This is a condition commonly seen in runners and yoga instructors who also have a job revolved around sitting. That is because for one reason of another the hamstring tendon has become irritated typically from a spike in load. As you can see in the picture below, the hamstring tendon wraps around your sitting bones before it attaches onto the pelvis. So what proceeds an acute tendinopathy, is the inability for recovery because of the extend time it is ‘compressed’ from sitting and stretching. For example, a runner who increases her uphill running too quickly may overload this tendon. While it is trying to recover she spends 8+ hours a day compressing this tendon sitting at work.
As discussed above, your tendon attaches onto your pelvic which makes it easily irritated with positions like sitting, driving and prolonged forward leaning in standing. It is important in the early days of rehab to limit these positions if it is causing irritation. If sitting is a must, then altering your position, raising the chair height and bearing weight mainly through the muscle belly of your hamstring (rather than on your sitting bones) can be effective. This will take us nicely into #2.
This is a common mistake because it’s human nature to stretch a sore tendon. Particularly because it feels good in the moment. But stretching the leg out straight and reaching forward to touch the toes will only cause further compression, increase pain and delay recovery. So if stretching is out, what should we do?
Firstly, avoid complete rest of the tendon because this will lead to further weakness and a prolong recovery. For more information on this topic read this blog titled Tendon pain. Instead, you should start hamstring strengthening exercises outside of a compressed position if the tendon is unable to tolerate compressive loads. A double leg or single leg bridge and hold can be a good start if symptoms allow. Other examples include a prone hamstring curl or a bridge with leg curl on a swiss-ball.
This requires a trial and error basis depending on symptoms, but the goal is to slowly allow the tendon to adapt to more compression. You will need to follow instructions from your health professional to see what pain levels are appropriate during and after these exercises. These include deadlifts, full range squats and standing arabesques.
When you run, your hamstrings work the hardest during the ‘eccentric phase’ (contraction while lengthening). Therefore, it only makes sense to prepare your hamstrings for this requirement. Once you are able to, implementing exercises like plyo lunges & kettlebell swings to help tick off this final component in your return to run plan. Keep in mind that a well-structured return to run plan can be beneficial if you have had considerable time off.
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