One of my athletes came to me complaining of constant hamstring tightness and pain while running fast.

We looked at things from all angles (recovery, fuelling, strength, and running).

Here’s everything we did to rehab his hamstring:

Unfortunately for this athlete it took a few weeks to catch that his hamstring was bugging him.

He thought initially it was just tight from sitting too much at work.

He tried stretching it out after running but this didn’t change much.

Eventually he came to see me when his fast running became impossible.

We assessed everything from hip to foot to see how he was moving and what seemed to irritate the area.

We identified 3 things that were irritating:

1. Fast running (2x workouts per week)
2. Hinge movements (pull and pain in hamstring)
3. Deep palpation of the hamstring tendon

So here’s what we did about it:

First we reduced all fast running for a few weeks.

This accomplished 2 main goals. Reduced the overall volume slightly and reduced one of the main irritating factors for the hamstring.

In place of fast running we kept 1x strides per week and an extra higher-intensity session on the elliptical (since that didn’t bug the hamstring).

Next, we introduced some isometric hamstring exercises to build some tolerance in the proximal hamstring tendon.

My favourite one here is a hamstring bridge. Starting with a 2-foot bridge and progressing to a single leg elevated bridge.

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If you don’t feel the hamstrings on these you need to have your legs straighter.

To help recovery we made sure that he was fueling enough, sleeping well, and moving a little more through the day at work.

We wanted to make sure the body had what it needed to recover well. AND tried to reduce the extra pressure on the hamstring tendon from sitting at his desk.

Now for the tightness.

Given the proximity of the sciatic nerve and the hamstring muscle I often find it helpful to add some gentle nerve flossing to mobilize the tissues in the postior chain.

Before bed I encouraged this athlete to floss and use his foam roller to loosen up the hamstring muscle and calf.

This unlocked a ton of movement through the posterior chain.

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We stuck with this for 2 weeks or so before progressing to strength and endurance training.

This allowed enough time for the tendon to settle down and the isometric load to build some initial tolerance.

For strength training we progressed to 3 movements:

1. Single leg bridges (to keep some ISO load)
2. Straight leg deadlifts (to load the upper portion of the hamstring)
3. Single leg hops (to tolerate plyos)

My goal for him was to do this 3x per week at the start to ensure the tendon got the load it needed.

Alongside this we progressed back in to some faster running.

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Because he was able to maintain some strides and faster elliptical work it was less of a struggle to transition back into faster running.

We started the running progression with 3 x 5 mins at a mod-fast pace.

No specific pace or HR targets just a feeling of running in control but faster than the easy work he was maintaining.

After tolerating this well 1x per week he was able to progress these workouts back to his regular half-marathon builds extending the time and adjusting pace back down to race targets.

For continued care:

I encouraged dropping those strength exercises into a short full-body circuit that he was already doing 1-2x per week (depending on how much endurance work was there).

(I use a template to make sure you cover all the right aspects)

I hope this gives you an idea of what you can do to rehab your hamstring.

Thanks for reading!

Reply to this email if you have any questions about hamstring rehab.

Chandler

Thanks for being here! If you're new here I'm Chandler an endurance coach and physiotherapist. Each week I send a letter about sustainable endurance training or triathlon rehab. Say hi on X or Instagram.

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