Thursday, March 17, 2016

How I Trained for a Marathon with Hamstring Issues

I promised to go over the physical therapy I did while marathon training, and I intend to follow through on that promise, even though it's more than three months late at this point (sorry!).

It's difficult to find pictures to illustrate this kind of post, so... CAT PICTURE.
First, a bit of history on my hamstring: I've had issues with my right hamstring (strains, pain, etc.) on and off since 2013. It got serious when I trained for my first marathon in Fall 2013. I was road tripping through the west for two and a half weeks, and the combination of lots of 7+ hour days in the car and running 30+ miles a week led to a hamstring strain.

With rest and some PT, I pulled it together enough to get to the start line of the Chicago Marathon and finish it, but it definitely limited my training a fair amount in the last six weeks. After that, I had minor issues, where I'd have to take 1-2 easy/rest weeks while training for half marathons.

I really focused on weight lifting starting in Fall 2014, to try to compensate for weak hamstrings. I thought that would fix the issue, but unfortunately in late October while training for the California International Marathon, I started feeling tell-tale hamstring aches. ARGH.

When I went in to ProSport Physical Therapy, my physical therapist, Sam (we'll call her PT Sam), said my hamstrings were strong -- so the weight lifting worked! -- but my glutes were super weak and not doing any work, so I was straining my hamstrings. Awesome. Here's what we did to combat that without totally resting so I wouldn't lost fitness pre-marathon.

Being as lazy as Mason is great when you want to be lazy. Not so much when it's forced.

Pre-Marathon Physical Therapy

At the time, the only issue I was really feeling was in my right hamstring (my traditional problem area, not the new, young, hip (ha!) problem area I dealt with post-marathon). PT Sam wanted me to focus on the most important workouts and keep total mileage volume low, so Coach Jess had me doing my long runs and one to two other short runs during the week. Since using the elliptical didn't bother my hamstring, I'd do 1-2 elliptical workouts each week as well, just to try to keep up cardio endurance.

One of the shorter runs would include some tempo portions, but it was all about effort and not pace -- I would try to push my cardio as much as I could without feeling any pain in the hamstring. I found that if I kept it slow, I could run pretty close to pain-free, so we focused on keeping up a base, and I was able to get in a 22 miler without aggravating the hamstring.

I would do my typical dynamic warm-up before every run, and on the long runs I also would stop to stretch out the hamstring and try to keep it from stiffening up every few miles (usually when I'd take fuel). I would also stretch then ice after each run to lessen inflammation, in addition to doing "legs up the wall".

My training was constrained basically from the beginning of November until the race in the first week of December, which sucked. Part of the reason I've been so motivated with physical therapy post-race is that I am determined to solve the structural issues that caused the hamstring pain and get through a training cycle without having to back off due to injury.

I got to the start line and made it through with a PR of almost 11 minutes, and while I was happy with the result (particularly given the stabbing abdominal pains I dealt with in the latter half), you will always feel a pang of regret when you haven't been able to give training your all due to injury.

Post-Marathon Physical Therapy

Initially, things felt okay after CIM. Running didn't feel good, and both my hamstrings kind of hurt (especially up high), but I figured it was normal post-marathon aches and pains. However, as I tried to run a bit more, I started realizing that the pain wasn't normal.

So what sidelined me after the marathon? I was having pain and stiffness in my left TFL (the tensor fascia latae), which is a hip abductor muscle that works with your glutes, and my right high hamstring. I couldn't run more than half a mile without stopping to stretch and more than two miles hurt too much for me to possibly think it was a good idea to keep going.

Initially I was running so little for the couple weeks after the marathon that it wasn't much of a problem. But the pain got pretty bad after I got back from South America. After a busy week of work (and sitting a lot, tightening my hips up even more), I did deadlifts, thinking I was using my glutes. I now know I was really using my hips. I tweaked the TFL and later on that day it hurt so badly that I made an emergency PT appointment.

When I talked to PT Sam, I was almost on the verge of tears. I had just basically rested for ten days (with the exception of walking and two hikes), but I had suffered no pain while on the trip. When rest doesn't make something better, it makes me very nervous, and we were now almost two months out from the marathon. I couldn't believe I still wasn't back to 100%, and was starting to get really worried that there was something more serious at play (and also, I had not run much and that doesn't lead to me being at my happiest or sanest).

Sam had me do some exercises extremely slowly, and we realized that all those times I thought I was using my glutes, I was really using my hamstrings and hip flexors. Despite the constant "are you squeezing your glutes?" from PT aides as I did my exercises, I had always just assumed that I was using them. Nope, I was largely using the other muscles, continuing to leave my glutes sadly underdeveloped and weak, and overusing the muscles surrounding them. This had inflamed my TFL.

Thankfully, this gave us something to focus on going forward. Sam calmed down the angry TFL, and adjusted some of my exercises, and we started focusing anew on building up my glute strength.

One of the biggest changes was focusing on squeezing my glutes when running. For most people this may not be necessary, but I've realized that I have to really focus on using my glutes when I run if I want to engage them. If I'm doing it correctly, I'll also feel my lower abs contracting (which makes sense, since Sam was always having me focus on lower ab exercises).

ProSport also moved recently, so now we have this whole awesome turf area to do exercises in!

Another change? I moved offices at work and now have a set-up where I can create a makeshift standing desk. For the past month, I've alternated between sitting and standing throughout the day, and I've felt a huge difference in how tight my hips are.

We also had a breakthrough last week where we figured out the source of my lingering high hamstring ache. It didn't rise to the level of a pain, but something just wasn't 100% on most runs, and I was starting to feel it more as I was upping the mileage. Turns out what seemed like high hamstring was actually inner thigh, which was/is very tight. We've started working on that, and I'm already seeing a lot of improvement. Although damn, having that high inner thigh muscle worked on is brutal.

So if you've gotten through all that, congratulations! You win ... well, nothing. I guess you win knowledge about all the aches and pains I've been dealing with the past five months (wow, I just realized it's been five months, no wonder I feel like I'm BFFs with Sam).

We're hopeful that I'll be all clear to stop PT near the end of this month, and at that point Sam will start working with me to develop a post-physical therapy plan. I'll keep y'all updated!


  1. Ugggghh I have been through so much of the same stuff & I *totally* feel you. I think I'm finally starting to get it marginally under control & fixing my left/right imbalance, but it's been a LOOONG road. Good luck!!

    1. It seems like you've been progressing well over the past few months! Reading blogs of people who've dealt with various injuries and made form changes with success has helped me feel like the work will be worthwhile :)

  2. I'm glad you finally got to the bottom of it! Now I am going to be hyper vigilant if I am actually using my glutes or not...

    1. It's so crazy that I thought I was using them for so long but totally wasn't!

  3. Holy cow, what a process. BUT you found the root of the issue and can now fix it. You have a great outlook as always. Looking forward to following your progress

    1. Thanks, Carrie :) Yeah, it's been a process... but so happy that everything seems to be turning around now!