Not All Hamstring Pain Is a Hamstring Problem
About the Author: Hannah Breal, PT, DPT is the co-owner of Made 2 Move Physical Therapy in Charleston and Charlotte. She helps athletes and active adults rebuild strength, mobility, and confidence so they can move pain-free for life.
Made 2 Move Physical Therapy – Charleston | Daniel Island | Mount Pleasant | Charlotte
Not all hamstring pain means you have a hamstring issue.
I had a super interesting evaluation with a new patient a couple weeks ago who originally came in for hamstring pain: she plays a lot of tennis and thought she had torn or pulled her hamstring,
so she had been doing hamstring stretches and exercises in the gym to try and make it go away…
But it was only getting worse.
When I started asking deeper questions about her pain, what she said made me realize it wasn’t a hamstring issue at all:
“The pain travels from my glute down into my calf”
“It really hurts when I’m driving”
“I feel a big pull/tightness in my calf when I bend over”
“I was having bad lower back pain a few weeks ago”
“I don’t remember having any sort of hamstring injury”
My spidey senses were tingling, but I still needed to confirm my hypothesis (physical therapists are really like mad scientists) once I got her moving, it got even clearer.
The big thing that confirmed it:
When we did a sciatic nerve tension test, her nerve was very Unhappy, and she got the same pain she’d been feeling for the last few weeks.
Nerd out with me for a second
Our sciatic nerve travels from our back, down our glute, hamstring, and into our calf and foot.
When people feel pain/pulling/tightness in their glute/hamstring and changing their foot position makes it worse (aka, driving), that’s not the hamstring.
We didn’t change anything about the hamstring length when we moved her foot… we changed the length and tension on the NERVE.
You don’t need to memorize this unless you’re like a PT like me.
But what I do need YOU to know:
If you have “hamstring” pain… it might not be a hamstring issue at all, and aggressively stretching your hamstrings can make it WORSE.
“Sciatica” is a blanket term people use to describe their sciatic nerve being unhappy and irritated.
when that nerve gets unhappy, you might have pain, tightness, or a pulling sensation anywhere along that path, which is exactly what she was describing.
Why all that stretching made it WORSE
When the issue is an irritated and sensitive nerve, aggressively stretching it is like purposefully getting into an argument with your hangry wife.
She’s already upset. now you’re trying to make it worse??
It might feel like you’re doing something productive... but you’re not loosening a tight muscle.
you’re tugging on an irritated nerve that’s begging you to chill out.
(This is why “just stretch it” is bad advice - also stretching doesn’t do much for a strained hamstring anyway)
She had spent weeks doing the one thing that was keeping her stuck.
The first thing we did was stop pulling on the angry nerve
Instead, we switched out stretches for nerve glides to gently move the nerve without further pissing it off. watch the nerve glide example here
A few days later, her nerve was already calming down and she wasn’t feeling as much pain or tightness. wooo!!!
Not all hamstring pain is a hamstring problem.
Sometimes the pain you’re feeling is just the messenger - and the actual issue is something else entirely.
This is exactly why an assessment matters so much.
If she’d kept guessing (and stretching), she could’ve spent months frustrated, in more pain, and convinced her “hamstring” was torn - when her hamstring was fine the whole time.
If you’ve got “hamstring pain,” before you start targeting your hamstring, LOOK DEEPER and get assessed!
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Written by Hannah Breal, PT, DPT, Co-Owner of Made 2 Move Physical Therapy, helping Charleston and Charlotte move pain-free for life.
