THE CLINIC: Diagnosis: Hamstring Tendonitis?

Thu, 27 Sept. 2012 - 12:40 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

 I’m 37, very small-framed (5’ 1”, 99 lbs), and having chronic pain in the back of my left thigh, in the upper part of my hamstring. The pain does sometimes move to other areas on the back of my left leg, however. This has gone on for several months.

 

When it started, I was training for a marathon, although I follow a very conservative run-walk program. My mileage increases very gradually, and never gets particularly high. I was originally diagnosed with hamstring tendonitis. I stopped running for three weeks and went through several weeks of physical therapy, but it didn’t really help. The pain would resume almost immediately, even when increasing mileage very gradually.

 

I went back for an MRI, but nothing abnormal showed up on my left leg. I did get through a marathon with little discomfort. In fact, the pain is often most noticeable on days when I’m not doing any activity, such as standing up at work after sitting all day. Also, over the last few months, I’ve started to have tailbone pain, sometimes manifesting as a tightness, particularly after I run. I rarely notice it during a run. I haven’t fallen so I don’t believe it’s fractured. I saw my regular physician about this and she just gave me a basic exam and some anti-inflammatories. 

 

I only run about three times a week, so it doesn’t seem that it’s from overuse. I max out at 30 miles a week, and that is often closer to 20. The pain is not more noticeable on an 8-mile run than on a 4-mile run. Could I really have hamstring tendonitis?

 

Lori Helmsley

Holbrook, AZ

 

ANSWER:

 You don’t appear to have hamstring tendonitis. Your problem is with the low back. You should get an MRI, which may reveal disc disease at L4/5 or L5S1. Regardless of what an MRI shows, you will need to start on a low-back flexibility program. It may take up to 6 months to work. Once you feel better, you need to remember that unless you continue to fight back stiffness, your condition will return in 6 weeks. Anti-inflammatories only address the symptoms, not the underlying etiology.

 

The simplest program is to sit on the edge of a chair and bend between your legs. Do this 10 seconds at a time and 5 to 6 times a day. For about $24 you may also purchase a lumbar elastic belt at your local drugstore. Run in it and see if the pain is slightly less. Your best bet is to see a sports therapist for a home low-back stretching program. After the first month of more comprehensive back-stretching techniques, you might be able to go to the simple stretch I explained above.

 

Robert C. Erickson, MD

Canton, OH

 

ANSWER:

 I agree that the cause of your discomfort is not likely your hamstring. Even if you do have tendonitis, the treatment has to be directed at the reason the tendonitis arose, and not simply at the symptoms that declare themselves. Lumbar pathology may well be the cause of your thigh pain. The muscles of your pelvis and trunk may not be working well enough to stabilize your pelvis during running, and so your hamstring and/or adductors get overloaded trying to keep you upright and moving somewhat efficiently. You should work on hip abductor (gluteus medius) strength. Using a cable column, stand on one leg and pull the cable away from your side with the other leg, from the ankle. Also do side-lying leg lifts, as well as squats with your buttocks back and loaded as if you were going to sit down.

  

John Cianca, MD

Houston, TX

 



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(RUNNING & FITNEWS® November / December 2009 • Volume 27, Number 6)





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