Runner’s butt is characterized by pain along the upper hamstrings and buttock. It is caused by repetitive strain to the hamstring tendon and its attachment to the bottom-most bone of the pelvis, which is called the ischial tuberosity, or the “sit bone.” Also referred to as “high hamstring tendinopathy,” this condition is most common in runners and ultimately causes some to give up running altogether.
The simplest way to test for runner’s butt is with a hamstring isometric test. While standing on your good leg, elevate your painful leg and place your heel on a chair or step. This puts your hamstring into a stretched position. Contract your hamstring by pressing your heel downward. If you get a jolt of pain, odds are you’ve got runner’s butt.
Unfortunately, most common approaches for alleviating the pain, such as using a foam roller or sitting on a tennis ball, ice or heat applications, stretching or physiotherapy modalities like electric stimulation, don’t work. Excessive stretching often makes the condition worse. Painkillers like ibuprofen provide only temporary pain relief and are not worth the side effects of long-term use.
Be aware that other problems can cause buttock pain, including arthritic hips, hip bursitis, lumbar spine disc herniations and pelvic organ diseases. Also, large tears in the hamstring tendon are common and make runner’s butt impossible to treat. Sometimes an MRI is required to rule out these conditions.
For self-help, try self-massage. Find the most tender spot along the hamstring. Firmly press and rub it with a fingertip for up to three minutes. Don’t roll or squash it on a tennis ball or foam roller. Exercise the hamstring by doing one-leg dead-lift repetitions with moderate weight. Or, while on your back, place your heels on the top of a gym ball, and while keeping knees bent about 30 degrees, lift your butt off the ground. This is called a supine ham bridge (go to www.drgillman.com to watch a demonstration of these exercises).
Avoid stretching. If you must run, shorten your stride. If possible, take a break from running. If these options don’t work, seek professional help. A credentialed sports chiropractor is ideally suited to properly evaluate and treat your condition.
When you search for skilled health care providers, find those who are certified and experienced in both sports medicine and soft tissue treatment. Graston Technique, FAKTR (Functional and Kinetic Treatment with Rehabilitation) or deep transverse-friction therapy are methods that can help, as can kinesiologic tape, such as Rocktape.
Follow through with exercises that condition the hamstring. Because the hamstring attaches to the pelvis, expert joint manipulation to the pelvis to promote better pelvic joint movement is important. (A chiropractor is best suited for this treatment.) Therapeutic ultrasound or low-level laser therapy over the tendon, when combined with other soft-tissue methods, can help.
Page 2 of 2 - Lastly, platelet-rich plasma (PRP) injection has been successful in resolving stubborn tendon problems. Unfortunately, there is no research that shows who will respond best to what treatment.
Sports chiropractors and orthopedists are among the most expert at diagnosing your pain before embarking on treatment. You can eliminate runner’s butt with appropriate treatment and time, but if buttock pain doesn’t improve after approximately 10 sessions of professional therapy, then get a second opinion.
Scott Gillman is a doctor of chiropractic in Natick, Mass., in practice since 1991. He is also a chiropractic sports medicine specialist with a diplomate from the American Chiropractic.