Hamstring Issues Before My Marathon

Question
Hi Robert -

I'm running my first marathon on Sunday.  I've encountered some hamstring problems throughout my training, and I thought I'd gotten over them.  

However, in this taper week, I can feel my hamstring tweaking a little again.  It's not so much of an injury as much as it is just them totally tightening up and giving me lots of pain during my long runs.  

I'm afraid I'm going to have issues during my marathon on Sunday.  I battled the issue before by taking electrolyte pills and drinking lots of Gatorade in addition to stretching and ice bags, which seemed to eventually help.

With only a few days before my marathon, is there anything that can help with such a problem?  Is a sports massage worthwhile to keep the issue at bay?  Or any procedure to make sure I'm not limping to the finish line?

Answer
This is a hard one to answer, because the problem could be one of two things : muscular or fascia.

There are numerous causes for myalgia (tight, painful muscles).  Since the pain only occurs in your hamstrings, and develops after running, I think it is reasonable to rule out things like infections and auto-immune disorders.  This still leaves many possible causes, each of which would require different courses of treatment.  Consider the following :

- Training hard without ingesting enough dietary electrolytes

- A latent injury (many muscles will tighten up in response to localized in injuries to limit mobility)

- Muscle shortening from prolonged training with large-heeled shoes and/or improper running stride

- Drugs (fibrates, statins, occ ACE inhibitors, cocaine, some retro-viral drugs, etc.)

- Repetitive strain injury

Fascia is a type of connective tissue that surrounds many other tissue types, including muscles.  It serves multiple functions, such as allowing muscles to glide back and forth over other surrounding tissues, structural support, limiting mobility, and so on.  A surprising fact about fascia is that it is continuous throughout the body.  You can trace an uninterrupted path of fascia from your foot to your head!  There are different types of fascia.  Deep fascia, which surrounds your muscles, has sensory receptors that detect pain and proprioception.  It could therefore also be source of your pain.  Fascia does respond well to massage, so a sports massage may, in fact, help with fascia-related issues.

Since I don't know anything about your diet, drug usage, or previous injuries (overt or repetitive strain), let's assume that your problem is due to muscular and/or fascia tightness.  Many, many people have tight hamstrings.  In particular, westerners who utilize European-style furniture for sitting and reclining underutilize their hamstrings and wind up with tightness.

If this is your problem, then there good news and bad news.  The good news is that you can loosen your hamstrings (and the associated fascia) with a regimen of different stretching and strengthening exercises.  The bad news is that this takes time - much longer than a "few days before" your big race.  Although you cannot induce significant changes in your flexibility in such a short time, you might be able to make minute improvements in a few days, which might mean the difference between finishing your race or not.

I think the best all-around exercise for this situation are toe touches.  This exercise may seem old fashioned, but it has been around for so long because it works.  Perform this exercise with your toes elevated about two inches.  You can use an old book, a piece of wood, etc.  Keep your heels on the floor, with your toes angled up toward your head.  Keep your feet together.  Now bend over and try to touch your toes.  The key to this exercise is to not just pivot your back - your hips need to move backwards too.  In other words, as you bend over, stick your butt out.  Can you touch your toes without bending your knees in this position?  If you can easily do so, then your overall flexibility is good and you may simply need to keep everything loose and stretched out before your big run.  (Or perhaps there is another cause to your pain.)

However, if you can't touch your toes without bending your knees, then you have limited flexibility.  Most men are unable to do this, so don't feel too bad about it, but you are in need of flexibility work.  Perform the exercise as instructed, and when you can reach no further, bend your knees the least amount in order for you to touch your toes.  Then return to an upright position.  (I like to lean backwards a little at this this point to flex my back, but this is optional.)  Repeat this 15 times for one set.  Do at least 4-5 sets a day, separated in time by at least 5 to 10 minutes.  Most people can fit in sets during the day at work, or in the evening while watching TV.  For example, you might commit yourself to do this exercise everything a commercial comes on.

If this exercise is particularly hard for you, you can help yourself with a trick taught to me by a personal trainer.  Hold a small compressible object between your knees (like a soft toy ball, bean bag, koosh-toy, etc.)  Next, when you try to touch your toes and feel the strain start, squeeze your knees together.  When you do this, you should be able to reach a few inches more.

There are multiple other exercises you can Google to help increase your hamstring flexibility, but make sure toe touches are in your repertoire.  This one exercise can help tremendously, even if you don't do any others.

Lastly, I would also point out that your running shoes and stride might also be a cause of this pain.  However, I don't think you can realistically change any of this so close to a race.  It takes time for muscle memory to develop so that you can effortlessly run using a new stance.  It also takes time for your muscles to adapt from a strength/endurance perspective - you might be able to run a marathon now, but if you change something so fundamental, you will find yourself tiring out after just a few miles.

Good luck with the race - let me know how it goes!