Therapist Pages

Hamstring Strains in Runners


            Most of us have heard the phrase “pulled a hammy,” or other various references to hamstring injuries being thrown around during professional games and in different sports settings.  In reality, these injuries affect not only high level athletes, but recreational and weekend athletes as well, often causing pain with sitting, soreness with prolonged walking, or difficulty running.   If you’ve injured a hamstring, you know just how stubborn they can be!

            Seemingly a straightforward injury, hamstring strains are very likely to become chronic, with a strong rate of recurrence especially in runners.  As a PT, they can be very challenging to treat, especially in active patients who are itching to get back to their sport!  The discouraging part is that hamstring strains don’t always feel better immediately after you stop running or participating in sports.  They seem to bother patients with normal daily activities such as driving, sitting in school, or working at the computer.  This is because the muscle that is normally aggravated in hamstring strains attaches to our ischial tuberosities, or “sit-bones.”

             When sitting for an extended period of time, as most of us do during the day, we are putting pressure on the hypersensitive area in the scar tissue which forms as a result of injury.  In the past, I’ve treated this sensitive area with anti-inflammatories, gentle stretching, and massage in addition to ergonomic adjustments, including adding a wedge or cushion to ensure a patient’s hips are above the knees when sitting.  New research also suggests that deep tissue massage, such as that performed with your handy tennis ball or foam roller, can stimulate cellular repair. 

            As therapists, we always stress the importance of core strength and trunk stability, but another recent study shows that patients treated with core strengthening and agility drills had better outcomes than patients treated with stretching and hamstring strengthening.  Re-injury rates one year post-injury were also lower in the trunk stability/agility group as well. 

            This doesn’t mean that stretching is ineffective, however!  Another study showed that when hamstring stretching was performed during a sporting event, athletes were less likely to injure their hamstrings.  The take-home point is that if you have had an injury or are prone to hamstring strains, stretch often when out on a long run or in the middle of a sporting game – stretching doesn’t take much time and can be effective at warding off injury!  If you have a stubborn hamstring injury or need advice on mending a nagging ache/pain, don’t hesitate to call us at (707) 447-9750


Iliotibial Band Syndome

We’ve all heard of IT bands in the running community, and for good reason! This can be one of those pesky sharp pains that causes you to pull up short during a run, and often lingers into daily life - stairs and walking often become much less comfortable.

So what is IT Band Syndrome, and how can you avoid or “fix” it?

Your IT Band is a long wide band of fascia that runs along the outside of your thigh from your hip to your knee. It originates at your hip (specifically your tensor fascia lata and your gluteus maximus both insert into your ITB) and travels down to your knee where it attaches to the end of your femur (thigh bone), your patella (kneecap) and your tibia (shin bone).

There is still some debate regarding the cause of the pain that is felt with ITB syndrome, with current theories suggesting that a layer of fat and connective tissue with significant blood flow and nerve endings separates the ITB from these bones. What is well known, however is that people suffering from ITBS tend to have weak hip abductors, and reduced stability and control at the hip and the knee.

If you are dealing with some lateral or “outside” of your knee pain, or just want to minimize your risk of developing ITBS there are several things you can do. If you are currently dealing with pain, icing for about 10 minutes several times daily will help reduce excess inflammation. 

Foam rolling along your lateral quad and hamstring (pressure should be moderately firm with slow, controlled speed for about 10 sweeps up/down your leg or 30-60 seconds duration), stretching your piriformis, and glutes (several sets of 20+ seconds each is ideal), and working on hip instability or weakness are good all important.  

Great hip stability exercises include bridges, side lying clamshells, kneeling side planks, and wall squats. You want to “feel the burn” at the outside of your hip with any of these exercises. As runners we need muscles that have lots of endurance so you should perform 1-3 sets of 15-30 repetitions or 3+ sets of 30 sec. or longer holds. 

As a general rule of thumb, if your pain does not improve or worsens within a few weeks, it’s time to seek more specific medical advice from a physical therapist or doctor. 

(This article is for informational purposes only and is not  intended to replace official medical advice, diagnosis, or treatment.)


What's Really Causing Your Knee Pain?

The knee seems like such a simple joint. It bends and straightens as we run, walk,

squat, and kneel, among other things.  Why, then, do runners so frequently end up

with seemingly mysterious knee pain?  In short: the knee is much more complicated

than you realize.

Sure it does bend and straighten, but it also rotates slightly. Additionally, it is

between a very mobile joint (the hip) and a mobile load bearing joint (the ankle). I

could go on and on here since knee pain is often related to problems at either of

these joints, but for now, let’s focus on the knee.

This article will give you an overview of the knee in general, because before you

can understand what causes knee pain, you first have to know what happens when

the knee moves. But fear not, in future articles, I’ll write on specific causes of knee


Your knee joint is made up of the end of your thigh bone (your femur) and the top

of your shin bone (your tibia). Your fibula (a smaller, primarily non weight bearing

bone along the outside of your shin) ends just below this joint. Why does this

matter?  It connects to your tibia at both your knee and ankle and together these

bones allow for rotation. Last but certainly not least you have your kneecap (or

patella) which is very mobile and floats on top of your “knee joint”.

All of these bones are connected to each other by various ligaments and (in the case

of the patella) tendons. Ligaments and tendons are dense cartilaginous tissues that

serve as stabilizers and connectors of bones and muscles. Why do these matter?

They can get overloaded either acutely (if you roll your ankle or twist your knee) or

over time (if your form is less than perfect and you have repeated stress at these

sites). Just as we don’t do well when hungry, tired, or sick, our ligaments and

tendons don’t do well when too much abnormal or less-than- ideal load is applied,

and they tend to let us know. How? By sending pain signals to your brain!

In between your femur and tibia you have your meniscus - this is your knee’s shock

absorber if you will, and a commonly dreaded site of injury. The reason is simple, if

you try to run without shock absorbers it’s not going to be fun. Additionally, this is

not a structure that will just regrow if surgery is performed.

As if all of this wasn’t enough, you also have numerous muscles that cross over your

knee joint and provide the force that bends, straightens, and rotates your knee.

Primary culprits of injury include your hamstrings (at the back of the leg), your

gastroc (at the back of your calf) and your quads (at the front of your leg). You also

have your IT Band or Ilio-tibial band which is a band of fascia that runs along the

outside of your leg from your hip to just past your knee joint.

So what does this all mean? What can cause knee pain? There are mainly 4

different types of structures that can cause pain: your bones, your joints (in between

your bones), your ligaments (stabilizers for your bones) or your muscles/muscle

tendons (movers of your bones). This is not to say that these are the ONLY things

that can cause pain - you could, for example have pain where a tendon attaches to

a bone; or multiple structures might be involved ie. bones and joint. To complicate

matters further you also have numerous bursa, fat pads, and nerves, among other

connective tissue, that could potentially lead to problems. But to keep it simple, and

less overwhelming, just worry about those 4.

Phew! Now that that’s over keep an eye out for the fun stuff - what causes pain

where? That, my dear readers is a question I will answer in future posts.

(This article is for informational purposes only and is not  intended to replace official

medical advice, diagnosis, or treatment.)