CLINIC: Hamstring Pain After 10 Trouble-free Years

Mon, 5 Dec. 2011 - 11:57 p.m. MT
Credit: ARA Staff - American Running Association

QUESTION:
I am a 46-year-old woman weighing approximately 140 lbs and I run 20 to 25 miles a week. I do all of my running on a treadmill, no incline, at 6.5 mph. One mile takes 8:46. I recently increased the speed from 6.3 mph to 6.5. 
 
During one of my runs I felt an awful pain in my right outer side and back of my leg where the thigh and hip connect (I do not know if you would consider this the groin area or not), and the back of my hamstring feels tight/sore and is not as flexible as my left thigh when stretching. It felt like a misstep, a quick jarring pain when it happened and for a few steps afterward it hurt, but then stopped. I took one month off from running, thinking my injury could heal. When I recently started running again, at 5.6 mph four miles, I noticed somewhere into my second mile it has been happening again. It is not as bad, but it nevertheless occurs, and then goes away. I notice this pain happens at least 4 times during my daily run.
 
I never have had an injury like this in all of my 10 years of running. I know something is not right here, but I do not know what. I still run but I am very careful not to go too fast—and still it occurs. I tried just walking but it still occurs. I love running, and I would be absolutely devastated if I couldn’t run anymore. I don’t want to have a problem with this either for the rest of my life. Could you please enlighten me as to what the problem might be, and perhaps offer a solution to it?
 
Carol Givens
St. Clair, MI

ANSWER:
There is nothing worse than a pitcher with a shoulder problem, unless it is a runner with a hamstring tear. More likely than not, this is the correct diagnosis. It could be a tear of one of the buttock muscles but this is less likely than a proximal hamstring tear. Also don't forget the possibility of a stress fracture in the pelvis or avulsion fracture of a hamstring origin.
 
I would guess a misstep or a strange stress applied resulted in the tear. Why, and why now, is the question. It is obvious you have done this workout faithfully for 10 wonderful years. Congratulations on your running career to this point.
 
Taking the month off was a good thing. Going back to running was worth the try, but now you may need to go to Plan B.
 
1. Never run more than 4 days a week in the future. Start with one day and add one day every week or so if you remain pain free.
 
2. Make much better use of crosstraining. Biking, rowing, swimming, aerobic dance, strength training, or circuit aerobics can help you maintain cardiovascular fitness with reduced impact forces, or at the very least, by working slightly different muscles and joints to allow for more post-run recovery. I would try to perform a walk/jog Monday, Wednesday, and Friday and cross-train on Tuesday, Thursday, and Saturday. Take Sunday off. You can vary the days but don't do the same activity 2 days in a row. Allowing 48 hours between running will be the most helpful. Anytime you work out more than 5 days a week you increase the risk of wear-and-tear injuries.
 
3. On running days, start with the walking portion, then jog after about a half mile. After a half mile of running, stop and stretch.
 
4. In the very near future see an orthopedist for evaluation. Someone with an interest in running or experience with runners is always a plus. An x-ray will rule out stress fracture or avulsion fracture at the pelvis or sight of hamstring origin, and a bone scan may be useful. An MRI could be necessary to evaluate soft tissue tears or strains, if a clinical diagnosis is not possible. 
 
5. Physical therapy treatments including massage and hamstring stretches, with a gradual return to activity, could be the most helpful. NSAIDs are of value for some people, as are eccentric exercises.
 
6. Firm diagnosis is important and then implementation of some of the above is now a must.
 
7. You will find that in your 50s and 60s crosstraining will become even more valuable. At 68 years I now find crosstraining makes it much easier for me to stay fit without soreness, stiffness, and nagging little injuries. At 46 I much preferred solely running, as you, too, have clearly expressed.
 
Larry Hull, MD

ANSWER:
Pain at this area can be a tendinitis at the origin of the hamstring tendons from the pelvis. One can even have avulsion of the hamstring origins. However, this generally requires significant trauma. Your condition does not sound like you suffered enough injury to be suspicious of that diagnosis. The third possibility is simple lumbosacral radiculitis (pain coming from and irritation of the nerve in your lumbar spine). This is a little atypical in that it generally radiates down the back of your leg to the foot or ankle, but occasionally the pain will be very focal. The fact that you seem to get this pain only while running supports the diagnosis of tendinitis. If this was coming from your back, I would expect at least some pain with prolonged sitting, standing, or walking. This should respond to simple anti-inflammatory medication and stretching exercises. You need to see a physician to discriminate among the diagnostic possibilities. I apologize for not being able to be more specific but I simply don't have enough information to make any more specific recommendations.
 
Klaud Miller, MD
 
(RUNNING & FITNEWS®  February / March 2007 • Volume 25, Number 2)

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