High Hastring Pulls: A real pain in the butt!
The hamstrings are a group of 3 muscles. They all have a proximal attachment at the ischial tuberosity otherwise known as the sit bones. The Bicep Femoris has 2 heads, the long head attaches at the ischial tuberosity and the short head attaches at the lateral lip of the linea aspera. The distal attachment is at the fibula, the bone on the outside of your lower leg. The Semi-membranosis and Semi-tendinosis attach distally at the medial tibial condyle, on the inside of the knee.
The Bicep femoris flexes and laterally rotates the knee as well as extends the hip. The Semi-tendinosis flexes and medially rotates the knee, and also extends the hip. The Semi-membranosis flexes the knee and extends the hip.
The Adductor Magnus also has an attachment at the ischial tuberosity. It helps with hip extension, adduction and medial rotation. This is actually the area injured when one has a high hamstring pull.
Hamstring pulls occur when the muscles are strained. They may occur with high impact activities such as, running or jumping. There can be a feeling of a ‘pop’ and sharp pain when it initially occurs. The pain is usually right at the sit bone but may also be down the back of the leg. Sometimes bruising will occur. Most mild pulls will resolve quickly with rest and gentle stretching. If the pain is lingering, it’s important to follow up with a physician and to start physical therapy.
In the clinic, I have found the adductor magnus and hamstrings to be overworking and compensating for the rectus femoris, a quad muscle that flexes the hip and extends the knee. For these compensations, we do massage to the adductor magnus and hamstrings, usually at the site of pain, and gently work on lengthening or dynamic stretching followed by an exercise to strengthen the rectus femoris. A great exercise to lengthen the adductor magnus and the hamstring and strengthen the rectus, is a weight shifting exercise in stand. To do this, stand with feet apart, the involved leg at 10:00. Start by weight shifting onto the uninvolved leg, allowing that leg to bend and the involved leg straight. Then shift onto the involved leg. When shifting away, you should feel a stretch on the inner thigh, high up by the sit bone. When shifting toward, the work will be in the front of the thigh. Go slowly back and forth between the two positions, sensing what you are feeling and not forcing any motion.
Because the hamstrings, and adductor magnus, attach at the ischial tuberosity of the pelvis, I also find it common to have decreased core stability. Either the lower back or abdominals may be underworking and this decrease in stability will contribute to an overuse at the hamstrings. Creating better mobility-aka flexibility and reflexive stability-around the core is important in fully recovering from a high hamstring pull. This may involve proper breathing techniques or cog exercises that I’ve talked about in previous posts. Gradually progressing to standing weight shifting in the phases of gait and incorporating 3 planes of movement can be a big benefit and are easy to do anywhere. Once resting pain is resolved, and mobility is improving, adding resistance exercises for the core such as a Pallof press (see the video by Girls Gone Strong below), chops and lifts, or quadruped planks are good to help keep the core strong.
Healing from an injury is never a linear experience. Listening to your body and knowing when to increase or decrease an activity will be important. If you are unsure or if your symptoms are not resolving, seek help. Too often I see people return to full participation in a sport before they are ready, and they reinjure and take a step backwards. Remember to walk before you run, start with lower level plyometrics before powering into a full jumping routine. Regain flexibility along with stability before really pushing jump height or speed. If you respect the process, that pain in the butt will resolve and you may even be better overall for it too.