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<h3>What is a high hamstring tendinopathy?</h3><p>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.</p><h3>Mistake #1: Avoid compressive positions</h3><p>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.</p><h3>Mistake #2: Stop Stretching your hamstring tendinopathy!!</h3><p>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?</p><h3>Start building up strength out of compression</h3><p>Firstly,&nbsp;<strong style="color: rgb(16, 94, 162);">avoid complete rest of the tendon</strong>&nbsp;because this will lead to further weakness and a prolong recovery. For more information on this topic read this blog titled&nbsp;<a href="https://runsmarter.online/top-3-tips-about-tendon-pain/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Tendon pain</a>. Instead, you should start hamstring strengthening exercises outside of a compressed position if the tendon is unable to tolerate compressive loads.&nbsp;<a href="https://www.youtube.com/watch?v=hYj5rQ2LBKE" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">A double leg or single leg bridge</a>&nbsp;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.</p><h3>Progress strengthening to include compression</h3><p>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.</p><h3>When appropriate add in power movements</h3><p>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 &amp; 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.</p><h4>Relevant Blog posts:</h4><ul><li><a href="https://runsmarter.online/managing-your-healthy-tendons-when-returning-to-the-gym/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Managing your healthy tendons when returning to the gym</a></li><li><a href="https://runsmarter.online/top-3-tips-about-tendon-pain/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Tendon pain: The top 3 tips all runners should know</a></li><li><a href="https://runsmarter.online/blog-45-the-dangers-of-rest-why-you-shouldnt-rest-your-running-injury/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The dangers of rest: Why you SHOULDN’T rest your running injury</a></li></ul><h4>Relevant Podcast episodes:</h4><ul><li><a href="https://runsmarter.online/podcasts/talking-tendons-1-tendinopathy-101/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Tendons 1: Tendinopathy 101</a></li><li><a href="https://runsmarter.online/podcasts/why-your-hamstring-tendiopathy-isnt-getting-better-with-maryke-louw/" rel="noopener noreferrer" target="_blank" style="color: rgb(237, 24, 74);">Why your hamstring tendinopathy isn’t getting better with Maryke Louw</a></li><li><a href="https://runsmarter.online/podcasts/10-years-of-hamstring-tendinopathy-with-vicki-smith/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">10 Years of hamstring tendinopathy with Vicki Smith</a></li></ul>

Common mistakes a runner makes with their hamstring rehab

<p>Most runners know what and where the ITB is located. Some of you may have even experienced iliotibial band syndrome resulting in pain on the outside of the knee. Commonly, this condition is linked to female runners, perhaps with a lower cadence &amp; a recent bout of downhill running. I thought I would help shed some light on the ITB and provide some tips if pain is occurring.</p><h3>Your ITB pain is not from tightness</h3><p>This is the most common fallacy around the ITB. You may have the perception of ITB tightness and dry needling, massage, foam rolling may help reduce symptoms. However, it most certainly isn’t ‘releasing’ the ITB. This extremely thick fibrous band is consisting of strong connective tissue, not muscle. It doesn’t contain any elastic properties and surgeons even report the ITB blunting their scalpel when operating! The perception of tightness may be due to the tissue and surrounding structures being overloaded. Now that is understood let’s explore further.</p><h3>Consider your running bio-mechanics</h3><p>ITB syndrome is more common in females due to the greater angle created from your hips to your knee during midstance. If you view a runner from behind, you will see the knee cutting in toward the midline in relation to the hip. This will put the ITB under more tension especially if it is combined&nbsp;<a href="https://runsmarter.online/running-cadence-take-full-advantage/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">with a low step rate (under 160)</a>&nbsp;and a<a href="https://runsmarter.online/running-technique-step-width/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">&nbsp;‘crossover’ strike pattern</a>. If you think this might be the case, then having your running assessed is the best option.</p><p><img src="https://runsmarter.online/wp-content/uploads/Untitled-design-2020-09-01T092325.371.png" alt="Side by side runner with hip drop" height="294" width="530"></p><h3>Running modifications &amp; gait retraining</h3><p>If you wanted to settle down symptoms or prevent symptoms the first intervention might include changing your training, for example spikes in training load. If you have identified a crossover pattern (see image below) in your running or a lower cadence, then gait re-training is a good option. Otherwise, running uphill while walking downhill can be a good solution until symptoms calm down. Another preventative approach is to include terrains like trial running where you have more foot placement variety.</p><p><img src="https://runsmarter.online/wp-content/uploads/HEEL-STRIKE-2-2.png" alt="side by side photo of runner with wide and narrow step width" height="279" width="502"></p><h3>Consider hip control &amp; strength</h3><p>Even though the evidence shows that hip strengthening does not alter running biomechanics, it does help your body become more resilient when tolerating load. Get your glutes, quads and hamstrings has robust as you can and your ITB will have more reinforcements when tolerating the load required for running.</p><h4>Relevant Blog posts</h4><ul><li><a href="https://runsmarter.online/running-cadence-take-full-advantage/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Running cadence: How the take full advantage</a></li><li><a href="https://runsmarter.online/running-technique-step-width/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The running technique: Step width</a></li><li><a href="https://runsmarter.online/running-and-stretching-is-there-benefit/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Running &amp; Stretching is there any benefit</a></li></ul><h4>Relevant Podcast episodes</h4><ul><li><a href="https://runsmarter.online/podcasts/itb-friction-syndrome-what-you-need-to-know/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">ITB friction syndrome: What you need to know</a></li><li><a href="https://runsmarter.online/podcasts/the-benefits-of-trail-running-with-daniel-farrugia/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The benefits of trial running with Daniel Farrugia</a></li></ul><h4>References</h4><ul><li><a href="https://www.researchgate.net/publication/230893219_Iliotibial_Band_Syndrome_in_Runners_A_Systematic_Review" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Iliotibial Band Syndrome in Runners A Systematic Review 2012.</a></li></ul>

How to Overcome ITB Issues

<p>Lateral (outer) hip pain will commonly present as gluteal tendon pain. A correct diagnosis is obviously important, but I have seen ‘hip bursitis’ over-diagnosed throughout the running population. In fact, some studies have shown that in subjects with lateral hip pain, only 8% have bursa involvement. None-the-less management is quite similar. So how do we overcome persistent or acute lateral hip pain? Our first step is to categorize you into the ‘activity modification’ phase or the ‘capacity building’ phase.</p><h3>Hip Pain step #1: Activity modification</h3><p>This is quite an irritable, acute phase with aggravation when attempting to strengthen the area. This may take up to a week to settle but requires&nbsp;<strong style="color: rgb(16, 94, 162);">identifying 2-3 activities that cause pain</strong>&nbsp;and modifying the angle of the hip out of compression. Some common strategies involve:</p><ul><li>Sleeping with a pillow between your knees</li><li>Sitting on higher chairs</li><li>Avoiding cross-legged sitting</li><li>Avoiding the knee buckling inwards when climbing stairs</li><li>Not over-stretching your gluteal muscles</li><li>Widening your step width when running.</li></ul><p>After symptoms are less irritable, we can move onto the next phase.</p><h3>Step #2: Capacity building phase</h3><p>This is the bread and butter of physiotherapy management and involves strengthening the leg/hip/trunk and raising the load tolerance of the lateral hip structures. This may initially require side lying leg raises in outer range to avoid compression or doing some more functional strengthening exercises like controlled squats with wider feet. Depending how the hip is responding we will gradually progress the load but also trial loading the hip into greater ranges of compression. Closely monitor symptoms with your physio and progress as needed until you have returned to all functional activities.</p><h3>Hip pain for running: Steroid Injection Vs Strength Training</h3><p>The research supports education and exercise as the most effective treatment and alternatives such as injections and long-term passive treatments should be avoided.&nbsp;<a href="https://www.bmj.com/content/361/bmj.k1662" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Consider the study below.</a></p><p>The Mellor study in 2018 looked at 204 people with more than 3 months of lateral hip tendinopathy and assigned them</p><ol><li><strong style="color: rgb(16, 94, 162);">Corticosteroid group&nbsp;</strong>(one ultrasound guided injection)</li><li><strong style="color: rgb(16, 94, 162);">Strength exercise &amp; advice group</strong>&nbsp;(14 sessions over 8 weeks, advice on tendon loading and a home exercise program)</li><li><strong style="color: rgb(16, 94, 162);">Wait and see group</strong>&nbsp;(one session of advice about condition).</li></ol><p>Results found better outcomes in pain &amp; function questionnaires for the exercise group at 8 weeks and 52 weeks compared to the other 2 groups. Exercises within the exercise group included strengthening of the hip abductor muscles and dynamic control of adduction during function. Starting with side lie hip abduction, bridging, squats. And progressing to single leg standing control, side steps with band and scooters.</p><h4>Relevant Blog posts</h4><ul><li><a href="https://runsmarter.online/early-signs-for-running-injury/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Detecting early warning signs running injuries</a></li><li><a href="https://runsmarter.online/top-3-tips-about-tendon-pain/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Tendon pain: The top 3 tips all runners should know</a></li><li><a href="https://runsmarter.online/am-i-strong-enough-for-running/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">How to know if you are strong enough for running</a></li><li><a href="https://runsmarter.online/why-stretching-wont-help-muscle-tightness/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Why stretching won’t help muscle tightness</a></li></ul><h4>Relevant Podcast episodes</h4><ul><li><a href="https://runsmarter.online/podcasts/running-technique-insight-for-injury-prevention-performance-with-chris-bramah/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Running Technique insight Chris Bramah</a></li><li><a href="https://runsmarter.online/podcasts/strength-training-4-exercises-program-planning-for-runners-with-richard-blagrove/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Strength training 4: Exercises &amp; program planning Richard Blagrove</a></li></ul><h4>References</h4><ul><li><a href="https://www.running-physio.com/lhp-webinar/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Tom Goom Lateral hip pain webinar series</a></li><li><a href="https://www.bmj.com/content/361/bmj.k1662" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Mellor 2018 study: Injection vs Strength vs Wait &amp; see</a></li></ul><p><br></p>

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