Pain At Top Of Hamstrings

[Mark Plas]

I have pain at the top my right hamstrings at the point where the hamstrings attach to the pelvis (I think it's the tendon).

It only occurs when I do a pike stretch with slightly bent legs, not when I do it with straight legs. It doesn't even have to be a pike stretch where I put my handpalms on the floor. Simply bending the legs slightly and bending forward makes the pain come.

The pain doesn't occur when I do NLC and it doesn't occur when I just sit or walk. It's stretching that causes it. I feel it when doing HLL but also when squatting deep (without weight, just air squats) while trying to keep the natural arch in my lower back.

When the muscle/tendon has been irritated, it causes my right hamstrings to tighten a bit which, the next day, results in pain in my lower back.

Massaging the hamstrings with a tennisball fixes the problem, but the day after it usually comes back.

I stopped stretching the hamstrings since about 2 months and it has improved, but it doesn't seem to go away. I think the pain started about 2 months before that, but I thought my hamstrings were just tight so I ignored it. I still do some other stretching (like low lunges) which sometimes slightly irritates the painful part (which I believe to be the tendon that attaches the hamstrings to the pelvis).

I've been thinking about skipping every exercise that causes even the slightest irritation.

Would that be a good idea? Does anyone have tips on how to speed up the healing? Are there perhaps exercises I can do? Should I keep on massaging it with the tennisball?

Thanks for any advice,

Mark

[FREDERIC DUPONT]

I think giving it some time with regular massaging is a good idea; but It has been a month since you posted, so maybe (and hopefully ) it is better now 

[Joshua Naterman]

It sounds like it may be a gluteal issue, bending the knee takes tension off of all the hamstrings. As you bend the leg, you place more tension on the glutes and less on the hamstrings. It could also be a deep hip muscle, but it would take an in-person examination to determine any of this for sure.

 

You may want to see if reverse hyperextensions (should be called reverse back extensions, really) reproduce any of the pain. If so, it is probably NOT your hamstrings.

 

I am personally leaning towards a tight deep hip muscle because of the specific location of pain, but it is definitely possible that you have a small proximal strain of the hamstrings near the ischial tuberosity. That's the bone you sit on.

 

If you have the same pain with resisted hip external rotation, or with hip internal rotation stretches, then it is nearly 100% due to injury of these muscles.

 

 

 

 

If it is a hamstring, you will most likely benefit from the bird-dog exercise and high repetition hamstring curls. Since you do not get pain with NLC I personally do not believe you have a hamstring problem, but that doesn't mean I think it's impossible. If you had hamstring problems, you would almost certainly feel intense pain with NLC.

 

The deep squat pain is another clue that what you have is very likely a hip external rotator, either deep or superficial. They all get stretched in that position.

 

It is neither ethical nor practical for me to help you assess this.

 

I am trying to give you details to help you understand why it is important to go to a non-surgical hip specialist and request specific muscle testing with 45 and 90 degrees of hip flexion and full hip extension for both internal and external hip rotation (in addition to whatever else the practitioner wants to do). It is difficult to assess what is going on alone, and you don't have the detailed knowledge needed to do so successfully.

 

Please, visit a professional. They may not be perfect, but they should be able to tell you whether it's a hamstring, glute, or something else.

 

I won't be licensed to do things like this for another 5-7 years, so don't wait on me.

[Mark Plas]

I'll give an update on this.

I haven't been stretching or causing the pain in any way since my post, but recently I tried something:

Just two weeks ago I bought a squat rack and started doing squats (60kg, a bit below parallel), super setted with NLCs.

After just one training, the problem of my hamstrings tightening up (which I attributed to my injury) had disappeared! No more tight hamstrings! This tightening caused lower back problems and these are now mostly gone! Squats are great! These tight hamstrings must have been another problem.

When squatting below parallel I very slightly feel the pain, but it doesn't prevent me from doing the exercise. It's just a mild irritation, nothing more.

I was hoping that squats may also have fixed my injury so earlier this week I decided to check whether the pain still occurs when I try to do a "ballet dancer" stretch (stand up, put one leg on a table, the other on the floor. Bend forward to bring your nose to your shin).

Result:
Simply trying to lift the (bent) leg onto something that's 90cm (3 feet) high already caused quite some pain.
However, when I do a pike stretch with slightly bent legs, I don't feel the pain! It seems it gets caused when my legs are in a "front-split" position with bent legs. Maybe that tells you something more about a possible cause?

You're probably right that it's not the hamstrings. Everything I do with the hamstrings doesn't cause pain, and the NLCs are quite heavy (I do full ROM and still bend a bit at the hips, but not much, and I don't feel pain in those circumstances).
 
When I do (weighted) archups I don't feel anything either.

When I feel the pain, I try to feel with my fingers where the pain exactly is, and it seems to be "underneath" the hamstrings. I feel the hamstring muscles, but the painful part lies deeper and I have to do some digging to touch that spot.

 

So, short story: Doing splits with bent legs definitely causes pain. Strength exercises targetting the hamstrings don't cause pain.

I'll have to visit a doctor I suppose. Simply resting or massaging doesn't seem to heal it, and the magic squat exercise doesn't cure it either

Thanks for the replies guys!

[Joshua Naterman]

Almost 100% is a quadratus femoris, obduratur externus, or gemellus inferior or superior problem. WIth what you're saying, my money's on quadratus femoris.

 

It probably hurts with the raised leg because the glutes can't share the stress the way they do when you're standing. They're an anti-gravity muscle, so to speak, because they keep your torso from falling further towards the earth when you're bent over.

 

With the raised leg you can't use the glutes in that way, because any glute activation would actually accelerate the leg in the same direction as gravity. That's useless in the standing stretch, so they don't work, so the deep hip muscles are getting much more of the force. That's probably what you're feeling.

 

Sitting on a lacrosse ball, in that exact spot, can help loosen up the muscle. A baseball will work too, and at first a tennis ball might be your best option until you adapt to the pressure. You'll need one of the hard balls, either lacrosse or baseball, to really get in there, but it might be too painful at first. Don't push past a 6-7 out of 10. You might have to do this for a long duration at first, like up to an hour. Always go by feel, and choose to push slightly less hard for longer instead of harder for shorter periods of time. You don't want a crush injury

[thenail01]

Here's a link to another thread which I posted on: https://www.gymnasticbodies.com/forum/topic/9509-pain-when-doing-sidestraddle-splits/

 

When you bend your knee, you place the stretch on the more proximal (closer to your butt) portion of the hamstring, at its insertion, by the proximal free tendon of the semimembranosus which is a type 2 hamstring strain typically seen in gymnasts and dancers.  The average time to heal is in the 1 year mark.  Yes, 1 year.  Forceful repetitive eccentric contractions are how to exercise this - the best I've found is simply pike forward 90 degrees with your hands over your head, now parallel to the ground, grabbing a bar.  Forefully kick your non-affected leg back (hip extension) then externall rotate at the the top of your back kick.  Essentially, a back kick or donkey kick or whatever you call it, but bent the waist to increase the hamstring action.  You can add ankle weights, etc, as needed.

 

When you do this, you are eccentrically contracting the down leg (affected leg).

 

You can also get into a runner's lunge, with affected leg forward, and have a resistance band pulling your leg forward.  Now bring the affected forward leg from 90 degrees knee flexion to letting it "shoot" forward then trying to stop it abruptly at end range before your knee full extends.  It helps if your heel is on a furniture slider, or sock on hardwood floor.  This will also eccentrically contract your hamstrings.

 

Another, additional, option is to use a nitroglycerine patch over the affected area if you can find someone who will prescribe it off label for you.

[Joshua Naterman]

Nail, assuming it's a proximal hamstring strain, which is definitely possible, why do you think he has no pain during the loaded stretch, but pain during unloaded stretching? Do you think there are fascial connections that are reducing the strain on the ischial tuberosity attachment?

 

 

If the nitroglycerin can't be prescribed, you can also try far infrared. There are a number of infra-red heating wraps that you can buy on Amazon, and average price seems to be 60-80 bucks for the multi-purpose devices. The IR and the nitroglycerin both promote blood flow, which will speed up the healing process.

 

If you didn't know, Nail is in a Physical Medicine and Rehab residency, so don't ignore what he just posted. He's an MD with specific training in musculoskeletal medicine. He is doing what I will be doing in 6 years or so.

 

When trying the exercises Nail described, it is probably best to start off slow and figure out where you feel like a safe amount of force is. Over time things will get easier, but like he said... this is a long healing injury. My hamstring's been healing for almost a year and is now mostly asymptomatic, but the first 6 months didn't seem to change much. I may have recovered more quickly if I had done what Nail described for you. I definitely had a proximal hamstring injury, but it was lower than yours appears to be.

[thenail01]

Not sure.  I had (have) this problem too - not very good at following my own advice.  It bothers me also when I do straddle presses which I'm not sure if you'd consider a loaded stretch.  It seems to get better and worse cyclically.  I can do near full splits but as soon as I bend my knee I look like I've never stretched in my life... and pancake is rough.  Hamstring injuries associated with sprinting and what mainstream knows as hamstring pulls occur lower, tend to be more functionally debilitating initially, but heal pretty quickly vs. these proximal ones which seem to nag endlessly.  To normal people you look like you're just whining, because you can pretty much do most all of your activities, it just kind of hurts - and even if it limits a gymnasts flexibility, they're still more flexible than probably 99% of the population.

[Mark Plas]

One year recovery? Oh boy...

The "donkey kick" exercise you're suggesting, does it look like this:

http://www.trickstutorials.com/images/d59.jpg

If so, should I slightly bend the affected leg (which is on the floor) or do I keep it straight?

And should I also work the area with a tennis ball/base ball?

Thanks for your help Joshua and TheNail01!
 

[thenail01]

Looks about right.  Pretty straightforward.  The knee doesn't matter too much, probably just not locked out.  Can't go wrong with the ball - certainly won't do harm and if it helps then that's great.  Carl Askling has done some of the more recent hamstring research if you want to read more. 

 

Of course as Joshua said above, this is no guarantee this is what your 'injury' is, so if it's really bothering you get it checked out.