Hamstring strains and rehabilitation

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Dale Barrett
5 years ago
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1 Hamstring strains and rehabilitation In this series of articles I want to explore common hamstring injuries suffered by tri-athletes, their causes, and what you can do to avoid them. I also want to give simple rehabilitative advice that can be used at home or down the gym. I m starting this series by looking at the most common injury suffered by tri athletes, the Hamstring strain. The hamstrings are a group of muscles located in the back of the thigh and made up of three muscles; Biceps Femoris, Semi Membranosus and Semi Tendinosus. A hamstring strain refers to the tearing of the muscle fibres due to the muscle being overstretched beyond its normal functional range of movement. When hamstrings are tight they are pre-disposed to developing tears and these tears can become debilitating and result in a loss of training if not managed appropriately. Causes of hamstring strains; Hamstrings strains occur for 4 main reasons: 1. When a muscle is fatigued. 2. General lack of flexibility. 3. Muscle imbalances at either the pelvis or ankle that can cause a dysfunctional pattern culminating at the hamstrings. 4. Re-injury after inadequate rehabilitation. The actual way a hamstring is torn is when the leg is being eccentrically loaded (lengthened under a load, i.e. when kicking a football). When we run, our leg swings out in front of us and the hamstrings have to contract in order to decelerate the leg so that our heel can strike the ground. It s during this

2 swing phase of gait (the way we walk and run) that the hamstrings are most vulnerable to straining, especially when sprinting because the swing phase is much larger than normal and so the hamstrings eccentric load is increased. The causes of hamstring strains have been attributed to fatigue (Norris 2004). It is therefore more common to strain a hamstring towards the end of a run or when tired. Athletes should be especially careful to stretch after a run for this reason (see below). A lack of flexibility to the hamstring group of muscles is common and can lead to injury. A normal functional range of movement is between degrees whilst maintaining a straight leg. An easy way to test your hamstring length is to see if you can keep your leg straight against a wall, keeping both sitting bones on the ground. Normal functional range of the hamstrings is approx 90 degrees An imbalance around the pelvis can also be a major cause of hamstring strains as they re placed under constant tension by the shortened hip flexors at the front of the pelvis. Alternatively, an imbalance at the ankle can cause the tibia (shin bone) and femur (thigh bone) to excessively rotate, creating a pull on the hamstrings and therefore making them more prone to tearing. Hamstring strains tend to reoccur if a lack of adequate rehabilitation has not been applied after being previously injured. We re now going to explore the appropriate rehabilitation advice for adequate recovery from a hamstring strain.

3 0-72 hours after the strain Rehabilitation from a hamstring strain depends upon the severity of the damage how many muscle fibres have actually been torn. Initially you need to rest the injured leg for the first 3-5 days, and apply regular ice to the strain for approximately 15 mins. This helps to reduce pain, blood loss and inflammation. Once the swelling has reduced and the pain has subsided, you need to apply a stretching routine to the hamstrings, to prevent adaptive shortening that will occur due to excess collagen deposits. 72 hours 21 days after the strain Stretching will help many types of hamstrung injury and I usually recommend my clients begin with the type of stretching that is referred to as static maintenance. This means that you stay still and only hold the stretch in one position, as opposed to develop the stretch to help increase a range of movement. Begin with standing tall, lean your body forwards, attempting to keep your back straight. Bend one leg and keep the other one straight. You should feel the stretch at the back of the bent leg. You can increase the stretch by leaning forwards After 2-3 weeks post injury you can begin to develop the stretch. At this point, returning to running should be possible depending upon pain avoid running if it s still painful. At the same time as developing the length, you need to address the strength. Atrophy (muscle wastage) is not necessarily obvious so you may not realise that you ve lost muscle mass. In order to strengthen the hamstrings at this

4 point and aid the repair of the strain, the kinds of strength exercises outlined below are best performed. Dead lift Start position Finish position With the barbell resting on the floor, place your feet under the bar so shins are lightly touching. Bend at the hips and knees, grasp the bar with a slightly wider than shoulder grip. Chest out, head and maintain a neutral spine Lift the bar up from the floor keeping a straight back As the bar passes the knees, drive up through the hips, pushing them forward, keeping the shoulders back throughout On the return to the start position, tilt from the hip, thus driving the hips backwards. As the bar descends past the knees, allow them to bend until you reach the starting position. Keep your chest lifted and maintain a straight back throughout 21 days 8 weeks + More advanced exercises can now be introduced i.e. single legged dead lifts theses are highly effective for the runner as they trigger both the glute maximus and medius to stabilise your leg, helping maintain the ideal alignment through the hips whilst running. However, if a weakness exists in either of these muscles, a dysfunctional load will pass through the knee and hip, creating muscle imbalances and injuries. Considering when we run, we spend all our time on one leg, its imperative that strength training incorporates any one legged exercises.

5 Start position Finish position NB only attempt the single legged dead lift once you have developed good co-ordination with the double legged dead lift. Stand tall on one leg, holding a dumbbell in the opposite hand. Slowly bend at the hips, lowering your back towards the floor, maintaining a straight back and keeping your shoulders stable and head up As you return to standing again, drive through the hips, targeting the hamstrings and Glute max at the back of the thigh To become fully rehabilitation from a hamstring strain can take approximately Back at the start position, stand tall with your head up and chest out 4-12 weeks, depending upon the amount of fibres torn. By this time, and with After adequate rehabilitation, the strain should have repaired itself sufficiently, so you should find that you are able to re-integrate intervals and sprints back into your training routine. However, if it has not it s best to seek some kind of rehabilitative treatment or medical support. For more injury advice contact Becky Hudson at BodyWorks Soft Tissue Therapy. Happy Training! mob

Hamstring Strain. 43 Thames Street, St Albans, Christchurch 8013 Phone: (03) Website: philip-bayliss.com.

Hamstring Strain. 43 Thames Street, St Albans, Christchurch 8013 Phone: (03) Website: philip-bayliss.com. 43 Thames Street, St Albans, Christchurch 8013 Phone: (03) 356 1353. Website: philip-bayliss.com Hamstring Strain The hamstring muscles are very susceptible to tears, strains and other common sporting