A frustrated runner wonders why she isn’t able to get back on the road.
A forum user writes: I am a 40 year old female. I’ve been running for about five years with only minor injuries (plantar fasciitis, shin splits). About six weeks ago, I experienced a pain in the upper part of my left leg, close to my behind. My doctor said it was a hamstring pull, and told me to stop running or exercising until the pain was gone. She also gave me some stretches to do, which I have been doing diligently since then.
Four weeks later – about two weeks ago – the pain was gone. I tried going on a short run and about a couple of kilometres in, it started hurting again. I stopped running and walked home. I called my doctor, and she said it may be from overuse (walking) and sometimes healing can take longer. I continued to do the exercises for another two weeks and again, felt fine. I tried once again to go on a run yesterday. Three kilometres in, it began bothering me again. I’ve now been referred to an orthopaedist, and I have an appointment coming up. I’m writing because I am so frustrated. I’ve done everything I’ve been told and I still can’t run or even exercise. How long could this take to heal?
It seems as if I saw you in my clinic last week – a runner with a very similar story was in for a visit.
Several things can cause pain at the upper end of the hamstring. The first is a hamstring strain where the muscle-tendon-bone unit stretches beyond the zone of full return. This tissue acts like a spring, returning to normal length with each cycle, unless it is stretched too far (like your slinky when you were a kid). Strains can take as long as 12 weeks to fully heal, but after four weeks, the tissues should be healed to the point where you can walk easily without pain. I see this most often in older water-skiers trying to pull up on one ski, and soccer players or sprinters moving at full speed. The best cure for this is progressive eccentric hamstring strengthening. These are known as Nordic hamstring curls. You may need help with this from a physical therapist or personal trainer, and it is critical to start slow, with a low load, and increasing over time.
There are other problems that can cause pain in the same area, however. Osteoarthritis of the hip is one, and I would expect pain from an arthritic hip to come back easily. But you are very young for this problem. So, if you do not have a strong family history of osteoarthritis, you have not had some form of reasonably severe trauma to the hip, and you can swing your leg back and forth like a windshield wiper while sitting, then this cause would be unlikely.
The most common cause of pain in the butt area that I see in runners is due to sacroiliac joint dysfunction and a rotated pelvis. The pelvic ring has three areas where ‘movement’ occurs: the symphysis pubis in the front of the ring, and the two SI joints where the ilium articulates with the sacrum. Anything that interferes with the normal motion in those three joints can cause muscle spasms and pain downstream from the pelvis. When the pelvic ring is rotated out of its normal configuration, it is common to have pain in the piriformis and related muscles or in the upper hamstring, or both. This often masquerades as a hamstring strain or sciatica, and the symptoms always return with activity until the pelvis is returned to its normal configuration.
To address this, you will need to seek out someone who is trained in manual therapy and able to evaluate the configuration and motion through your pelvis. An osteopathic physician, chiropractor, or physical therapist is most likely to have the training and skills to evaluate you for this this problem and give you a fix.