chance of a successful outcome for what is historically a very painful problem that can take many months to heal (if in fact it heals at all)! Some of Australia’s most well known distance runners have been inflicted by such problems. Both Julian Paynter and Sarah Jamieson required surgery during their careers for hamstring tendon injuries.

Signs and Symptoms

 If you have gluteal tendinopathy you will have some of the following symptoms which mainly revolves around pain which progressively worsens:

* Pain on the outside of the hip

* Stiffness

* Decreased strength in the gluteal muscles

* Pain during running, hopping, using stairs and getting out of a low seated position such as a car

* Pain whilst lying on your side

* Radiating pain down the outside of your thigh

How does it happen?

As a tendinopathy is an overuse running injury the causes are often associated with biomechanical breakdown, weakness and dysfunction at another body site causing the gluteal and hamstring tendons to take on more stress and begin to breakdown. Below are some common factors that may increase your risk of developing such problems:

* Training errors, particularly increasing intensity, time or frequency too quickly

* Gluteal weakness and pelvic instability.

* Hamstring weakness

* Poor dynamic pelvic stability

* Poor running biomechanics (as shown to the right)

* Running up and downhill

* Running with inappropriate shoes, including proper shoes that have worn out

How do I treat Buttock / Hamstring Pain?

The most important thing in the early stages of a tendinopathy is to avoid the aggravating factors and movements to settle the tendon down and then to correct the causes of the injury be it weakness, biomechanics or dysfunction. Like all tendon injuries too much load is the primary issue that needs to be addressed. Too much load is the cause but some load is needed to get rid of the problem so in conjunction with your physiotherapist you need to become the master of how much load you are placing on the involved tendon. Complete rest is not the answer. Pelvic stability is very important in managing either hamstring or gluteal tendinopathy. If your pelvis most ever so slightly as shown in picture attached every step you take and you run for 10+ km, then you are going to have problems. Getting a proper running assessment with a sports physio or podiatrist who deals with runners can help get you on the right track with many running related problems. 

What not to do

* Sitting with legs crossed

* Sitting in low chairs- Use a cushion or pillow if necessary

* Hills and stairs

* Standing with most weight shifted across to one leg

* Mum’s don’t carry a child on your hip

* Lying on your side

* Stretching the ITB with a foam roller

* Squats and lunges

* Clamshells and side lying abduction

What to do

* Strengthen glut med and glut min isometrically (muscle contraction without movement) initially then progress with increasing the hold time

* When sitting at work etc try sitting with knees slightly further apart than normal

* Strengthen hamstring

* Strengthen glut max

* Dry needling is shown to help reduce night pain

* Massage and release work through the tight muscles such as glut med and min and adductors.

* Reduce running load and volume, especially running up and down hills

* Correct poor biomechanics through walking and running such as lateral pelvic tilt.

Recommended exercises

 

Squat


Crab walk


Single leg bridge

Article written by Rob O’Donnell, Physiotherapist at Southern Suburbs Physiotherapy Centre. Southern Suburbs Physiotherapy has clinics in 3 loactions:  705 Centre Road East Bentleigh, 100 Lower Dandenong Road Parkdale and 99 Bay Street Brighton and there are physio’s with special interests in treating runners at all locations. For more details go to www.sspc.com.au