03/30/09
Hamstrung!!
Having a chronic hamstring problem? Better read this article to learn ways to banish the hamstring demons forever!
Category: Your Body
Posted by: ryan
My experience with hamstring injuries and rehab has been a profoundly personal one…..ever since I found myself clutching a severely cramped left hamstring at mile 22 of the 1999 Portland Marathon. I’d been training all summer hoping to run under 3:30 in my first marathon and although I’d been on pace to go under 3:30 with 6 miles to go, a combination of poor pacing and foolish nutrition extinguished any hopes of accomplishing my goal that day. When the cramp subsided, my deathmarch to a 3:45 finishing time began!
The experience left me with a painful memory, and a painful hamstring for several days. The cramping had been severe enough to cause a moderate mid-belly hamstring tear and I proceeded to make all the classic mistakes with respect to healing musculoskeletal injuries even though I was weeks away from finishing chiropractic college. As the saying goes, “you are your own worst doctor, and your own worst patient.”
Instead of icing, resting, maintaining my flexibility and range of motion, seeking conservative care like chiropractic, massage, and other physical therapies, I took a complete break from all physical activity. I didn’t pursue any type of treatment. I allowed the area to stiffen up with fibrous connective tissue that the body tries to “patch” the muscle up with, and I inadvertently promoted a decrease in muscle flexibility.
Within a week I enrolled in a martial arts class that required ballistic kicking movements that created further microtears in my hamstring over the next year. My running became labored, and my left leg began to feet “dead,” like it didn’t function properly and didn’t swing freely during my running stride. My back and hip began to be painful as the entire lower left kinetic chain of my body began to operate in an asymmetrical fashion. Sound familiar?
When a muscle is torn, active bleeding occurs and a complex chemical cascade is initiated that attracts cells called fibroblasts into the damaged area. Their main job is to repair the tear by laying down fibrous tissue – like patching a puncture hole in a bike tube. The only problem with this is that just like a bike tube patch it ends up creating an area in the muscle that is inherently less flexible than the muscle itself.
Once a patch like this is created the most likely place for the muscle to be reinjured is at the edge of the patch. Have you ever seen a bike tube patch fail in the middle? In over 15 years and hundreds of patches, I haven’t. But I’ve seen plenty of them fail at the glued edges. And just like a patch, I’ve seen many patients come in to my clinic with chronically irritated hamstring tears that have been “patched” by the body, but keep giving the athlete problems because the patch isn’t flexible. Sure, the muscle is flexible because the rest of the muscle is flexible and can compensate somewhat for the inflexible patch. However, under the stress of a heavy training load or race effort, the edges of the patch fail and the injury creeps back to become a nagging injury.
In my experience, a multi-treatment approach is most successful for returning an athlete to sport following a hamstring strain. The process starts with a correct diagnosis, since chronic hamstring strains can mimic “sciatica,” knee pain, hip pain, and a host of other conditions. Next, the treatment phase is aimed at loosening up the patch. This may be accomplished through deep tissue massage work, ultrasound, active release therapy, or other myofascial techniques. Deep myofascial work can be somewhat painful, but it’s necessary break up adhesions that are “sticking” the muscle together and causing it to function asymmetrically. Multiple sessions are typically needed, but each session is usually more comfortable than the previous one.
I recommend light, non-impact training during the treatment phase (swimming – avoid flip turns and fins, cycling – avoid one-legged drills) with the goal being to maintain fitness, promote flexibility, and deliver oxygen and nutrients to the healing area. Cycling, swimming, pool running or elliptical workouts are all options at this point.
Applying ice to the area for 10-15 minutes after a workout helps to decrease any residual swelling, delay inflammation, and break the pain cycle that is created by chronic inflammation. If you do ice your hamstring, make sure you lightly stretch the muscle during the ice application. This will keep the muscle from tightening up and causing discomfort in the hours after the ice comes off.
As the pain and dysfunction in the muscle subsides, I recommend entering a rehab phase consisting of a general warm up (15 min. light cycling) and specific hamstring isolation exercises. Since the hamstring is responsible for both knee flexion and hip extension, it’s important to include both hamstring curls (seated or prone) in addition to standing hip extension exercises with a theraband or cable/pulley machine. Remember to start very light and gradually challenge the area with more reps followed by an increase in resistance.
When the pain of the original injury has decreased and hamstring flexibility has increased, add a few light walk/run sessions into your rehab schedule. Start with about three minutes walking followed by three minutes light running, and build from there as your comfort and confidence levels improve. Avoid pushing the mileage early…it’s a sure-fire way to re-injure a cranky hamstring and send you straight back to the treatment phase.
Finally…be patient! It’s what we call you when you walk into a clinic, and it’s what we expect you to be! Chronic injuries take time to develop, and they take time to treat and rehabilitate but with the right amount of patience and persistence strong, injury-free hamstrings will improve your run splits and see you across the finish line with a personal best.
The experience left me with a painful memory, and a painful hamstring for several days. The cramping had been severe enough to cause a moderate mid-belly hamstring tear and I proceeded to make all the classic mistakes with respect to healing musculoskeletal injuries even though I was weeks away from finishing chiropractic college. As the saying goes, “you are your own worst doctor, and your own worst patient.”
Instead of icing, resting, maintaining my flexibility and range of motion, seeking conservative care like chiropractic, massage, and other physical therapies, I took a complete break from all physical activity. I didn’t pursue any type of treatment. I allowed the area to stiffen up with fibrous connective tissue that the body tries to “patch” the muscle up with, and I inadvertently promoted a decrease in muscle flexibility.
Within a week I enrolled in a martial arts class that required ballistic kicking movements that created further microtears in my hamstring over the next year. My running became labored, and my left leg began to feet “dead,” like it didn’t function properly and didn’t swing freely during my running stride. My back and hip began to be painful as the entire lower left kinetic chain of my body began to operate in an asymmetrical fashion. Sound familiar?
When a muscle is torn, active bleeding occurs and a complex chemical cascade is initiated that attracts cells called fibroblasts into the damaged area. Their main job is to repair the tear by laying down fibrous tissue – like patching a puncture hole in a bike tube. The only problem with this is that just like a bike tube patch it ends up creating an area in the muscle that is inherently less flexible than the muscle itself.
Once a patch like this is created the most likely place for the muscle to be reinjured is at the edge of the patch. Have you ever seen a bike tube patch fail in the middle? In over 15 years and hundreds of patches, I haven’t. But I’ve seen plenty of them fail at the glued edges. And just like a patch, I’ve seen many patients come in to my clinic with chronically irritated hamstring tears that have been “patched” by the body, but keep giving the athlete problems because the patch isn’t flexible. Sure, the muscle is flexible because the rest of the muscle is flexible and can compensate somewhat for the inflexible patch. However, under the stress of a heavy training load or race effort, the edges of the patch fail and the injury creeps back to become a nagging injury.
In my experience, a multi-treatment approach is most successful for returning an athlete to sport following a hamstring strain. The process starts with a correct diagnosis, since chronic hamstring strains can mimic “sciatica,” knee pain, hip pain, and a host of other conditions. Next, the treatment phase is aimed at loosening up the patch. This may be accomplished through deep tissue massage work, ultrasound, active release therapy, or other myofascial techniques. Deep myofascial work can be somewhat painful, but it’s necessary break up adhesions that are “sticking” the muscle together and causing it to function asymmetrically. Multiple sessions are typically needed, but each session is usually more comfortable than the previous one.
I recommend light, non-impact training during the treatment phase (swimming – avoid flip turns and fins, cycling – avoid one-legged drills) with the goal being to maintain fitness, promote flexibility, and deliver oxygen and nutrients to the healing area. Cycling, swimming, pool running or elliptical workouts are all options at this point.
Applying ice to the area for 10-15 minutes after a workout helps to decrease any residual swelling, delay inflammation, and break the pain cycle that is created by chronic inflammation. If you do ice your hamstring, make sure you lightly stretch the muscle during the ice application. This will keep the muscle from tightening up and causing discomfort in the hours after the ice comes off.
As the pain and dysfunction in the muscle subsides, I recommend entering a rehab phase consisting of a general warm up (15 min. light cycling) and specific hamstring isolation exercises. Since the hamstring is responsible for both knee flexion and hip extension, it’s important to include both hamstring curls (seated or prone) in addition to standing hip extension exercises with a theraband or cable/pulley machine. Remember to start very light and gradually challenge the area with more reps followed by an increase in resistance.
When the pain of the original injury has decreased and hamstring flexibility has increased, add a few light walk/run sessions into your rehab schedule. Start with about three minutes walking followed by three minutes light running, and build from there as your comfort and confidence levels improve. Avoid pushing the mileage early…it’s a sure-fire way to re-injure a cranky hamstring and send you straight back to the treatment phase.
Finally…be patient! It’s what we call you when you walk into a clinic, and it’s what we expect you to be! Chronic injuries take time to develop, and they take time to treat and rehabilitate but with the right amount of patience and persistence strong, injury-free hamstrings will improve your run splits and see you across the finish line with a personal best.