Hamstring Pain in Marathoners: Why It Hurts Under Your Butt and What to Do
- Marie Whitt
- 11 minutes ago
- 6 min read
Most runners don't realize this is a hamstring issue.
Until it's a little too late.
I had a runner in the clinic once with a stubborn pain she could only describe as "right under my butt cheek".
She was concerned, wondering is this sciatica? Do I have a low back problem? Do I have some kind of glute strain?
So I asked her to point to the spot and she was able to place a finger on exactly where the hamstring met her glute.
And to be honest, that proximal or "high" hamstring location is the most common hamstring trouble spot I see in runners.
The problem?
It tends to sneak up on you.
It masks itself as stiffness, tightness, or an odd pulling sensation that can creep up, but you can still ignore. Until you can't.
And if you're in marathon-training mode (or simply increasing your mileage), you've probably noticed that your high hamstring starts talking:
on longer long runs
threshold workouts
intervals at near race pace
strides
and especially flaring up with hills.
But what throws you for a loop, is that you can still run. But that nagging tightness that can become crippling although the pulling doesn't start up immediately.
Instead, it tends to build at mile 6, getting tighter at mile 10, really pull at mile 13, forcing you to stop at mile 14, leaving your 18 miler unfinished.
woof.
So how about I give you the exact exercises I would start one of my marathoners on if they came to me 8 weeks out from race day, telling me they struggle to finish their long runs because of nagging high hamstring tightness?
But I also want you to realize...
These exercises are for educational purposes only.
Yes, they can help. But I'm not promising they'll cure all your hamstring ailments.
Hamstrings can be finnicky (especially proximal hamstring tendinopathy) and often require 1-on-1 help to fully resolve these issues. Exercises need to be progressed, hamstrings need to get stronger, and often the runner has to learn how to balance eccentric exercises alongside the demands of running.
If you'd like help with this, I do have 1-on-1 running rehab and performance coaching which you can check out here.
But let's hop into the workout!
The “Tight Hamstring” That Won’t Go Away: Should Runners Stretch?
Short Answer:
Probably not. I have rarely ever prescribed hamstring stretching to a patient. And never to a runner.
Long Answer:
I've found that often hamstrings are tight because they're gaurding, or protecting another body part your body or brain percieves as vulnerable (not saying "it" actually is).
I've also seen hamstrings become tight after a hard hill, speed, or strength session. In this case, the hamstrings are protecting themselves from over use as they recover.
What I want to change your mind on:
Tightness isn't always a bad thing that immediatly has to be addressed. Often it's more of a white flag, the only way for a muscle to communicate with you and get your attention.
So when a marathon who is 8-10 weeks out from their race is experiencing an unrelenting tightness right at the bottom of their glute, as a physical therapist who works with runners, I see this more as a "tendon + muscle meets bone" (or musculotendinous junction) issue where an increase in mileage, speed, and/or hills as placed a LOT of load pretty quickly on this one particular area.
Lots of load + On small-ish area = ouchies.
And honestly, it's extremely common. (so if this is you, don't panic. It's happens a lot, especially when you're running longer distance at a faster pace than previously).
So instead of traditional passive stretches, I give my runners this dynamic stretch which often provides longer lasting relief. Feel free to use this as many times a day as needed.
Proximal Hamstring Tendinopathy: 4 Exercises for Long Distance Runners
Circuit:
3 sets each // medium to heavy weights + resistance band (amount of resistance will depend on what's comfortable for you)
Alternating Glute Bridge March with Paloff
12 reps total (6 each side) X anchored resistance band
Single Leg Bridge with Foot on Bench with Weighted Overhead PullOvers
Reps X weight
Single Leg Hip Thrust
30 Reps X weight
Eccentric Hamstring Sliders
Reps X weight
Hamstring Tightness In Marathoners 10 Weeks Out From Race Day: Exactly What to Do
Single Leg Bridge with Foot on Bench with Weighted Overhead PullOvers
Hear me out: I'm usually NOT a strictly for which order you do these exercises in but...
THE POINT: if your hamstring is being a particular pain in the butt, you'll probably want to start here first. This is one of the more gently hamstring isometrics I give my runners. It can technically be done with both legs on the bench, but most times runners can hop right into the single leg version, which I prefer since it more closely replicates your runnign stride.
The weight overhead pullover is a fun core addition that can also gently begin to challenge your single leg hamstring strength. Often hamstrings will start to calm down with gently isometric loading, resulting in decreased pain levels, and with your core integrated as an active team member, it can help the pain relief to last longer.
Alternating Glute Bridge March with Paloff
I think this is a fun challenge ;)
THE SECRET: yes, you really will want to do this with a resistance band anchored to a stair banister, a heavy kitchen table, or a squat rack. Also, don't be surpised if when you're standing on the OUTSIDE leg, that this side feels harder. That completely normal!
But what I love about this, is that it continues to resemble your running stride, while challenging your single leg strength and core activing together, to stabilize against switching legs. It also starts to bring in a feeling of "change in direction" right away, but in a safe, isometric manner. Yes, I realize as runners we're predominatly moving forward, but even road runners have to avoid curbs or crumbling pavement.
Don't forget to spin around and do the other side too!
Single Leg Hip Thrust
Is it basic? Yes. But boy, does it look like running.
PRO TIP: I know some runners can be scared away from hip thrusts because they look too "gym-ish" and they can feel a bit awkward. But really and truly: try them. They're essentially a progressed version of the basic glute bridge most runners start with, but it's a position that can more easily progressed with heavier weight, while still resembling your running stride and directly targeting that proximal insertion of your hamstring (the "under your butt" hamstring pain").
The most important part I want you to learn: DON'T rush through these. I know there's the temptation to whip through these because they can feel awkward, but moving slowly through these reps (3 secs down, 3 secs up) can help you target and strengthen the tendon exactly. We can focus a lot of the ascent from this rep, but the magic happens in controlling the descent.
Eccentric Hamstring Sliders
What the video carefully.
THE KEY: this is actually a very gently way to start eccentric hamstring strength training. What you're doing is starting in a bridge position, with sliders under both feet. Straighten both legs, up to the point where you lying flat on the floor (i.e: your bum is no longer in the air!). With your bum still on the ground, bend your knees back to the starting position.
This is on purpose! Eccentric exercises place a BIG DEMAND on your muscles. That doesn't mean be scared of them; it means progress them appropriately. And often, I find this version of hamstring sliders, with both legs helping, is a great pain free option. So don't skip it!
WRAPPING UP
Before you peace out, I NEED you to know this.
You MUST do eccentric hamstring exercise to make a full recovery and stay recoverd from "high" hamstring injuries or proximal hamstring tendinopathy.
Often, runners (and athletes in general) don't want to do these types of exercise because they can leave you fairly sore for 2-3 days. Somtimes for 5 days if you've never done these consistently.
This isn't just a physical therapist telling you "these are good for you".
Recent research has found that hamstring strains, pulls, tendinopathies etc occur most often during changes in direction, increased speed work, high velocity kicking, or...more specifically for long distance running...
...During the swing phase of your running stride (the moment in your stride when your leg is airborn, traveling forward).
But WHY?
Because the sarcomeres, the individual units, that make up a muscle cell are too short for the elongated, or stretched out, position the muscle is being asked to move into (again: think your leg stretched out in front of you).
Eccentric exercises are HOW you create this physiological adaption -- lengthening sarcomeres, building a stronger hamstring, that can handle the distance and speed your training at.
And if you feel you're prone to repeat hamstring strains, you'll most likely want to pick 2 eccentric hamstring exercises and perform those 1-2x a week, just sliding them into your regular leg day strength routine.
Consistency is key here.
But if you're stuck and unsure which exercises to do, how often to do them, and what a full hamstring rehab plan looks like for a runner, you may want to check out my 1-on-1 running rehab and performance coaching here.
If you're unsure whether it's a good fit or the right move for your specific situation, just send me a DM on Instagram @dr.whitt.fit or email me at drwhitt@drwhittfit.com.
Yes, it's really me.
So until next time running fit fam...
Dare to Train Differently,
Marie Whitt, PT, DPT //@dr.whitt.fit
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