The Active Maine Blog: Running & Living Inspired

Hamstring Pain with Running? Here's How to Build a Smarter Rehab Progression

Written by Dr. Kelton Cullenberg, PT, DPT | Apr 30, 2025 7:23:31 PM

Hamstring injuries can be frustrating. They often show up at the worst times: just as training is going well or right before a goal race. And for runners, they can be especially tricky because hamstring pain doesn’t always require total rest—but it also shouldn’t be ignored.

At Steady State Health, we help runners recover from hamstring pain every day. In this blog, we’ll walk you through:

  • How to decide whether or not you should keep running
  • Why faster running is especially tough on the hamstring
  • And what a smart rehab progression looks like—from early strength work to returning to high-speed efforts

Can You Run Through Hamstring Pain?

Here are some signs we use with runners to help guide that decision:

You can usually keep running if:

  • The pain warms up and improves as you go
  • Pain stays in the mild range (1-3/10) and doesn’t increase significantly during or after the run
  • You can run without changing your form or limping

You should hold off on running if:

  • You're limping or noticeably compensating
  • Pain worsens as the run goes on
  • Pain is moderate to severe (4/10 or above) and lingers afterwards

We often say: running through some mild discomfort is okay, but running with altered mechanics or increasing symptoms is not worth the risk of further setback.

Also important: pain does not always equal damage. On the flip side, being pain-free does not mean you're fully rehabbed. Many runners feel fine once pain fades but still have underlying strength deficits that leave them vulnerable to reinjury. In fact, research shows that nearly one-third of hamstring strains recur within the first year, and recurrent injuries are often more severe than the original (van der Made et al., 2018). Building full strength and resilience—not just eliminating pain—is key to preventing setbacks.

Why Sprinting Hurts More: The Forces Behind It

Even at slower speeds, your hamstring absorbs a huge amount of force with every stride—around 3–4x your bodyweight. But as you speed up, those forces jump significantly—often upwards of 7–9x your bodyweight during fast running or sprinting (Bramah et al., 2023).

Most of that load is absorbed during the late swing phase, just before your foot hits the ground. That’s when the hamstring is working hard to decelerate your leg and control impact. It’s also the phase where many hamstring strains occur.

This is why returning to faster running too quickly is a common cause of reinjury—and why your rehab plan needs to include both strength and speed-specific loading.

A Smarter Rehab Progression for Hamstring Pain

We break down rehab into three general phases. Here’s how we usually guide runners through each step:

Phase 1: Calm the Irritation & Rebuild Foundational Strength

Goal: Decrease pain and reintroduce safe, controlled loading

Examples:

  • Supine hamstring isometrics (at different angles: 90°, 30°, long lever)
  • Bridge walkouts
  • Bodyweight RDLs (Romanian deadlifts)
  • Soft tissue work & dry needling as needed

Why it matters: Runners often stretch their hamstring when it hurts, but that’s usually not what it needs. Early rehab should focus on controlled tension and strength—not aggressive stretching.

 

Phase 2: Strengthen Through Range & Introduce Eccentric Load

Goal: Improve capacity, especially in the lengthened position

Examples:

  • Conventional Deadlifts and Single-leg RDLs
  • Hamstring sliders (with a towel or sliders under your heels)
  • Nordic hamstring progressions (using a band or partner)
  • Return to easy running if the pain is mild and mechanics are clean

Why it matters: This phase builds the strength needed for running, especially when your leg is extended behind you or swinging through. Eccentric strength (controlling lengthening) is a key way to ensure your loading exercises are challenging enough to promote positive adaptation. 

Phase 3: Reintroduce Speed, Power & Plyometrics

Goal: Prepare the hamstring for real-world, high-speed running

Examples:

  • Banded hamstring pulls (mimic late swing phase mechanics)
  • Sprint drills: A-skips, B-skips, skips for height
  • Plyometrics: pogo hops, skater hops, bounding
  • Strides, hills, and short intervals (progressed gradually)

Why it matters: Sprinting is often the final progression. These movements help restore the hamstring’s ability to absorb and generate force quickly—just like it needs to during fast running. It’s super important to retrain your hamstring’s power even if you’re not intending on doing any fast running in the near future!

Final Thoughts

If you’re dealing with hamstring pain, don’t just stretch it or rest and hope for the best. A proper rehab plan should include:

  • Gradual strength progression (from isometrics to eccentrics to heavy load & explosive work)
  • Running-specific mechanics
  • And smart decision-making about when to run and when to rest

It can be hard to know exactly when to move to the next stage or reintroduce running without guidance. If you're tired of guessing and want a clearer path forward, we're here to help.

At Steady State Health, we help runners recover fully from injuries and build resilience for the long haul. Whether you’re training for your next PR or just trying to run without pain, we’re here to help you find your steady state.

Have questions or wondering where you fit in this progression? Reach out to schedule a running-specific evaluation in Portland or Scarborough—or virtually if you’re outside Maine.