The hamstrings are that group of muscles in the back of your thigh that every athlete is familiar with. Simply put, they are three muscles that provide motion to two joints – the hip and the knee. They’re of great importance if you choose to extend your hips, flex your knees, and rotate your lower legs.
Hamstring-type injuries tend to be common in many sports especially when running and jumping play a significant role. You may think that a sharp pain in the back of the upper thigh just opposite to the quadriceps is characteristic of “pulling a hammy”, especially if it occurred during a sprint or sudden, power-movement. Yet as often as these muscles may appear to be injured, they aren’t as common as you might think. Furthermore, when they are truly injured such as with the characteristic collapsing to the ground, thigh-grabbing muscle tear, they are most often the result of other biomechanical problems.
In line with the Sock Doc philosophy of almost never treating the area where the pain is actually felt, the hamstrings are no exception to this rule; actually they fit the rule more than any other area of the body. Therefore, in regards to therapy, the hamstrings should often be left alone when suspected of injury, with of course obvious exceptions (i.e. tendon tears). Actually, if you feel like you have injured a hamstring because you have pain or tightness in the back of your thigh, (and not gross bruising and swelling), then you probably didn’t, and your focus for healing the injury best be directed elsewhere.
Often Affected, Rarely the Problem
Every year I see many athletes as well as non-athletes who have pain in their posterior thigh. Some have felt like they pulled a muscle, whereas others have general discomfort and weakness in the hamstring area. Some of the athletes I see are Division 1 soccer players who often present in my office with hamstring-type pain. But rarely, if ever, have I actually had to treat their hamstrings to correct their problem which they feel to be in the back of their thigh. Typically each individual hamstring muscle is functioning fine when properly tested and the pain is either coming from a different muscle or the hamstring function is being disrupted by some other muscle imbalance somewhere else in the body – anywhere else in the body for that matter.
Look Above & Below
The hamstrings should be viewed as a bridge between the powerful gluteus maximus muscle and the calves. The hamstrings essentially end up taking the blow when either above or below just isn’t pulling their weight.
As the hamstring muscles insert into the lower leg bones (the tibia and fibula), the gastrocnemius muscle originates in the upper leg bone (the lower portion of the femur). An athlete is much more likely to have a gastroc weakness and pain than have an issue with their hamstring. Often what appears to be a problem with a lower portion of the hamstring is actually an upper portion of the gastroc. Since both these muscles flex the knee, they work in harmony with one another. Yet if one has a problem, the other is affected.
When the gastroc fatigues, which is very, very common in athletes especially due to its association with stress and adrenal gland function, the hamstrings have to work harder to take up the slack. This over-working of the hamstrings can cause a sudden tear or spasm resulting in pain and injury to the muscle. So although a hamstring may be injured, the gastroc must be treated aside from therapies to help diminish pain in the hamstring. Trigger point therapy around the origin of the gastroc as well as the lower belly of the gastroc right where it thins out and overlaps with the other calf muscle, the soleus, can be very beneficial. (* See photos #1 and #2 at bottom.) But again, as much as it may seem counterintuitive, you’re often better staying away from the pain in the hamstring.
Speaking of the soleus, athough this lower calf muscle primarily plantar flexes the foot, it actually has a huge impact on lower leg and knee stability. A failing (fatigued) soleus can result in a slew of problems, especially to the hamstrings. Trigger points are often found around the sides of the Achilles tendon as well as the just below the belly of the gastroc. (* See photos #2 and #3 at bottom.) Dig deep!
Let’s not forget to look above the hamstrings as that is where the meaty part of the glute max resides. The glute max, like the hamstrings, extends the hip. The fibers of the glute max extend deep into the femur and oftentimes this feels like a hamstring problem to many people. Like the calves, glute max problems are very common and usually what someone thinks is a hamstring pain because of the location is really their butt muscle. Again, trigger point therapy around the origin, (the upper pelvis as shown in photo #4 ), and the mid posterior thigh, (as I show in photos #5 and #6), can work wonders.
Pelvic Instability and the Psoas
Pelvic instability can result in the hamstring muscles functioning improperly and eventually lead to pain or injury in the muscles themselves or other pelvic muscles. But, like the glute max and the gastrocs (and soleus) involvement with hamstring-assumed problems, there is another muscle that can feel like hamstring pain even when it isn’t. This muscle, the psoas, is a major flexor of the thigh and interestingly enough it attaches to a small little eminence called the lesser trochanter which just so happens to reside on the upper backside of the femur. Hey, the hamstrings go right over this insertion point! As I show in the photo, you have to sort of dig deep and hook your fingers up the back inside of your upper thigh to get to this area, and it’s often very sore. (* See photos #7 and #8 at bottom.) Probably not a great idea to do in public.
Since the hamstrings and glute max extend the thigh, an injured psoas, a thigh flexor, can cause more strain to the back of the leg as these muscles work unopposed. Psoas problems are very common as many athletes have poor pelvic stability, low back issues, and breathing and posture issues all which rely on a fully functioning psoas.
Gait and the Hammies
Gait plays a huge role in the function of the hamstrings. Many times I have had to correct a shoulder girdle related muscle on the opposite side of the painful thigh as the shoulder-hip balance is compromised. This gait association is very common and neglected in patient assessments. I see the shoulder girdle to be the most undervalued joint(s) of the body; they’re often injured without the athlete knowing because there can be little to no pain. Yet, the shoulder throws off the gait and the hip is affected, and soon the hamstring. Poke and prod, ice and heat, ultrasound and E-Stim the hammies all you want and you will go nowhere.
This is not to say the hamstrings are not important. Of course they are. They are just way too implicated when it comes to injuries. I’d estimate that of all the “hamstring pain” and “hamstring injury” that show up in my office 49% of them are not the hamstrings and 49% are effecting the hamstrings function but stemming from another source. That final 2%, (that’s being generous), is actually a hamstring problem and a hamstring solution, (meaning that therapy to a hamstring muscle is necessary).
Of course don’t be a dummy – people really do tear these muscles and in extreme cases they need to be surgically repaired. But for most, both the patient and doctor, evaluating and treating where the pain is felt in the hamstrings is an effort that will only delay healing and result in other imbalances the longer the problem goes uncorrected. So look above, look below, look behind, and look to the shoulder girdle – but don’t waste too much time on your hammies because chances are they’re not your problem.