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Lower Butt Pain in Runners: High Hamstring Tendonitis

Updated: Jul 31, 2020

by Nora Gilman, MS, LAT, ATC


The Rundown:

The hamstrings attach on the ‘sit bone’ of our pelvis, called the ischial tuberosity. When runners have butt pain and point to their lower glute area, it is likely high hamstring tendinitis at the attachment on the pelvis. Muscle tendinitis occurs when there is overuse to an area, causing the tendon to become inflamed and painful.


Symptoms:

Common symptoms of high hamstring tendinitis is pain on the ‘sit bone’ and pain while sitting.

My Clinical Experience:

(Note: this experience has not been clinically trialed and are theories only)

This condition is the most common in endurance runners. Endurance runners have a shorter stride than sprinters which sometimes causes the endurance runner to recruit less glute activity in their running and therefore cause the hamstrings to overwork, especially at the attachment to the pelvis. The athletes typically have a hard time activating their glutes without involving their high hamstring. When this problem occurs repeatedly during running, the hamstring will become tight, painful, and inflamed.


What you can try:

  1. Modify running: If you find running makes your symptoms worse, try to find an intensity or amount of running that you can sustain without making the condition worse.

  2. Stretching and Strengthening: While you modify your running to a tolerable volume and intensity, adopt a regular regimen of hamstring release and glute strengthening. Perform this regimen as often as you can.

  3. Cross Train: You can find other activities to engage in to keep your aerobic fitness while you turn down your running volume. Some alternatives are biking, swimming, or water jogging. These activities can strengthen other muscles that you may not be using in running. If any of these activities make your symptoms worse, try a different activity.

  4. Use pain as your guidance: This muscle re-education process detailed above will take time and patience. The best way to know if you’re making progress is to keep track of your pain and symptoms and adjust based on progressions and regressions.

  5. Wear compression shorts: The extra compression can help circulation and provide more support during activity.

  6. Refrain from complete rest: This pathology is largely caused by muscles not working, therefore, complete rest will not likely assist your progress and could potentially make it worse. Choose movement instead of sitting.


When to contact an athletic trainer:

  • If you need help and advice on properly modifying your activity, an AT can provide you with ongoing support.

  • If you need direction with the right stretching and strengthening protocol, an AT can get you started on effective exercise progression and regressions.

  • If your hip pain worsens or you feel weakness in that hip, an AT can advise you on the right steps to take next.


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