Do Hamstring Injuries Recur?

In a previous post, I explained the assessment by Nicole from Spooner Physical Therapy regarding my hamstring injury. Nicole had an article of great interest to me: Hamstring Strains: Basic Science and Clinical Research Applications for Preventing the Recurrent Injury* from the National Strength and Conditional Association.**

Considering I'm grumpily at about the same point I was a year ago (on the injured list due to a hamstring) the first paragraph could have been written about me.  

"Athletes may show post injury structural changes in the muscle tendon unit and be at risk for reinjury for up to a year after return to sport."

Reading the above in a strange way made me feel better. I'm not alone.  The article suggests recurring hamstring injuries may be related to older age, muscle imbalances in the thigh, decrease in quad flexibility and of course, previous hamstring injury.

The article is science based and covers all athletes, not just runners. One study using Australian footballers (that's soccer to us Americans), showed the rate of recurrent was 12.6% during the first week returning to the sport, 8.1% during the second week and a 30.6% after 22 weeks.

Hamstring injuries are a strain or a tear, not of the muscle itself tearing from the tendon, rather is muscle tissue around that sustains the damage. Scar tissue forms as the muscle attempts to heal itself and it's the scar tissue that decreases the flexibility and increases the potential for a future injury.

All of that is nice to know, but how do you heal from it?***
The article says

"rehabilitation exercises targeting neuromuscular control of muscles in the lumbopelvic region are effective at reducing hamstring injury rates."

The article also indicates people treated with a "progressive agility and trunk stabilization (PATS)" program had a reinjury rate of 0% after 2 weeks and 7.7% after a year.  Compare this to the hamstring strengthening and stretching program reinjury rate of 54.5% after 2 weeks and 70% after a year.  So contrary to what many doctors, PT's and Chiropractors (not all...there are a few good ones out there) prescribe of stretching and exercises to strengthen the hamstring, there may be a different solution.

Watch for an upcoming post regarding PATS.

* Article was written by Marc Sherry, Thomas Best, Amy Silder, Darryl Thelen and Bryan Heiderscheit. Subscriber login required. http://journals.lww.com/nsca-scj/Abstract/2011/06000/Hamstring_Strains__Basic_Science_and_Clinical.5.aspx

**www.nsca-lifg.org is a member site. I'm assuming joining would give you online access to the article.

***Outside of personal experience with hamstring injuries and an interest to get back to running, I have no medical, PT, or other superpower training.

Hamstring Injury Evaluation

After two months of taking time off from running,  ART (active release therapy), running a half marathon and feeling worse a week later (surprise, surprise) I decided to go back to the physical therapist (again) for my injured hamstring. Nicole, from Spooner Physical Therapy, is a running specialist and a runner herself so she gets it. She understands.  She's different than a normal PT which will have you do some stretching, some exercises and then ice.  During the evaluation we didn't talk about the hamstring except for when I would interject because I felt it should be in the spotlight, at least a little bit.

I already knew hips and glutes were important for the entire lower body system, which is why I incorporated monster walks, lunges and planks into my inconsistent routine. Getting injured is a surprise because I thought I was doing enough maintenance.

Nicole didn't focus on the hamstring in the evaluation because she knew that wasn't the cause.  Nicole had me stand on one leg and perform a one legged squat. Like the old lady who swallowed a spider, I wiggled and squilled and about fell over. My balance was horrible.  No wonder you're hamstring is sending you a message, Nicole explained, it's needing to compensate.

My quads and my hamstring have been working overtime because my butt muscles aren't firing.  I need to retrain my body to speak a new language, the buttock language.  The exercises all begin with a pelvic tilt, which fires the buttocks. The tricky thing is my quads often want to do the work and it takes tweaking the posture, focusing on the muscles and readjusting to make sure that I'm using the right muscles.

Its going to take time to retrain the body to use the glutes instead of the quads. I hope I'm a fast learner.

Happy Running!

Pluralize the Plank

"You only do one plank? Nicole my new PT questioned.
"Yes", I replied with my tail in-between my legs, "and only on rare occasion" adding salt to the already embarrassing situation. I wish I were more like Jamoosh with his hard core workout (sorry I can't find the link but if someone emails me I'll update the post) being able to do the plank for 2 minutes.

Nicole pushed, prodded, twisted and watched my legs, knees and feet all with the amused look of putting together a picture of the sky puzzle without all the pieces. You know that type of puzzle...all the pieces look the same shape, the same color but there is just a little variation. How does it all fit together?

I'm fortunate Nicole is a 3:15 marathoner and like she says, she drinks the kool-aid so she understands the desire, the passion to run and how totally sucky not running is.  She's interested in figuring out the bio-mechanics of why my injury happened and getting the root cause fixed.  And she actually seems excited to try and figure it out. Nicole did say my injury isn't common based on the location, which is the top of calf, back of knee and into the hamstring. I guess usually an injury is lower in the calf, or higher in the hamstring.

Nicole's experience is many running injuries are related to the three B's

 Big Toe

 Belly

Butt

I completely understand the belly and butt but have never heard the big toe.  Luckily for me, my big toe is ok.  This is very good because I don't know how I would do big toe exercises.  Would I lift weights with it? Make it do push-ups?  To improve the belly and butt Nicole gave me these exercises

• monster walks
• lunges
• with an exercise ball put my heels on the top of the ball and lift the butt and hold for 3-5 seconds (10 times)
• with back and butt on wall slide down and hold for 5-10 second (10 times)
• and pluralize the plank and do more.. 10 of them and hold for 5-10 seconds and also side planks.

I have another PT appointment tomorrow but in the meantime, I'm off to do my homework...pluralize the planks!

Happy Running!