Suzie Says...Got a pain in the arse?
Updated: Feb 23
Got a pain in the arse? (...and no, I’m not talking about your work colleagues, mother-in-law etc)!
Here’s a quick guide to preventing and treating a pain in the arse or the upper hamstring (for the technically minded: Proximal Hamstring Tendinopathy - PHT). Luckily it isn’t overly common but can be difficult to diagnose!
So basically, your hamstring muscles (there are three of them in the back of each thigh) attach via tendons to your seat bones (ischial tuberosities) in your bottom, except a very small portion of one of these muscles that attaches to your thigh bone (femur). They are the muscles that predominantly bend your knee (i.e. to get your foot on your foot peg), but also help in hip extension (taking your leg behind you on each step when walking to get a beer from the fridge), so they are very important.
These tendons can get a little unhappy and this can cause pain, and can also result in subsequent irritation of the little cushion that reduces friction between the bone and soft tissue (ischial bursa). Sometimes this ‘pain in the arse’ can get misinterpreted as ‘sciatica’, which to keep it simple is more of a nerve irritation. Unfortunately, if the tendon is getting a bit worn (suffering from degeneration) this can eventually have an impact on the (sciatic) nerve to, and can make the situation a little more problematic to resolve.
Who will likely get PHT?
People who have previously damaged their hamstrings or even just the lower limb, especially when there is subsequent muscle weakness, e.g. core, pelvis, hamstrings and quads (muscles in front of the thigh), and muscle imbalances along with inflexibility of the muscles. So how many of us overland travellers fall into that group then?!?!
Runners are also prone to this, so if you like to run a lot, have had a previous injury and ride your bike often, you may end up with a bit of a problem...maybe. Also, i’m afraid if you are a bit older and female you do have a little more susceptibility.
Symptoms of PHT:
Pain deep in the bottom (and I mean the bottom of your butt cheek, not a central pain! If you have central pain you need to see a doctor or review your bedroom antics)!
Pain when sitting, especially for long periods or on hard surfaces...so get off your butt!
Pain with repetitive activity...maybe leave the Karma Sutra alone for now?!
Pain when fully flexing (bending) the hip e.g. bending forward....behave!
Pain with deep lunging/squatting and/or when stretching the back of your thigh.
If you like to run you may notice the pain when you run fast or suddenly speed up during running, like if you see a spider or worse, a bear.
Sometimes you may even get pain radiating down into the back of your thigh (referred pain).
What to do:
Prevent it by stretching and keeping your muscles strong and flexible, especially the quads and hamstrings, because it’s hard to get rid of! This will benefit you in more than one way.
Reduce pressure on the area as much as possible...no spanking. Off-road/enduro bike seats can be super tough so may make the pain worse quite quickly.
You can use a foam cushion when sitting and even cut holes in it.
Relative rest if you can (not always easy when on the road), but not too much you lazy thing, the tendon still needs to work so it's not an excuse to do f**k-all!
If on the bike, stop for regular photos/coffee's/siestas to reduce the constant compression of the tendon.
Load the hamstrings in an uncompressed position like lying on your front, slowly bending your knee to 30-40 degrees and then holding this position for 20 seconds (slowly increase time of holds over time), up to a minute per hold.
Do the above but with a small weight around your ankle (or object to dig heel into like underside of skid plate etc) for resistance if tolerated. Remember, you may not get pain from overloading the tendon until 2-3 days post-exercise so DO NOT increase exercise until at least 3 days after the last increase/progression.
Double leg bridge activation to get your big bottom muscle working (glut. max.) - hint: have knees quite bent up (feet closer to your bottom) to reduce the use of hamstrings and increase use of the bottom. You can then progress this to incorporate hamstrings and then to single leg bridge holds.
Massage and trigger-pointing of the back of the thigh (hamstring muscles).
Please remember: this is one of those stubborn arse issues (sorry for the pun) that won't respond very quickly to rehab/treatment.
What NOT to do:
Foam rolling, (like you would have one of these on your travels anyway, but just in case you did bring the kitchen sink with you I thought i’d mention it).
Running, especially up hills, unless you need to escape that bear I mentioned earlier.
Cycling...well that’s why you choose a MOTORbike!
Massage or soft tissue work directly over the seat bone (ischium), so you may need to give that 'sensual bedroom tips' download a rest for now.
Sitting for long periods especially on hard surfaces...again, don’t be so lazy, get moving.
Compressive tendon loading exercises (i.e. working and squashing the tendon at the same time) such as stretching, lunging and squats.
If all else fails, a coffee liqueur cocktail will do nicely! (Not evidence based...please consume alcohol sensibly)!
Sources of evidence based information include:
Physioedge podcast with Dr Alison Grimaldi (2012)
Physioedge podcast with Tom Goom (2016)
Goom et al. (2016) Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Treatment. Journal of Orthopaedic and Sports Physiotherapy, 46 (6), pp 483-493.
Please note, although it can be difficult when travelling, it's often beneficial to get a physiotherapy/professional assessment where possible, especially if symptoms are persisting or worsening.
Please e-mail me at firstname.lastname@example.org for any constructive comments/feedback or questions.