Is it too cliched to say High Hamstring Tendinopathy is a Pain in the Butt for Runners? Probably!
Ok so in this video, I’m going to show you five exercises we almost always give to runners
who present with cases of high hamstring Tendinopathy.
First we need to understand the nature of the injury.
The clue’s in the title here; high up at the top end of the hamstring muscles we find
their common origin, where their tendons insert onto the ischial tuberosity of the pelvis,
that's the bony part towards the bottom of your butt cheek.
Being a tendinopathy we know that it’s this conjoined tendon that currently in dysrepair.
This is very much one of your typical overuse type running injuries, and in my experience
comes as a result of chronic overload of the hamstring tendons, usually with a more acute
trigger.
What do I mean by overload?
Well, if there’s one thing that tendons don’t particularly enjoy it’s the combination
of being compressed while under high tensile loads. They are great at dealing with tension
when in an optimal position, but when you add compression, it’s a simple trigger for
tendon problems.
Now, because of the specific way in which the tendon attaches to the rear part of the
ischial tuberosity near your butt crease, loading the hamstrings in increased amounts
of hip flexion will begin to compress the hamstring tendon against the bone. Repeat
this excessively and you’re on a fast track to high hamstring tendinopathy.
So what kinds of exercises load the hamstrings in this high hip flexed position?
Well anything that’s going to force an increased stride length, such as speed work and hill
reps. These are also often the aggravating factors that trigger symptoms when runners
are trying to train-through cases of high hamstring tendinopathy.
Now, when it comes to rehabbing the injury, it’s important we take this understanding
of the injury and it’s anatomy into account. As with most tendinopathies, we need to load
the hamstring tendons to stimulate healing and repair, and to build strength in the hamstring
muscles themselves - muscular weakness is also a risk factor to tendon problems, don’t
forget!
We need to ensure however that we load the hamstrings and their tendons in such a way
that doesn’t create this combination of tendon compression under tension. In other
words, while initially rehabbing the injury we need to look for hamstring exercises that
avoid working into too much hip flexion.
I’ll leave a link in the description below, so that you can find the free high hamstring
tendinopathy download on the kinetic revolution website,
containing more information on this frustrating injury, and video demonstrations for some
ideal rehab exercises.
Be sure to check that out!
To begin with we focus on isometric exercises such as a simple double leg bridging exercise
to help engage the glutes and hamstrings, and load the hamstring origin tendon without
flexing the hip.
Try varying the position of this exercise; as you start with your heels close to your
butt, the exercise becomes more glute focused. Conversely, if you set-up with your heels
further away, creating a longer-lever, you’ll be placing more of an emphasis on hamstring
loading. You can build up to this!
Aim for 10 sets of 10 seconds holding the bridge position.
A simple progression is to incorporate a single leg variety of this isometric hold exercise.
The single leg bridge. Most runners find this much tougher than the standard double leg
version!
Again you can aim for 10 sets of 10 seconds on each leg.
When these become easier, you can progress to working the hamstrings through range of
motion at the knee, while still avoiding loaded hip flexion. To begin with, we can use an
unloaded exercise such as prone hamstring curls, then add resistance from the other
leg to increase eccentric demand on the hamstring muscles and tendon.
Aim for 3 sets of 20 on each leg, while maintaining core control. Don’t let your back arch excessively.
We can then add more complex exercises such as swiss ball hamstring curls and single leg
hamstring curls which being to re-introduce a loading into hip flexion. At this point
working into knee flexion and hip flexion combined should be far less irritating on
the proximal hamstrings tendon than if we were to combine knee extension and hip flexion.
Again aim for 3 sets of 20 with each of these exercises.
Of course there are other factors to take into account when it comes to rehabbing high
hamstring tendinopathy, such as dynamic control of the pelvis, and running technique. I’ll
leave links in the description to other videos you might find helpful on these topics.
Don’t forget to head on over to the kinetic revolution website to download your free high
hamstrings tendinopathy rehab guide.
Best of luck, and I’ll speak to
you soon.
Bye now!