High Hamstring Strain Injury - Avoiding the Dreaded “Runner’s Butt”

Jill Murphy, DPT, LAT, CSCS

Hamstring muscleContinuing in our series on avoiding common running injuries, this month’s topic can be a big problem for many runners. “Runner’s Butt” is an injury to the high hamstring where it attaches to the ischial tuberosity at the top of the thigh. Due to the location, it frequently causes pain not only with running, but also with sitting. Pain in this area is very debilitating for runners, since the hamstring is one of the primary running muscles utilized with every step. It is considered almost a more tendinous area of muscle and is typically an overuse injury very frequently related to or following some symptoms of low back or pelvis pain. Changing a training program involving increased mileage, tight track turns all in the same direction, and adding more aggressive hill work-outs all may contribute to this injury. Any underlying asymmetry in the alignment of the pelvis and mobility in the low back can contribute to pain in this area, as well as asymmetric tightness between the hamstrings.

The symptoms of runner’s butt are easy to identify, with localized pain, possible clicking or crepitus in the area with hip flexion, excess tightness in the affected hamstring, some hamstring weakness, and localized swelling. This diagnosis is frequently accompanied by problems in the spine and pelvis, whether or not these areas are painful. Therefore, the treatment is to address the pain and spasm in the hamstring with icing, soft tissue work, gentle stretching, and eventual eccentric hamstring and gluteus medius and maximus strengthening, along with a full evaluation of the spine, pelvis, and the sciatic nerve and manual therapy treatment of any issues found in these areas as well. Phonophoresis, a type of ultrasound that delivers an anti-inflammatory medication to the specific area of pain and swelling will also be helpful to reduce symptoms. Rest and modification in training will also be important to get rid of and prevent future re-injury in this area.

If you happen to be suffering from an injury to this area, begin addressing the problem with icing and rest, and you can try (with a very gentle approach) the high hamstring functional stretch (shown below) specifically intended to address the high hamstring affected in runner’s butt. If your pain continues for more than several days despite resting and icing, you may need some extra assistance from a physical therapist that specializes in treating sports injuries.


High Hamstring Functional (Active) Stretch

High Hamstring Functional Stretch

1. Squat to place your fingers of each hand under the corresponding balls of the feet.

2. Slowly and gently straighten the knees to feel a stretch.

3. Hold only for one second.

4. Return to the squat position by bending your knees.

5. Repeat this stretch 15-20x by flexing and extending the knees.

6. Repeat this exercise 2-3x/day.