That stubborn hamstring/glute pain – to stretch or not to stretch?
7 March 2017
You have had this niggle at the back of your thigh for a while. You have been trying to stretch it out but it doesn’t seem to getting better. What’s going on??
Not all hamstring/ glute pains are the same.
The conventional hamstring injury usually involves an incident – sprinting or over stretching. The site of tear is within the muscle tissue. Patients normally comment ‘it feels like I got shot in the back of the leg’. We discussed this in our previous post. These injuries respond to gradual stretching once the acute inflammation has settled.
The next type of injury is a connective tissue/ fascia strain. The function of fascial tissue is different from muscle tissues and their healing capacities are different. Like the conventional hamstring injury, patients normally recall an incident but milder. There is much less acute pain and inflammation compared to the muscle injuries. However, the fascial type injuries take a lot longer to heal and require a slightly different rehabilitation protocol. Gentle stretching does facilitate recovery.
The 3rd injury we are discussing are the tendon injuries (tendinopathies or partial tears). The tendon is the white tissue that connects the either ends of the muscle to the bone. A common site of tendon issues is below your glute muscle, where your hamstring attaches onto your ‘sitting bone’. These don’t respond to stretching. Strengthening should also be done without the muscle on stretch. Massage and foam rolling through the muscle belly helps maintain flexibility without irritating the tendon.
Last but not least, is sciatic nerve irritation. This can happen following trauma (eg tethering of the nerve due to scarring from an old hamstring injury or disc injury in the back) or poor biomechanics/ posture. This often feels different from regular muscle tightness, almost painful, and patients normally complain of it extending to behind the knee. When a nerve is being irritated, it does not like to be stretched and will therefore tighten the muscles around it. Trying to stretch the muscles to loosen them can create further irritation of the nerve. After proper assessment, specific nerve stretches (known as neural flossing techniques) may be appropriate to help settle down an irritated nerve.