Do you have ongoing hamstring issues that won’t go away? Maybe it gets better for a bit and then all of a sudden the hamstring pain is back with a vengeance?
You may have even tried a specific hamstring-specific stretching and strengthening programs but after all of your hard work, the symptoms don’t seem to be changing.
If this is you, then your pain may have nothing to do with hamstring injuries, but other sources instead. This is why no matter how many times you roll out your hamstring or how many hamstring curls you can fit into the week the pain doesn’t change. The source itself isn’t being addressed!
In the clinic we commonly have clients coming in and reporting what feels like hamstring pain or tightness that isn’t getting better. The most common source of this is actually the sciatic nerve that runs down the back of your leg and innervates the hamstring muscle.
Does an achey lower back or tight hips sound familiar?
The sciatic nerve starts in your low back and passes through your glute muscles, in particular a muscle called piriformis. If these muscles get tight or overloaded they can compress and irritate the sciatic nerve, which can cause hamstring pain due to where the sciatic nerve continues to run once it pasts through the hips.
Another sign that the sciatic nerve may be responsible for your hamstring pain that won’t go away or your history of repeated hamstring injuries is that you develop problems on both sides. For example, if you have a problem with your hamstring on your left leg, it shouldn’t then jump across to the right leg also. Hamstring pain on the left leg, should stay a one sided problem.
Since the sciatic nerve supplies the hamstring muscles, pressure on it can also cause the hamstrings to tighten. Therefore, you can do as many hamstring stretches as you want but if the areas higher up are never addressed it’s going to keep coming back!
One of my pet hates is clients coming in complaining of these issues despite seeing a physiotherapist forever, but yet the Physio has never even checked if the sciatic nerve is the source of all the issues! This is actually one of the most common sciatic nerve problems, that a therapist has assumed it is the hamstring and treated that for weeks, months or even years with constant issue and recurrence of pain. In fact, many people say they can’t touch their toes because their ‘hamstrings are too tight’ when in reality it is, and always has been, their sciatic nerve.
A quick test you can do right now at home to see if it may be your sciatic nerve:
- Sit on the edge of a chair
- Put your leg out in front of you
- Point your toes away from you
- Lean forwards until you feel a hamstring stretch
- Slowly pull your toes up towards you in that position
If you feel your stretch or pain worsen in that final position, it indicates that this is actually your sciatic nerve and NOT your hamstrings!
This neural tightness can also put you at an increased risk of an actual hamstring injury in the future so it’s important to get on top of it early. It may also be the reason why you’ve strained your hamstring on multiple occasions in the past.
So how do I fix it?
By taking the pressure off the sciatic nerve! First of all it’s important to loosen up those tight hip muscles and low back that are causing the issues. However, this alone isn’t a long term fix. These muscles are tightening up because they can’t keep up with the load they’re being put through.
Your flexibility needs to be worked on, and is best completed by following by a specific rehab program focusing on glute and deep core muscle strength to take pressure off your low back. By strengthening up these muscles you are increasing the amount of load they are able to cope with. The stronger they are the less they are going to tighten and irritate the sciatic nerve.
Why does hamstring take so long to heal?
The length of time for your hamstring to heal is very dependent on that nature of your injury, ie how badly you have torn the muscle. Grade 1 and 2 tears can have a complete recovery and return to sport within 4-6 weeks if rehabilitated correctly, with emphasis on eccentric strength training (strengthening the muscle as lengthens). For grade 3, or complete tears, we often see the recovery time ranging from 10-12 weeks for a full return to activity. Due to the severity of a grade 3 tear, there is a longer period of rest to begin with which is what lengthens your rehab journey.
How can I speed up my hamstring recovery?
The number one thing you can do to speed up your rehab journey is to see and experienced sports Physiotherapist. We will help to guide you through the early stage of your rehabilitation with movement and strengthening, from day one. This graded early movement will be one of the most important factors in speeding up your hamstring recovery. The biggest mistake we see is too much rest and immobilisation in the early stages of hamstring injury!
Are hamstring stretches bad for sciatica?
Hamstring stretches are not necessarily bad for sciatic pain. The sciatic nerve runs from your back, down the back of your leg and into your feet, meaning that when you stretch your hamstring you may also stretch your sciatic nerve. If you do a hamstring stretch whilst pulling your toes/foot up towards you, you will put your sciatic nerve on stretch – which can feel a little weird and you may feel it anywhere along the nerve, from your foot to your back! The most important thing to remember is to not hold a nerve stretch for a sustained period of time like you would for a muscle stretch, as this can cause irritation and pain.
Can sciatica cause hamstring pain?
Sciatica won’t cause any ‘real’ hamstring pain, as both the sciatic nerve and the hamstrings are independent structures, however sciatica can cause pain that feels like it is coming from your hamstring. This is because the sciatic nerve runs down the back of your leg and if this portion of the sciatic nerve is irritated then the pain is often mistaken for the hamstring.
What should you not do with sciatica?
The worst thing you can do for sciatica is to rest completely; and unfortunately this is the advice many people are given by their GP or therapist. Getting up and going for a walk may feel uncomfortable at first, however after a few minutes you will start to feel much better! Conversely, if you lay down and rest you may feel better whilst resting, however when you go to get up you often feel even worse!
How to tell the difference between pulled hamstring and sciatica?
The easiest way to tell the difference between a pulled hamstring and sciatica is to stretch your hamstrings with your toes pointed away from your body, before slowly bending your ankle to bring your toes up towards your body. If your pain increases with this test, it is most likely sciatica rather than a pulled hamstring.
Why isn’t my hamstring healing?
The most common reason that your hamstring isn’t healing is that you are placing too much stress through the hamstring muscle. Whilst muscles need movement in order to heal effectively, when you add too much movement or weight in the early stages of your rehabilitation you may be prolonging the healing process. A general rule to follow is to avoid pain above a 3 out of 10.
What does hamstring pain feel like?
A hamstring muscle tear will usually feel like someone has suddenly stabbed you in the back of your leg with something sharp; and can also feel like a burning sensation in some people. You may also notice hearing a tearing or popping sound at the time of the injury, however not all people experience this.
What to do when sciatica won’t go away?
When your sciatica won’t go away with rest and recovery, the best thing to do is to seek professional help. Physiotherapists are experts at relieving nerve pain through evidence based natural, holistic methods. A Physiotherapist will set you up with a plan to completely get rid of your sciatic pain through gentle mobilisation and exercise.
Look out for our follow up on this blog with some hip and back exercises to get you started!