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One of the great things about being a coach and an athlete is that when you get injured as an athlete, you improve as a coach. Experiencing first hand what an athlete is going through is extremely valuable – especially when helping an athlete rehab. Over the years, for whatever reason, I tend to work with a lot of runners and cyclist coming back from injury. So anytime I have injury symptoms, I get excited.

Earlier this summer, I hurt my hamstring practicing acceleration during 3-pt stance drills. I usually lead with right-leg. But I decided to practice leading with the left leg on this rep. Once I took off, I immediately felt a very sharp pain in my leg hamstring. It lasted only a few seconds, so I knew I didn’t tear anything. I regrouped by doping a few quick movements to loosen things up. Then I was able to do a few more acceleration leading with the right leg without too much pain. But the power was limited. My brain was holding my muscles back.

The Piriformis? Sciatica?

I was able to continue my regular training the next day and the day after and so on. But something was wrong in the left hamstring. I felt a deep nerve tension. I had this same sensation a few years back when I had sciatica caused by piriformis inflammation. So I figured the piriformis was the source of the problem this time too.

I focussed on stretching the piriformis using a stretch I learned from Kit Laughlin. And, rolling the piriformis using my Yoga Tune-Up Therapy ball. These simple interventions worked very well in the past. But this time it didn’t help much.

During a 400m race-pace workout a few weeks later – part of my Five-Pace Training program – I realized the problem was different than I had experienced before. Each rep my left hamstring got worse and worse. I kept feeling more electricity. In the past, with the piriformis issue – my hamstring would feel better and better each rep.

The instant that brought it together was during a Base Run with Surges a few days after the 400m race-pace workout. One of the Surges ended up being on a steep uphill that was part of my regular part loop. I had the same electricity feeling. But, on all the other Surges during that run which were on flat ground, there was no electricity feeling. Surges are much slower than 400m-pace, closer to 5k-pace, but why so much pain on the uphill?

High Hamstring Tendinopathy

When you quickly accelerate (like 3-pt stance drills), run at near top-speed (400m-pace or faster) and when you run uphill, you use your high hamstring a lot. It assists your glute to generate forward propulsion. But no so much at slower speeds on flats. My problem exactly.

What was going on was inflammation in the semimembranosus tendon (medial hamstring) that is basically under your butt cheek. It feels like a ball is under the glute. The hamstring tendon was impinging my sciatic nerve. And when I would engage the high hamstring, the impingement worsened. The name for this is Proximal Hamstring Tendinopathy or High Hamstring Tendinopathy.

What I Did

Now I knew the issue so I could address the situation with more clarity. Hills were removed from all my runs, I stopped accelerating quickly, and I avoided sprint speeds.

I tweaked the Park Loop I usually run during Base Runs to avoid the four very steep hills I go up and down. That was easy.

I was able to run at 800m-pace with no issue. So I removed the 400m-pace workout from my program that I would do once every two weeks. I swapped with a second 800m-pace workout because my current focus is on middle-distance speed.

I stopped stretching and rolling my piriformis. Instead, I focussed on rolling the high hamstring in two ways. First, I sat on a chair with my Supernova Ball under my left hamstring and rolled the topmost portion of my hamstring against the grain. A general hamstring “smash” like this relieves any tension coming from the muscle itself. Second, while still sitting on the chair, I placed a Yoga Tune-Up Therapy ball directly on the problem tendon to pin it down. Then I would sit tall and lean forward from the waist maintaining a super flat back. The forward lean engages the tendon similar to how it functions while running. It was pretty nasty at first. But it improved rapidly over a few days.

I worked the hamstrings with eccentric exercise. Whenever an injury is related to a tendon, gentle eccentric exercises are beneficial. This means exercises that load the muscle while it lengthens. Do not do static stretching though, that usually makes things worse. I did not stretch my hamstring at all. All I did was a few sets of bodyweight straight-legged deadlifts every day. With a gentle bend in the knees, I would hinge from the hips until I felt a stretch in the hamstrings. Then I would bend my knees and stand-up using my thighs.

I avoided sitting down as much as possible. Anytime you sit down, pressure goes on the high hamstring tendon worsen the symptoms and create more inflammation. Not good. So, I used my stand-up work station in my office for all my computer work. Before this issue, I’d sometimes sit down on a barstool to relax. But no more of that. In the car or when eating with my family, I would put a soft cushion under my bum to make there was little upward pressure in the high hamstring. Not sitting helped tremendously – likely more than anything else.

During this whole process, I did not miss one day of training. I am very cautious to avoid putting myself at risk of injury, so the tactic I used to maintain confidence in my body and brain to keep training.

What I Learned

I used to think that the high hamstring played a prominent role in generating propulsive force at all times. I first learned about the importance of the high hamstring from legendary sprint coach Charlie Francis. Hence, I figured the role of the high hamstring would be significant at any speed. However, it is evident from my experience this was not the case for anything slower than 400m. The exception being running uphill.

The high hamstrings operate concentrically only for acceleration, top-speed and uphill running. For middle- and distance-runners on flat courses, the hamstring functions predominantly eccentrically and isometrically. The high hamstrings are either slowing down the leg as it moves forward (eccentric) or holding the leg in the same position (isometric). More evidence that any hamstring training specific to running should be mostly static or eccentric. I already knew this “in theory”, but I am very grateful to have experienced it kinesthetically.

Runners who tend to struggle with uphill running, or feel that uphills are a weakness relative to the peers, likely require more concentric high hamstrings work. I know that it is often the quads that burn when running uphill. And no doubt the quads do a lot of good work. But if the high hamstrings learn to help out more, all the better. Simple exercises like deadlifts, lunges and step-ups would be a good start. Focus on feeling the high hamstring activate. Then translate that feeling into a hill repeats workout.

Lastly, if you are a sprinter or field-sport athlete that repeatedly accelerates or sprints, you absolutely must avoid your sport until you completely resolve the issue. Focus on rolling the injured hamstring and tendon as described above. Avoid sitting. And meet with a Physical Therapist to formulate a progressive eccentric exercise program. In the meantime, to maintain your aerobic fitness, you may be able to do some slower speed running – but do not run through symptomatic pain. Do not ride a bike because it is sitting and places a concentric load on the high hamstring. Also, take advantage of the time off to get in the gym and work on other weaknesses or muscle imbalances. The time you take to allow your high hamstring tendinopathy heal is time well spent. And improving on other weak points during this period will enable you to return to competition stronger.

High Hamstring Tendinopathy Resources

Physio-pedia has a great article on High Hamstring Tendinopathy. Read it.

High Hamstring Tendinopathy can easily be confused with general swelling to your Sits Bones. If you’re not sure which you have, Bob & Brad have a video that discusses the differences between the two.