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Bilateral hamstring tightness and glute pain with low back pain and restriction of movement

Question: Bilateral hamstring tightness and glute pain with low back pain and restriction of movement

8 or so years ago I was training for a marathon. Each week the pain got worse but by the day I was running 15 miles, I had to stop and just walk back to the car. No amount of stretching during the runs helped for any more than a few minutes. At this time the pain was centralized deep inside my glutes.

I first saw a sports physiatrist about 6 years ago who after seeing nothing on a scan, suggested it was an overuse injury and I should back off running completely to let it heal. he could not determine anything wrong in his exam that indicated a pinched nerve or spinal issues. At this point I began lifting more seriously, backed off running and started participating in distance rides. After a number of months I began incorporating running back into my routine. The pain was still there, and at times after a day I ran, sharp pains in my hams/ glutes would wake me from sleep.

3 years ago the pain was becoming so bothersome that I saw the physiatrist again and he referred me to a PT. She had me adjust my running gait and we used the Graston Technique on my glutes a few times. It was painful but it was a strangely good pain and left visible bruising on my skin. The feeling that it helped was like stretching however, temporary.

6 months ago I returned to a different PT recommended by the first who in his exam discovered nothing weak but that generally my body was balanced and strong. What he did find though was that my hamstrings were so short they pulled my lower back when he lifted my leg. Also, in a leg swinging exercise the tightness caused my pelvic girdle to tilt with the leg movement which apparently it should not do and indicated a lack of flexibility. They gave me some band exercises that didn't ultimately feel helpful and instructed me to shorten my stride. These have not helped. While I can shorten my stride and pick up my pace, this just hides the pain a bit because it does not challenge the shortened ham. It is so bad now though that a few months ago I took a 5 mile walk and was so painful the following day I called to make another PT appointment in desperation. It was cancelled due to a schedule conflict.

Most recently, in the past 2 months, I hired a trainer who gave me some severe stretching exercises that really did seem to help in the short term, at least as long as my workout. He also had me roll with a small ball under my butt to break up any fibrous tissue. Since meeting with him I have been religious about stretching in every way I can the hams and glutes prior to any workout. It helps in the short term but I am no more flexible than I was 2 months ago and the pain remains. I have been avoiding running because it hurts and even avoiding squats and other leg exercises because after wards the pain is too much and I assume building muscle is only making it worse.

Today, I am painful and tight in my hams and very low back while just standing, walking, squatting to pick something off the floor. It hurts to life my legs to a surface to stretch. I am desperate...age 44 and not ready to be using a walker.

Answer:

Three things come to mind that may or may not have been considered by those who have checked you out so far:

My first thought was could there be some sort of sacral instability ? An occult spondylolisthesis if you will - that is only irritated with repetitive loading and which would not show up on a static image sequence without the proper positioning. There has to be a reason the area you are referring to remains tight (some sort of irritation causing muscle spasm or scar tissue in place trying to stabilize a damaged or unstable structure).
From there a more aggressive physical exam may be needed or some creative imaging techniques ? What are the effects of heat and ice ? What sort of medical treatments have you had i.e..muscle relaxers, steroid injections, NSAIDs, etc.

Next I am curious if you have adverse dural tension in the area ? Based on the remarks you made of the second exam this could also be the case. Adverse neural tension or dural tension in my experience can easily be overlooked as a source of pain, can develop insidiously or after injury, and does not necessarily show up on MRI scans (to my knowledge). To test this I would have you sit on the edge of a chair with both legs straight out in front of you. Next bend forward as if you were going to stretch your Left hamstring (first bend your right leg to a comfortable and stabilizing position). Reach your right hand toward the outside of your left foot, once you feel a decent stretch, bend your neck and then chin downward. You may also dorsiflex your foot (flex ankle and toes up toward your head). Try twisting your trunk L and R to see the effect.

Also worth consideration is SI joint dysfunction / pseudo instability and leg length descrepancies. Each of these can often be irritated by repetitive impact activities such as running.

Let me know how things go and I'd be glad to help you troubleshoot your issue.

Answer:

The kick was at a soccer ball and missed. A similar action later really hurt the hip area.
Ice and heat did not seem to help as it was very deep on if not even at the joint. X-rays showed nothing was wrong. Yet the area hurts enough so that once running starts, it is very sore.

Answer:

SanginiR

You need to look at a few things prior to stretching the hamstrings. Is your pelvis in the " neutral" position ? Or is it anteriorly tipped ? If it is tilted anteriorly, then it will appear that the hamstrings are "tight" since the hamstring attachment ( ischial tuberosity ) has moved upwards. This can increase the "tone" in the muscle, making it appear tight. Stretching the hamstrings with the pelvis in an anteriorly tilted position, will not resolve your issue. ( I can almost guarantee it) . Look up posturalrestoration.com for more insight on this. Also look up hruskaclinic .com and look at some recent blogs on what happens to the hamstrings with the pelvis in an anteriorly rotated position. Jason Masek, PT,PRC of the Postural Restoration Institute, has explained it really well.
I have been practicing the postural restoration approach for 10 years now, and can tell you that this stuff works way better than the traditional model of stretching when something feels tight, vs looking at what is it that is making it tight, and addressing that first domino that tipped the scales.( aka and anterior pelvic tilt)
Hope this helps ! Let me know if I can help you further.

Answer:

J Stisowain, MS
johnstisowainfitness.weebly.com

I agree with SanginiR. Have a look at your posture. He explains it very well, but if your hips are tilted anteriorly (or down in the front) then that will lift the back, lifting the attachment of the the hamstring muscles and lengthening those muscles. They feel tight, you want to stretch them but you may actually be creating a susceptibility to further or reinjury as they are lengthened even more from stretching. If this is the case..what's effecting the hips? A lot of runners I have trained, I've come across very tight hip flexors and week abdominals (the 1,2 punch) allowing the downward tilt of the hips. This is pronounced after long runs. Take a look at someone who has just finished a long run...chest is up real high but only because of hyperextension of the lumbar back (also lack of thoracic flexibility) because the hip flexors are tight and pulling and the abdominals are fatigued. By the way, the pain in the "glutes" may be more of the piriformis due to weakness of the glutes (which is ridiculously common and can contribute to the allowing of the hips to tilt forward). Try strengthening the glutes (bridges, lateral lunges). If they are weak, the piriformis might be trying to compensate for that and the overstretched/inhibited hamstrings. Your adductor magnus may also be trying to help out (as a hip extensor) and this can feel like tight hamstrings,...and also send pain to the SI area.
Can't at all be sure of any of this, but you have some good places to start. From the date of the post I hope you have already found relief! Good luck!