Hamstring Pain with Running, Hiking and XC Skiing

What movements do running, hiking and classic cross-country skiing have in common?

Very simply, the legs move from in front of the body to behind the body in the sagittal plane. The sagittal plane divides the body into left and right sides. You can see this in the image of the dancer to the right.

While you perform these alternating front and back leg movements, the hip, pelvis and thigh are in motion to propel the athlete forward. Since the hamstrings attach to the bottom portion of the pelvis, I will focus this discussion on the actions and positions of the pelvis.

For anatomical clarification, the pelvis has three bones—the right ilium, the left ilium, and the sacrum.  In the image to the left, you can see that the right and left ilium are labeled as "hip." The ball on top of the thigh bone inserts into the right and left ilium, and the sacrum is at the base of the spine.

Pelvic Rotation

According to gait analysis studies, the pelvis rotates forward when the leg swings in front of the body. Then, it rotates backward when the leg swings behind the body. These movements are happening in the transverse plane, shown in the image above. If you stand with your feet together and take a step forward with your right foot, you'll notice how the right side of the pelvis rotates forward while the left side of the pelvis rotates backward.

An Asymmetrical Pelvis

The Postural Restoration Institute^© identifies a pattern of the body in which the pelvis becomes oriented to the right during development and stays there. The growing body searches for stability and finds it in this distorted pelvic position. When the pelvis is turned toward the right side of the body, the center of gravity also shifts to the right. As a result, you tend to stand more balanced over the right leg. This postural deviation seems to be the result of internal anatomical asymmetries such as one liver on the right, one heart on the left and an unbalanced diaphragm. So, according to this pattern, the pelvis is already facing right, not straight ahead and neutral.

This right pelvic orientation predisposes athletes to left hamstring injuries, which is what I see in the majority of my clients. If the athlete is in this pattern, known as the left AIC (Anterior Interior Chain), her pelvis is twisted to the right and her left hamstring is in an overly lengthened position. Attempting to turn her pelvis more to the right while running, hiking or classic skiing will further increase the tension in these muscles. This can cause muscle or tendon damage and recurring pain with the activity.

Although left hamstring injuries seem to be more common, the right hamstrings are not immune. Some clients are so strongly held in the left AIC pattern with a right oriented pelvis that they can’t efficiently transfer weight onto their left side. The athlete is stuck on her right side and can’t move off of it! The overly dominant right side works too hard, and the muscles can’t manage the additional load and break down. We frequently see this with the hamstrings and many other muscles of the right side, not limited to the lower body. Oftentimes, athletes have these lower body muscle development imbalances. In other words, their the right leg is noticeably larger than the left.

Anterior Tilt

When the pelvis tilts forward in the sagittal plane, we refer to this as  an anterior tilt. In the image to the left, notice how a pelvis with an anterior tilt also lengthens the hamstrings (image b). During the gait cycle, the pelvis goes into more anterior tilt when the leg swings behind the body.

Tight hip flexors contribute to anterior pelvic tilt. These muscles shorten and pull the pelvis down and forward (image b). Because of repetitive hip flexion during running, hiking and classic skiing, many of these athletes have an anteriorly tilted pelvis as their starting position. Not good!

Anterior pelvic tilt + left AIC pattern + sports  = hamstring pain

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5 Exercises to Reduce Anterior Pelvic Tilt
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Dysfunctional Glutes

But wait. There's more! In addition to being in a poor position, the hamstrings may be injured due to increased functional demand. The hamstring muscles assist with the extension phase of the sports movement. They work synergistically with the gluteal muscles to move the leg backwards. You may recall from a previous blog that the gluteal muscles are prone to dysfunction. Anterior tilt is one of the causes. If the gluteal muscles aren’t doing their job, then the hamstrings may have to step in to provide additional power. Being in a compromised position themselves, these muscles are often injured when their demand goes up, such as when under the stress of running, hiking or classic skiing.

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Relieving the Pain

As discussed in the last section, you need to re-establish proper hip extension mechanics if you're going to rehab properly. Prior to this step, however, you need to reposition the pelvis so that it's neutral. I have posted an exercise below to get you started. Try it! Please contact me with questions and to learn more.