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!

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.

Simple running injury prevention tips

Check out the side bar on In Motion for a summary of past posts on simple injury prevention tips.

Darn rocks

My New Year began with a feeling of being well rested. I just completed my downtime month and started my January training with a couple of nice long runs. I was thinking about running a couple winter cross country races. That all came to a screeching halt on Sunday. I had decided that I would go out for a nice easy 3 miler on my favorite trail. After about a half mile I felt a sharp pain in my ankle dove to the ground. Yep, I rolled my ankle. After a few choice expletives, I looked back to see what I got me. I expected to see an unknown stick or root. No, it was a perfect round rock in the middle of my beautiful dirt trail and it didn't belong there. I promptly threw it back into the creek. I have no ligament issues, no severe swelling and no knee issues. I am fairly confident I strained my Peroneal Brevis. This can be a serious injury if it is not treated carefully.

So, time for me to try to listen to my own medicine! I will be hitting the ice bucket, iontophoresis and kinesio tape. No running until pain-free with everyday activities. Time to hit the pool!

Simple injury prevention--Tip 4

This week's topic in the Runner's lounge: "Take It and Run Thursday" involves training tips for the 5k or 10k. After reading a couple of great posts on periodization it reminded me how often we see clients who either don't know this concept or have forgotten it. Periodization is an important concept to include when planning a training schedule for up coming race or series of races. It will help a runner peak at the right time and minimize the risk or injury. In the clinical setting we continue to see runners who put the cart in front of the bull. In other words they, just start a running progression after being off from an injury but then ask if they can run a race in a couple of weeks. We usually respond by saying why? Why risk it? We remind them that their time would not be anywhere close to their potential and they could re-injury themselves.

In phase one of periodization, a runner needs to build a strong healthy running base. This should be a return to pain-free running and a gradual build-up of mileage with a occasional deloading. I also feel this phase should include function strengthening and mobility exercises which works each runners muscle imbalances. This will set the ground work to add more stress later. After this phase, it is time to work on faster paces or quality workouts. Next, the quality work outs can be more specific for the planned race distance. The best time to race fast is after these specific quality workouts have been completed. Now of course there is overlap during each phase and it should continue to include deloading. It is possible to race after some quality workouts have been completed but it must be understood that the times may not be to the runner's highest potential. Remember a runner can't remain at a high level of peak too long without having a period of rest, reduced mileage and effort. Then a new cycle of periodization may begin. It doesn't matter if the runner is elite or a beginner, these are important steps to follow with the distance and speed appropriate for their skill level.

Simple injury prevention--Tip 3

Learn how to read!

This week's topic in the Runner's lounge: "Take It and Run Thursday" we were asked to share the "best" of our blog. I don't know if this is my best, but I feel it is one of the most important simple injury prevention tips for all of us to learn. I also like the picture, which I took in Whitehall Michigan.

This is a re-post from March 11, 2008.

My input this week involves learning how to read your body. As the weather finally warms up and the spring races draw nearer, most of us are adding to our training. We are either adding some miles and or introducing some quality (speed). During any change in our training which requires an increase in effort, it is important to determine how our bodies are responding to this change in stress levels. We must learn to read our bodies / to be able to determine what we can ignore versus what is trouble brewing.

Here is a common scenario:

Fred ran 4-8 X's 400 in the first week and that this is the first time he has done any up tempo workouts this season. He wore the same shoes that he has been wearing all winter (250 miles) and they are showing some wear. On this workout, he felt really good and went quicker than scheduled. The next day was an easy run and he felt just a little tight. The next time he ran, his legs felt great so he pushed a little, but toward the end of the run he noticed a slight tightness or pinch in his distal Achilles. After the run, he gave it a good stretch. The next day he felt slight soreness during the day but a mile into his scheduled 10 miler it went away. At 3 miles it comes back and by the end of the run it is more of an aching pain. After he stopped, it goes away so he stretches it out some more. The next AM, Fred can barely walk as his Achilles is very sore and tight.

Where did Fred go wrong in this scenario? How could he have avoided this injury?

The biggest issue here, was his inability too read and listen to his symptoms. When he felt the tightness the first time, he should have used ice on his Achilles and avoided the aggressive stretching. But the biggest mistake was continuing to run during the long run when his symptoms got worse. I advise that when symptoms are felt during a run and they don't go away or they worsen, STOP! At least slow down and shorten the work out. ICE and avoid aggressive stretching. If the symptoms had gone away and not returned, he could have finished the work out. It still would have been prudent to shorten the run and ice. If symptoms are felt during the day just walking around, it is better to not run. REST and ICE! No running until pain-free during everyday activities. Then the return to running needs to be a short and easy, followed by a rest day. This will allow Fred to evaluate how the Achilles is handling the return to running with less of a chance for re-injury.
Learn to read your body!

Other contributing factors:
Stick to the scheduled pace especially on the first quality run of the season.
Never a bad idea to break out a newer pair of shoes when doing quality runs or long runs.

I hope this is helpful!

Simple injury prevention--Tip 2

More on deloading.
I thought I would help to make deloading easier to follow with a quick glance chart.

Deloading
Miles per week	Deload week
50	37
45	33
40	30
35	26
30	22
25	18
20	15
15	11

For example: If I have been training 2 weeks at 40 miles per week with 6 miles of quality, I would "deload" my third week to 30 miles with 3-4 miles of quality and I would probably add a rest day. Deloading is a great way to allow the body recover & remodel itself. This format of 2 weeks up and 1 week down will allow an athlete to become stronger for what is next.

13 words of advice!

This week's Take It And Run Thursday is to write "13 Words About Running."
Thirteen words of advice is easy for me to come up with. As a PT, everybody knows I like to give advice.

It is as follows:
Please train smart, rest more often, listen to your body, and race hard!

Roll on!

Here is a link to a great summary article on foam rolling which, Lou & I do the day after our long runs and on rest days. I usually do this on my Quads, Hams & ITB. This helps my recovery and eliminates the need to "stretch" my ITBs.
Keep on rolling! http://www.sbcoachescollege.com/articles/Roll%20Out.html

More on Running injuries

Here is a link to a good post on Universal Truths about Running Injuries. I am pleased with the praise for physical therapy! I want to expand on the comment of "best PT". It is important not to automatically assume a MD or PT who tells you not to run is a bad one. I don't believe this was the intent of the author of this linked post. As I've previously posted, rest is a very important part of training but also of rehab. We must give the body time to respond to rehab without the stress that helped to cause it originally. As a PT, I often have my running patients stop running. In our current health care system, by the time they get to me it is not in their best interest to continuing to try to run through it. Most have already tried that and it hasn't worked. One of my biggest battles is to get my runners to actually stop "testing it out". I try to get my patients back to running as fast as possible but very carefully. I follow the rule of, if I feel my symptoms walking around doing my daily activities, then I have no business trying to run. I start back at a very low level/ walking then progressing to walk /jog then to continuous running. Each phase of this must be symptom free before progression to the next phase.

Please visit our other posts on strengthening, running injuries, prevention & rest.

Learn how to read!

This week's topic in the Runner's lounge: "Take It and Run Thurday" is Building the miles and going long!

My input this week involves learning how to read your body. As the weather finally warms up and the spring races draw nearer, most of us are adding to our training. We are either adding some miles and or introducing some quality (speed). During any change in our training which requires an increase in effort it is important to determine how our bodies are responding to this change in stress levels. We must learn to read our bodies / to be able to determine what we can ignore versus what is trouble brewing.

Here is a common scenario:

Fred ran 4-8 X's 400 in the first week and that this is the first time he has done any up tempo workouts this season. He wore the same shoes that he has been wearing all winter (250 miles) and they are showing some wear. On this workout, he felt really good and went quicker than scheduled. The next day was an easy run and he felt just a little tight. The next time he ran, his legs felt great so he pushed a little, but toward the end of the run he noticed a slight tightness or pinch in his distal Achilles. After the run, he gave it a good stretch. The next day he felt slight soreness during the day but a mile into his scheduled 10 miler it went away. At 3 miles it comes back and by the end of the run it is more of an aching pain. After he stopped, it goes away so he stretches it out some more. The next AM, Fred can barely walk as his Achilles is very sore and tight.

Where did Fred go wrong in this scenario? How could he have avoided this injury?

The biggest issue here, was his inability too read and listen to his symptoms. When he felt the tightness the first time, he should have used ice on his Achilles and avoided the aggressive stretching. But the biggest mistake was continuing to run during the long run when his symptoms got worse. I advise that when symptoms are felt during a run and they don't go away or they worsen, stop. At least slow down and shorten the work out. ICE and avoid aggressive stretching. If the symptoms had gone away and not returned, he could have finished the work out. It still would have been prudent to shorten the run and ice. If symptoms are felt during the day just walking around, it is better to not run. REST and ICE! No running until pain-free during everyday activities. Then the return to running needs to be a short and easy, followed by a rest day. This will allow Fred to evaluate how the Achilles is handling the return to running with less of a chance for re-injury.
Learn to read your body!

Other contributing factors:
Stick to the scheduled pace especially on the first quality run of the season.
Never a bad idea to break out a newer pair of shoes when doing quality runs or long runs.

I hope this is helpful!