Tis spring season, which means it is time for the sprinters and soccer players to come out of the woodwork, and hamstring strains to come right out with them! This is a fantastic and very prudent question as most of our school-based runners are getting into Track season.
Management and prevention of hamstring strains has actually undergone quite a fair amount of change over the last 5-10 years with some new information now somewhat changing how we approach this injury. Hamstring injury management was actually a pretty big topic at the World Indoor Track and Field Medical Symposium that I was fortunate enough to attend last week, so I will definitely give you some of the best and up-to-date knowledge from those presentations below. Among many other great speakers, I was fortunate to hear Holly Silvers-Granelli, MPT talk about knee injuries and hamstring injuries and Brian Heiderscheit, PT, PhD talk about his specific work with runners and hamstring injuries.
When do hamstring injuries occur?
This might seem like an inconsequential question, but it actually affects treatment and prevention of injuries quite significantly. For a long time, it was often assumed that hamstring injuries occurred as the foot was on the ground – usually when it was in the early phase of “pulling” the body over the planted leg; however, most evidence is indicating that is usually not when the foot is on the ground at all. Instead, most hamstring strains occur during “terminal swing” as the hamstrings works hard to decelerate the leg from swinging forward. As our speed increases, the hamstring has to work much harder to decelerate due to the velocity at which the leg is moving forward. This somewhat explains why hamstring injuries tend to be very speed dependent (i.e. typically don’t see injuries happening on hill sprints, longer tempo runs, or even power hamstring lifting movements). So, the injury occurs most often when the hamstring is doing eccentric work (strongly contracting as the hamstring lengthens) right before the foot strikes the ground.
How are hamstring injuries treated?
Often we find good ideas for preventing injuries when we find the most effective treatments for the injuries after they occur. This is not always the case and certainly is not a “gold standard” for injury prevention, but it certainly can give some guidance.
Traditional treatment of hamstring injuries for quite a long time was largely range of motion (ROM) and concentric strengthening-focused with a very gradual and slow return to running/sports. Below is an idea of how it might have looked 10 years ago … obviously this is a generalization
- Early rehab would often consist of rest, ice, and gentle motion work like heel slides and light stretching along with some form of massage work
- Mid stage rehab would consist of increased strengthening such as bridges, ball bridges, stool scoots, therapy band knee flexion, stomach knee flexion, and maybe a few exercises like deadlifts or step ups if you were a bit lucky in clinic choice or therapist
- End stage rehab would continue progressing strengthening and add in a gradual return to running program with speed work being the last component added
Progressive treatment of hamstring injuries really takes into account how the injury occurs and the demand of returning to a sport with the demands as described above
- Early rehab might include stationary bike, side shuffles, grapevine/carioca, fast foot stepping, planks, and single leg balance work
- Mid stage rehab might include bridge walkouts, windmill touches, lunges with trunk rotation, single leg small range deadlifts, and early return to running
- End stage rehab might include A skips, B skips, accelerations, single leg bridges, drills for sport, Nordic hamstring drop-curl, eccentric therapy band swing cycle work
That’s quite a difference in rehab programs. I would encourage any one with a fresh hamstring injury to make sure they are seeing a therapist who is treating more in line with the second approach than the first. These programs have been supported in research to be effective treatments for the hamstrings, especially for acute (fresh, recent) injuries. Below are a few articles that might be of interest if you want more information:
How can the injuries be prevented in the first place?
The above discussion on how most sprint/field sport athletic injuries occur and the best way to rehab them tells most of the story. We need the hamstring to be able to work really well and work really hard at slowing down the leg when we are running fast. So, for injury prevention, we have to find ways to strengthen the hamstring in an “eccentric” way. From a broader perspective, we need to also make sure that the surrounding muscles are doing their job to help propel us forward. Here are a few parts of most hamstring injury prevention programs that I recommend to individuals and/or teams that I work with:
- Deadlifts and/or single leg deadlifts
- Windmill toe touches
- Nordic hamstring drop-curl
- Chair squat and/or single leg chair squat
- Deep bench step up
- A skips and B skips
If you are unfamiliar with any of these, a quick google search will do you well. Also, you can take a look at this prior blog post talking about glute activation that includes videos of the single leg deadlift, single leg chair squat, and deep bench step up. Completing some of these 2-3 times/week for 1-2 x 8-10 reps (30 secs for skips) is all that is needed for a good prevention program. Pairing this with harder speed work days is actually recommended vs doing it on an “easy day”.
A safe progression of speed work is also recommended. For Track season this is especially difficult because the season is so short. I always recommend spending at least 3-4 weeks focused primarily on “speed development”, which is typically <60m work with full recoveries and often includes hill sprint work as the primary driver of sprint speed. In spite of this recommendation, most coaches don’t go this direction …
One of the better strength and conditioning coaches in the nation has a blog that I follow. He recently posted a short entry that basically recommended not having an injury prevention program for any sports teams … of course, my immediate thought was to get offended and formulate how I could convince him otherwise. That post is here.
In spite of that first thought, I think I actually agree with him for the most part. If you look at most of the above exercises, they are fundamental athletic movements. Any developing athlete should be able to do them or be doing preliminary work to get to those exercises. They are functional to runners and multiple other athletes and help form the basis of sound athletic development and movement.
Part of the reason the best rehab treatments often work as the best prevention is that they are sport and movement specific. They are exercises that are broken down into components that an individual athlete needs to be able to perform in their sport. This is why stool scoots are a much less helpful treatment or injury prevention tool than single leg deadlifts or Nordic drops – two of them are athlete specific and one of them is just muscle specific.
Where I would say that injury prevention programs can be important is for the athlete that isn’t part of a team and/or isn’t being supervised as much and/or isn’t coached … which means most of the people reading this blog! So, I hope that you have found some useful tidbits in the above discussion on how to help us all keep our hammies healthy this Spring and Summer!
As always, please feel free to leave a comment or ask any question that you have!
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