Hamstring strain recovery

Here is my post on recovery after a hamstring injury. Check out my previous post on hamstring strains for structure, function, signs, symptoms and risk factors.

Recovery:

When a hamstring injury is suspected it is advised to seek early medical attention from a sport medicine physician and physical therapist. They will be able to identify the severity of the injury and prescribe a very careful rehabilitation program. They will also be better is assisting you with return to sport thus minimizing the chance for re-injury. I see many patients that have made a minor injury significantly worse by trying to run too soon after the initial injury. They often feel the need to “test it” with a short run even though they don’t have a pain-free and unrestricted normal walking stride.

In the early stages of recovery stretching is avoided, as this actually slows the healing process by prohibiting muscle regeneration. I use the analogy of pulling the edges of an open wound apart. We don’t do that as it slow the healing process. When many “ old school” family practitioners diagnosis a hamstring injury, they often tell the patient to rest, heat and stretch. The research shows this is definitely the wrong approach and will likely lead to re-injury.

Restricted mobility of the hamstring is addressed by moving in the pain-free range of motion. Ice will help if it is done 2-3 times per day. The duration of ice depends on how the ice is delivered./ 5-8 minutes with an ice cup and up to 10 –20 minutes with a cold pack. Early stage exercises are done in a pain-free range of motion without direct resistance to the injured hamstring (no hamstring curl machines).

When pain-free and normal walking stride is achieved more functional strengthening is added. Aggressive stretching to end range should still be avoided. Core work and gluteal strengthening are emphasized. Hamstring curl machines are avoided as this is not strengthening the hamstring in a functional manner. Exercises that work the hamstring eccentrically (contracting but lengthening) are recommended. Speed of movement is gradually introduced and is one of the last things to improve. Return to running programs begin with downhill walks and uphill jogs progressing to continuous jogging to running over several weeks.

Hopefully this is helpful. Remember to seek help early, ice, avoid stretching an injured hamstring, avoid hamstring curl machines and don’t try to return to running too early!

Hamstring strains

Hamstrings strains are a very common running injury. These can be serious injuries, slow to heal. Nearly one third of these injuries return in the first year. The high chance for re-injury may be the result of the failure to identify several factors such as the underlying muscle imbalances, weakness, mobility and faulty movement patterns.

Structure:

The hamstring consists of the semimembranosus, semitendinosus, and the biceps femoris muscles. The long head of the biceps femoris is the most often injured.
These muscles originate at the back side of the pelvis off of the ischial tuberosity. The ischial tuberosity is the part of the pelvis that we sit on. The semimembranosus, semitendinosus insert on the inside of the lower leg and the biceps femoris inserts on the outside of the lower leg.

Function and mechanisms of injury:

When most of us think of the hamstring function we think hamstring curl or bending the knee to bring the foot toward the buttocks (knee flexion) and bringing the thigh backwards (hip extension). However, with movement (walking and running) the hamstring primary function is not knee flexion. Think of the hamstring in terms as reigns of a horse. With movement, the primary function of the hamstring is to decelerate the lower leg as it swings forward. The hamstring is contracting but lengthening(eccentric contraction). This is when most hamstring injuries occur with running. In other words, the hamstring is not strong enough to handle the velocity of the lower leg before the next heel strike.

Other severe injuries, such as partial or full ruptures, may occur with sudden hip flexion with the knee extended. This commonly happens with water skiing when the skier falls forward over the skis. Dancers, yoga enthusiasts and gymnasts also often rupture the hamstring with an extreme stretch.

Signs and symptoms:

When a hamstring is injured a "grabbing" sensation is felt, followed by pain, which may limit activity. A normal stride may not be possible. When the injury is near the ischial tuberosity (sit bone)it usually indicates a severe injury which is very slow to heal. With sitting the injured hamstring will tighten up and often body weight is shifted off the injured side. If excessive ecchymosis (bruising), severe tenderness to touch and significant loss of range of motion are present, the hamstring may be fully or partially ruptured. However, even in the absence of these signs, hamstring strains are very difficult to heal and shouldn’t be taken lightly. Even after rest, normal everyday activities such as kneeling, squatting and walking may be limited and may easily re-strain the hamstring.

Risk factors:

Age and prior history of hamstring injuries
Hamstring eccentric weakness with fatigue
Muscle imbalance
(very strong quadriceps to weak eccentric hamstring and glutes)
Lack of mobility
Hip flexor tightness with lower abdominal weakness

In my next post I will discuss the recovery process.

Momma Knows Best

Over the years, I've had many patients that complain of middle back, low back, neck and shoulder pain. Many of these patients also happen to be competitive or recreational runners/exercisers. A disturbing trend is developing where these clients aren't always adults. More and more, we are seeing children and teens with legitimate pain from poor posture not only in running and athletics, but in just day to day activities.

Postural weakness and pain develops from muscles being continuously put into a lengthened state (think slumped over at a computer). These muscles in between your shoulder blades and down into your lower back are much less effective in this state. They work much harder and fatigue much faster. This may result in muscle pain, trigger points, shoulder pain, back pain, or neck pain.

Now consider running. If these same muscles that are supposed to support your upper body, trunk, hips, and most importantly, your legs, are getting tired after 10 minutes of running, your body is going to fatigue much faster. Not to mention the fact that if you're slumping during a run, your lung capacity and overall breathing is going to be compromised, making your body work that much harder.

The next time you watch a race on TV, notice the form and posture of the some the world's greatest runners. They are all running with great form and posture. Now, I'm not saying that if you change your posture, you're going to be an olympian, but it will improve your stamina, prevent injury, make you more efficient over time.

Remember some of the things we talk about in this blog: core strength and functional strength. Most people think of abdominals when they hear the word "core". But, your abdominals are not the only part of your core. The muscles between your shoulder blades and throughout your trunk are all part of your "core". Your core is only as strong as the weakest link.

In the future, I will post some pics of simple postural exercises. Until then, remember what mom (or dad) said: Sit up straight! Stand tall! They were right, after all!

Here are some cool lyrics to 2 of my favorite running related songs.

"Middle Distance Runner" by Sea Wolf

Well I'm so sad tonight
And the words won't come out right
It's been a long day on the track
And its stamina that I lack

So won't you run to me tonight?
Tonight we could pretend that we're just lovers
But I'll only ever be a middle distance runner

Well my heart is beating hard
And I'm off with a shot at the start
And my legs tremble from strain
But by the finish line I am drained

So won't you run to me tonight?
Tonight let's not talk about next summer
Cause I'll only ever be a middle distance runner

Well I'm so proud tonight
Of the woman you've become
And I'm just too tired to fight
So my darling, I'll succumb

But you'll have to run to me tonight
Tonight I will love you forever
But I'll only ever be a middle distance runner

"Slowpoke" by Neil Young

I got some medals
hanging on my chest,
I've seen some good ones,
but I missed the rest.
Lady luck don't you turn on me,
I'm just a student of your history,
I'm just a student of your history.

Slowpoke I'm gonna run with you,
Wear all your clothes and
do what you do.
Slowpoke
we got some things to find,
When I was faster,
I was always behind,
When I was faster,
I was always behind.

Let the body adjust

With further reading of the April edition of the Running Times, I found a another way for us to increase our mileage after lay off or an injury. Jack Daniels (the exercise physiologist) suggests that the old 10% a week rule is arbitrary. He recommends staying at a certain mileage for 3-4 weeks then adding approximately 10 more miles in the next week. He suggests adding 1 mile or 10 minutes to each run you do in a week. Then you would stay at that level for 3-4 weeks before the next jump. This method give s the body a chance to adjust to this stress level before a new level is introduced.

More on dynamic warm-ups

I just got my April edition of the Running Times magazine. This issue is full of some great articles, one written by Mackenzie Lobby on the benefits of a dynamic warm-up rather than static stretching. This author shares more on how static stretching inhibits muscles action. Static stretching actually relaxes muscles which is obviously counter productive when you are about to run a hard workout or a race.

Dynamic mobility exercises will better prepare the muscles involved in running to begin their work and help to avoid injury. Static stretching is better suited for post workout routines. St. Vincent Sports Performance suggests a pre-race /workout routine of slow jogging then performing dynamic mobility exercises followed by some up tempo striders.

This has been my approach for several years. I no longer do any static stretching before any work-out or race. I also avoid static stretching after a hard race or workout as well. It is my opinion that it is safer to stretch a least 1 day after a heavy load is place on muscle. Give the sore muscles groups a chance to naturally stretch during your average day. It has been my experience that runners who stretch after a hard run or race actually predispose themselves to injury.

Here is a link to view what they are doing at St. Vincent Sports Performance.