Posterior Thigh Pain – Hamstrings, Calves, or Glutes? Assess, Treat, Rehab, and Develop!

Video Transcript

Hey this is Doctor Gangemi the Sock Doc and in this video I want to talk a little bit more about the hamstrings. We talked about it somewhat in the knee video that was put out awhile back. But the hamstrings are a very commonly injured muscle. A lot of people pull their hamstring; they end up with sore hamstrings after working out, even after running or playing a hard basketball game over the weekend. But actually I see the hamstrings not need to be treated as much as I do the other parts of the back of the leg there, in other words the glut max your butt muscle, and your calf muscles, your gastroc and soleus.

So the whole kinetic chain often is off in the back of the leg. The balance between your glut max or hamstrings and your calf, to drive you forward and give you propulsion in pushing yourself forward whether you’re running up a hill, cycling hard or kicking hard or whatever you’re doing.

So let’s talk just a little bit about what you can do. The hamstring, obviously your hamstring starts in the back of what you call your ischial tuberosity which is your sit bone. And if you put your hand in the back of your butt there you can feel your bone and that’s where all three of your hamstring muscles start. And then they come down and then they attach to either side of your knee. Two on the inside and two on the outside.

We’re not going to get into those names right now but basically what I want you to do is, if you notice that with your leg bent like this that you’re feeling some discomfort or tightness there, that’s probably going to be more your hamstring. Now if you start way down here and just bend it a little bit and you feel it out like this with your leg extended, that might be more glut max. And in here, with your hamstring like this a slight little bend, you actually might be influencing your calf the little bit more.

So hamstring think more neutral and a curl here, but at the bottom when you start to bend your leg, that’s more calf. So this is more calf here at the very bottom even though you’re using both muscles. But as you come up more, that’s more hamstring, and if you extend back and curl a little bit more you’re going to be using both the hamstrings and the glut max because your glut max is going to push you back like this. Okay.

Now the other thing you’re going to get more gastroc action is if your foot is dorsiflexed like so. So my toes are pointed down. So this is going to be more hamstring, like this motion here, and then gastroc here like this. So in other words if you’re feeling more pain in this direction here, this motion, think more gastroc calf, here, think more hamstring. So glut max, hamstring, gastroc way down here, the start of the flexion that’s more gastroc.

The other muscle of course in your calf, soleus, that’s more tippy toe. More pushing off on your toes, propelling you forward, that’s down there. Hamstring origin insertions, again you might find a tender spot, a trigger point. The origin of the hamstring is right up in your ischial tuberosity so if you’re feeling pain here you can actually touch that area and move your leg like I just showed you. If that relieves some of the discomfort, work that trigger point like we talked about in the trigger point video in the articles.

You can also assess yourself and work your hand down the belly of the hamstring and the back of the thigh here. Remember the glut max is going to come in there too and connect with the illiotibial band to go in the outside of your knee. But the hamstring in here, look for any tender spots. One of the hamstrings attaching to the outside of your fibula here, the bone on the outside of your lower leg and the other two on the inside of your tibia. The inside bone in there of your lower leg.

So you can look for tender spots in there. Again, hold them like that, you can do that, sort of grab your lower leg. Flex like this, you’re going to get a good balance on that opposite leg or you can even do it seated if it hurts enough, it’s like that. Or as I said earlier, more commonly you’re going to be dealing with more calf issues. Those are much more common in what I see with athletes than actually hamstring issues. You might have hamstring sore muscle or even pull your muscle a little bit, but most often the calf is the one that needs to be treated.

Those calf muscles come up and actually connect with your femur, your big thigh bone. And therefore, those trigger points are going to be in here right above the crease of your knee on the inside, and the outside, the median and lateral parts of your knee. So again, that’s this motion here. Foot flex, or the start of the flexion of the lower leg and dorsiflexed foot. You can feel them right in there. And you may have to rub those trigger points, you can rub them for a second. Hey that feels better. You’ve got more of a calf issue.

Let’s talk quickly about a couple of really good exercises for rehabilitation or really just strengthen your hamstrings other than just obviously natural movements of running and walking. One that I like to do a lot is a straight leg dead lift. Single leg dead lift actually. So, you can use a kettle bell for this. Or if you’re not used to that or you don’t someone to show you proper technique for kettle bell, you can obviously learn that from somebody who knows what they’re doing or just start doing by body weight where one leg is planted down, in this case my right leg and my back leg is nice and straight, I’ve got a nice straight back. My lumbar spine is nice and straight and strong. I’m stable and I’m coming forward like this. Back and forth, just like this. Nice, straight, and solid lower back.

So when you’re looking at me from the front my shoulders are staying square to you and I pick up the kettle bell right there, I’ll show you on the side. That kettle bell is right between my right foot, starting right next to my right foot. Coming down like this, nice straight back, lift it up and you can even put that opposite foot down. And I’m staying nice and strong, nice and stable. Coming back just like that.

From the opposite side. Now my left leg, it’s right next to the kettle bell. Nice and square. Coming down, nice straight back, nice square shoulders up like that and back down. Just like that. Notice how my knees bend, I’m not dropping it like this. It’s just a slight bend in my knee. And this hip stays back, this right leg extended. Strong and solid, right back up like that. Those are great exercises, good thing to work on your balance too with those.

And the second exercise is a squat. And I talk about this in the natural flexibility article on the Sock Doc site. But the squat ideally, you can’t your heels to stay on the ground and go as long as you can without extending your body too far forward. Because you’re trying to stay as vertical as possible, your shoulders over your hips. Just like that. And ideally if you can get down and sit in that squatted position, that’s where you want to be. And work on your stability here without swinging in any direction.

You can also grab a pole or have somebody hold if you’re trying to tip back because you’re not used to the balance. Your arms are nice and relaxed, stay here as long as you can. Again, heels stay down. So if I only can go to here before my hips start to come up then right now, just start with that. Come down like this. If you’re already good at a squat or if you want to develop some more strength on your lower legs, on your core, your abs and your back, grab a kettle bell. Any weight will do. You’re holding it right here and you’re driving up with it.

So you’re nice and strong like this. I’m not leaning forward, I’m hip hinging a little bit with my lower back. My knees are bent slightly to start and I’m coming down straight like that. My elbows are touching the top of my knees and I’m driving straight up like that. From the front, like this, my butt’s out. Kettle bell stays strong. Not resting this here, I’m just touching, and I drive straight up. So I’m not doing this. See the difference? Leaning forward, my shoulders. I want to be straight up and down just like that.

Great way to help your glut max, strengthen your glut max… that your glut max do the amount of weight you can do, couple sets, ten reps, you can do it. If you can’t, lower the weight a little bit, don’t want to be too sore the next day or you overdid the action the first time. Take your time doing it and it’s a great way to rehab the lower leg muscles, glut max, hamstrings, that sort of thing. Good luck.

In this video I discuss some easy ways to assess your posterior (back side) thigh pain or injury. Calf, hamstring, or glute max injury? Most don’t know how to figure out what they have injured let alone how to even begin to heal it. Hamstring injuries are very common, but I see them needing to be treated much less than most other injuries. Typically the calves and glute max are fatigued so the hamstrings become injured by working too hard – “pulled”.

I also demonstrate two exercises that can be incorporated into your rehab or training routine to improve strength, balance, and fitness.

Check out the Knee Pain Video too for more info regarding injuries to the hamstrings, glutes, and calves.

And special thanks to my friend and kettle bell mentor Clifton Harski at BA training in San Diego for giving the okay and pointers on my form in the exercises shown. So if I suck, really Clifton sucks and you can be the one to tell him that. Check him out.