Written by Tom Goom, senior Physio at The Physio Rooms Brighton. Follow Tom on Twitter.

Followers of the blog will know that I had an injury last year that was a literal pain in the arse! I developed Proximal Hamstring Tendinopathy (PHT) during marathon training in 2013 which has since resolved with rehab. One question during that time was whether my running gait may have contributed. Recent video gait analysis seems to have answered that question…

A few weeks ago I attended Dr Christian Barton's running biomechanics course in London. It was a great day and included having my gait analysed. If you're a physio, or interested in a more in-depth analysis of running gait and PHT, I've written in detail about it on Christian's blog. The aim of this piece is to translate that info into a non-geek friendly article!

The key factors for running gait in PHT appear to be stride length and the position of the trunk and pelvis. An increase in stride length (usually termerd over striding) is often accompanied by a foot strike that occurs a long way in front of the body (see picture below). This can place more load on the hamstring and its tendon and aggravate symptoms. A forward lean at the trunk can also increase provocative load on the tendon, especially if accompanied by an anterior pelvic tilt (tilting forward).

Everyone's running gait and individual cirmcumstances will differ so it's important to make gait changes based on that individual rather than a one size fits all aproach. However, for many with PHT addressing stride length and trunk position may be helpful.

3 cues are often effective in this;

  1. Run with shorter, faster steps
  2. Tighten your glutes
  3. Run tall, as if being pulled up by a helium balloon on your head!

See how these changes affect your gait, your symptoms and how easy it feels to run.

Note the over stride in the pre-training picture

In my case a shorter, faster steps combined with tightening my glutes reduced my over stride significantly. It felt slightly harder to run that way initially but I think, with practice, it will get easier.

There are pros and cons of changing your running gait and it can take a lot of effort. A larger stride length can also be associated with increased stress on the knee. I've had patellofemoral pain in the past and so, on balance, I think a slightly shorter stride will be helpful for me. However running injuries, including PHT and knee pain, are often multi-factorial. Deficits in strength, control and flexibility also need to be addressed and will have an impact on gait. Hamstring strength is a key factor in PHT and needs to be addressed with a progressive programme. Also, In my case, I have very tight hip flexors which limit my hip extension and effect my pelvic position. In addition any training errors that may have lead to the injury should be avoided by modifying training – I'll need to gradually build up my hill running which often aggravates PHT.

In conclusion, reducing over stride and forward lean of the trunk may help reduce provocative load on the hamstring tendon. However detailed assessment and individual gait analysis are recommended to provide a comprehensive treatment programme based on your specific needs. Gait retraining is not a one off intervention – you often need multiple sessions with clear feedback to help achieve a comfortable, efficient style.

As ever on RunningPhysio – if in doubt get checked out!

 

8 COMMENTS

  1. Thanks for the article it gives me some hope. 12 months ago I had to give up running and 8 months ago all gym and PT. I have had this injury for over 2 years. I am in the 50 age group runners where if you get it it is more likely to be degenerative and less likely to respond to any conservative treatments. There was no acute incident and no tear to the hammy it just started as pain on sitting. I have undergone two rehab program’s with my supportive physio, patches, glucose injections, steroids orally and injections, 3 PRPs, 3 MRIs and complete rest. Nothing worked and sitting just became uncomfortable all the time. Two weeks ago I had surgery where the fluid was removed from between the tendon and the bone and the tendon sutured to the bone. I will be (and am!!) uncomfortable and not able to do anything for 2 months. Surgery is not common and I have only been given moderate expectations but fingers crossed! And hopefully my physio and I start another journey together.

    • HI Karen,, are you now able to sit without pain? I am similar profile and am looking at surgery too. Tried all above treatments as well.

  2. I’m a mountain biker and my rides this summer have been getting longer – 3.5 to 4 – hours and demanding much of the ride (lots of bursts in speed and strength. I started getting that pain in the arse you refer to and thought a micro adjustment to my saddle was required but then at the top of a grinder climb I felt my hamstring give up (mid thigh). I’ve been doing PT exercises religiously and there’s no pain where the acute injury occurred but still some of what you describe as PHT. I hope it isn’t that – I hope it’s just related to mid-thigh injury.

  3. I still cannot sit without pain it has been 10 weeks since surgery. It is a slow process. Turns out the tendon had completely separated from the bone. I can do some strength work but no resistance stuff until 12 weeks. I have assistance with rehab from trainers expert in injury rehab and my physio. I can now walk the dog and go by the guideline a little bit of pain is ok if I over do it I feel it. I can sit for longer but need a cushion! I am determined to either run or bike again – onwards! Back to the surgeon in 3 weeks,

    • That sounds so frustrating. No choice for you but to be strong and patient. For people who are not as damaged as you and have not done serious damage to the tendon, Tom’s exercises have helped immensely. Also, Astym is working for me. I have had three treatments, and am walking without pain, and doing some slow gait running via the tips and suggestions on this website. Stretching has to be done VERY VERY carefully. Finally see a little light at the end of the tunnel. Time is the key,,,, and lots of PATIENCE

  4. Hi Karen. How are you doing now? I’ve struggled with this pain for over a year and haven’t ran in almost as long. Nothing has worked, PT, NSAIDS, shots, nerve hydro dissection to separate scar tissue…etc. How are you feeling? We’ve talked about PRP or Stem Cell therapy but are still struggling to pinpoint the exact locations it’s stemming from.

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