Running Considerations for Proximal Hamstring Tendinopathy Rehabilitation

Welcome to another episode of our podcast series dedicated to helping you overcome proximal hamstring tendinopathy (PHT). In this episode, we will explore the important considerations for runners working on their PHT rehab. Whether you’re an athlete or not, this information will empower you to take the right steps in overcoming this condition and return to your running routine. I’m your host, Brodie Sharp, an online physiotherapist and a recreational athlete with firsthand experience battling PHT.

Back from Break: New Episodes Coming Your Way

Firstly, I want to apologize for the brief hiatus in our podcast releases. I was on a holiday road trip, but I’m thrilled to be back and ready to deliver a fresh episode. Expect more episodes coming your way soon. Now, let’s dive into today’s topic: running considerations in PHT rehabilitation.

Running Considerations: A Focus on Technique, Speed, and Terrain

While our podcast isn’t exclusively for runners, a significant portion of our audience is involved in running or thinking about incorporating it into their rehab routine. Today, we’ll discuss various aspects of running that can influence hamstring tendon load. Much of the information we’ll cover is based on a recent research paper titled “Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management” by renowned authors Tom Goom and Peter Malliaris. In a previous episode, we discussed the paper’s key findings, highlighting the acceptable level of pain during and after exercise (0-3 out of 10).

Four Stages of PHT Rehab

Before delving into running considerations, let’s quickly recap the four stages of PHT rehabilitation, as mentioned in the research paper:

1. Isometric Hamstring Loading: This involves loading the tendon without moving in and out of the position, typically through isometric holds.
2. Isotonic Movement: Incorporating movement into strength exercises, with minimal hip flexion to avoid compressing the tendon.
3. Increasing Hip Flexion: Gradually increasing hip flexion to allow the tendon to adapt to more compression.
4. Energy Storage Loading: Applying more power-based exercises to strengthen the hamstring tendon.

These stages serve as a foundation for our discussion on running considerations.

Running Technique: Overstriding

The first crucial aspect to consider is your running technique, specifically overstriding. Overstriding occurs when your foot makes initial contact with the ground too far in front of your body. This can lead to excessive stretching and compression of the hamstring tendon, potentially causing issues. To address this, consider filming yourself while running and analyzing your foot’s initial contact point in slow motion. Reducing overstriding can help alleviate stress on the tendon.

Running Technique: Excessive Forward Trunk Lean

Another technique to keep in mind is your trunk’s posture while running. Excessive forward trunk lean can strain and stretch the hamstring tendon, similar to a mild hamstring stretch. Running with your chest upright and maintaining an efficient posture can reduce this strain.

Running Technique: Anterior Pelvic Tilt

While less significant, anterior pelvic tilt can also affect hamstring tendon strain. It’s essential to be aware of your pelvic position during running, although it may not be as crucial as overstriding and trunk lean.

Variables to Consider: Speed and Terrain

When running with PHT, two variables that demand attention are speed and terrain. Research indicates that running at higher speeds places more stress on the hamstrings, particularly during the terminal swing phase. If you’re struggling with your return to running, assess your speed, and ensure you’re not pushing too hard. For those further into their rehab, gradually reintroducing speed is advisable.

Running uphill is another variable to consider. When running uphill, you often make contact more in front of your body and lean forward, placing extra strain on the hamstring tendon. While you don’t need to avoid hills completely, ensure your hamstring is strong enough to handle uphill running. It’s crucial to balance terrain variations during your rehabilitation.

Gate Retraining: Increasing Cadence

To address running technique and improve posture, consider gate retraining. Increasing your cadence, the number of steps you take per minute, can significantly impact your running form. A higher cadence results in shorter, faster steps, reducing overstriding. Ideally, aim for a cadence between 160 and 180, as this has been shown to be effective in reducing hamstring tendon strain.

Gate Retraining: Cueing for Better Technique

Cues can be helpful when implementing changes in your running form. To reduce overstriding, visualize contacting the ground more underneath your body. When addressing excessive trunk lean, focus on keeping your chest upright. However, excessive pelvic tilt may not be as vital to change, as the benefits may not outweigh the effort required.

Walk-Run Programs: A Gradual Approach

During your PHT rehabilitation, implementing walk-run programs can be invaluable. Start with short bouts of running separated by walking intervals. This approach allows your tendon to adapt gradually and provides opportunities for recovery. As you gain confidence, you can transition to more continuous running.

Running as Part of Your Rehab

Finally, it’s essential to consider running as an integral part of your rehabilitation, rather than a milestone to reach. Start with small amounts of running and incorporate it into your overall rehab plan. Think of it as a progressive journey, where you gradually build up your running capacity, ensuring that your hamstring tendon is strong enough to handle the demands of running.

In conclusion, running with PHT requires careful attention to running technique, speed, and terrain. Gate retraining, particularly increasing cadence, can help improve your form and reduce strain on the hamstring tendon. Implement cues and walk-run programs to facilitate a gradual return to running. Remember that running is part of your rehab, not a separate milestone. With patience and proper considerations, you can successfully overcome PHT and resume your running routine.

Thank you for tuning in to this episode. We hope you found this information valuable and insightful. Stay tuned for more episodes to empower you in your PHT rehabilitation journey.