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!

Hamstrings

Here is a great post on Hamstring pulls written by Vern Gambetta. Here is a link to his blog. http://www.gambetta.com/blog.html

Wednesday, April 02, 2008

Hamstring Pulling Season
We have just started hamstring pulling season (AKA Major League Baseball Season) So far in first two days of the season there have bee two hamstring pulls. Do you ever wonder why? Is it the cold weather? No I don’t think so although can be a factor at times. Are they out of shape? I hope not they have spent six weeks in spring training getting game fit. Based on my observations over the years here is my take on the hamstring pull situation in baseball and for that matter other sports. Too much emphasis on static stretching in warm-up. Warm-up to stretch, do not stretch to warm-up. Flexibility of the hamstring is basically a non factor in hamstring pulls, it is dynamic hip flexibility that is important. You don't get that wallowing around on the ground in pregame stretch. Lack of sufficient warm-up. The current rage in warm-up does not involve enough movement, way too much at walking tempo, you need to build the warm-up in a crescendo to top speed sprints. Another reason is too much emphasis on linear running mechanics, very little on turns. The hamstring is a transverse plane muscle that is stressed when running a curve and on deceleration. There is too much strengthening using non functional exercises in prone and supine positions. The solutions are simple, but require understanding muscle function and compliance to a program. More lunges in all planes, step-ups both low and high, more emphasis on running turns and at least two days a week of all out sprinting outside the game. It takes time and preparation with attention to detail.

Our interpretation for distance runners. Stop doing static stretching as a warm-up! Stop doing hamstring curls for strengthening! As Vern says, we must keep our functional mobility (ability to squat, lunge and step up/down). Check out the archives on our blog for exercises to address functional mobility/strength.