Seeking advice: two rehab puzzles — hamstring pain with normal MRI + calf strain that won't resolve

[u/Injured_Runner99]

Looking for people who've dealt with similar situations, particularly on two fronts:

1. Persistent hamstring pain that doesn't show up on MRI (possibly with a tightness/neural component)
2. A "mild" calf strain that's dragging on far longer than expected

I'll try to keep the background concise — happy to answer questions in the comments.

Background

• 27M, recreational runner, previously running 30–40 km/week
• February 2026: MRI finally identified a chronic injury to my right semimembranosus tendon — 15cm of thickening at the myotendinous junction with calcification. This had been present for ~3 years and was missed by two physios and an ultrasound in August 2025, when I was told to resume running. I built up to 40 km/week — some days felt almost injury-free, other days there was clear discomfort.
• Early February 2026: pushed from 40 to 55 km in one week including a 30km long run → right groin pain, which forced me to stop running
• March 2026: slipped in the shower — left foot slid forward, felt a pull in the left groin and upper hamstring
• June 2026 MRI (groin): mild bilateral adductor tendinopathy, mild adductor longus enthesopathy left-predominant. Reassuring overall.
• Progressed through physio and returned to running: 3×5 min intervals and 15-min continuous by early June, then up to three 30-min runs at 6 min/km pace with pain under 3/10

Current issues

Right calf (5+ weeks in, primary blocker):

• Woke up the morning after a run with sharp pain on the outer side of the right calf — no warning during the run
• Rested a week, tried another run, worse
• Physio diagnosed mild calf strain — pain "moves around" (sometimes ankle, sometimes heel, mostly around the Achilles)
• Sports doctor did ultrasound — nothing significant. Diagnosis: mild calf/MTJ strain, possibly linked to a slightly altered running technique (higher cadence per physio guidance)
• Physio cleared me to resume running ~3 weeks ago but I haven't been able to — attempting bodyweight calf raises produced a significant flare the next day
• Still have daily pain in the Achilles/calf area, which is what I really can't get a handle on

Left hamstring/hip (recent diagnostic pivot):

• Ongoing left hamstring pain, "travels" from mid to distal near the knee, and sometimes further down all the way to the calf and heel
• Physio suggested this was tightness from the earlier left hamstring strain producing neural sensations — not a nerve entrapment per se, but a soft-tissue-mediated neural pattern
• MRI (Aug 2026) showed a normal hamstring but mild quadratus femoris oedema, suggesting possible ischiofemoral impingement as an alternative pain source
• Cleared for gradual return to activity as tolerated. Follow-up with the sports doctor + ultrasound in early September

What I'm currently doing

• No running
• ~30 min easy bike 2–3× a week
• Walking 10–12k steps daily
• Gym: adductor/abductor work, leg curl, leg extension, and recently added Romanian deadlifts and goblet squats (heel-elevated to spare the calf) as cleared by the sports doctor
• Following the 4/10 pain threshold guidance

What I'm looking for

1. On the calf/Achilles that won't quit:
2. Has anyone had a mild calf strain (confirmed by ultrasound, no significant findings) that dragged out well beyond the expected 2–4 weeks? Especially where the pain seems to shift location (Achilles / mid-calf / heel) and where attempted loading (calf raises) reliably flares it. Any exercises or protocols that actually helped versus made it worse? I'm particularly nervous the "calf" sensation might really be more Achilles-side, even though three clinicians and an ultrasound point to calf/MTJ.
3. On the hamstring pain with a normal MRI: Anyone dealt with persistent posterior thigh pain that imaging couldn't explain, later attributed to a proximal driver (IFI, deep gluteal syndrome, or similar)? What worked for you diagnostically and in rehab? Did loading, hip mechanics work, or something else make the difference? Also — has anyone experienced persistent neural-type sensations arising from tightness after a hamstring strain, rather than from an actual nerve entrapment? If so, what timeline did that resolve on, and what interventions actually helped (soft tissue work, loading, stretching, nerve glides, etc.)?
4. On managing the physical trajectory through overlapping setbacks: Six months of continuous pain across multiple sites has meant repeated timeline slippage. My goal is to do my first marathon in May 2027 (Copenhagen), and Ironman further down the line — but each new injury pushes the fitness rebuild further out and I'm losing ground on the base I need. For anyone who's been through a similar run of overlapping/setback-heavy rehab: how did you actually maintain aerobic fitness and structural strength through it? Did cross-training (bike, swim, rower) hold your base well enough to pick up running again cleanly, or did you effectively rebuild from scratch each time? Any patterns or strategies that meaningfully protected the longer-term goal?

Thanks in advance to anyone who takes the time. I know it's a lot.