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!

Running Question Challenge- What is your Favorite Strength Training Exercise?

Feel free to comment or answer the question on your own blog. Click here to see past questions.

Having been to PT more than once, there are many exercises I could pick from.  Single leg bridges, the plank and lunges are frequent rotations in my schedule.  But my favorite exercise is the monster walk.  A big rubber band around my ankles and enough space to walk around and I'm all set.  Check out this link to learn about monster walks.

What is your favorite strength training exercise?

Happy Running!

Even the Elites Get Injured

It's easy to feel alone when you get injured or to think that you're the only person or that the elites have it easier.  Kara Goucher recently posted on her blog about an injury that kept her from racing in London.  She labeled her post appropriately Heartache and Hope

Kara's blog post confirms:

1. Even the elites get injured.  The injury monster isn't biased about who it attacks.
2. Elites have access to some pretty sweet equipment.  Who wouldn't want to run on an underwater treadmill?
3. Running through an injury isn't always the best solution.
4. Sometimes a setback isn't a true setback in the big scheme of life
5. Injuries suck (big monkey balls)

A couple things struck me about her post.  She had the tight hip for months and that became "normal" and she continued to run through it.  She used  ART (active release therapy) to help manage the tightness but even ART (which has worked wonders for me lately) wasn't THE answer.  It's muscle imbalances that she can remedy or improve with specific strengthening exercises.  I'm sure her regular routine includes various exercises but in this case the exercises weren't addressing the specific areas.  We runners love to just go out and run and ignore the exercises but those exercises help keep us running.  

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!

Monster Walking

For whatever reason the song Time Warp from Rocky Horror Picture Show came into my head when Have Dental Floss Will Travel asked me what monster walks are.

Chorus

Let's do the Time Warp again

Let's do the Time Warp again

Criminologist

It's just a jump to the left

Chorus

And then a step to the right

Criminologist

With your hands on your hips

Chorus

You bring your knees in tight

But it's the pelvic thrust

That really drives you insane

Let's do the Time Warp again

Let's do the Time Warp again

Monster walks were a staple at the PT when I had an IT band problem.  Since then I'm a strong believer having strong hips/glutes minimizes injuries.  When I get slack on monster walking through the house, the IT band or the outer part of my calves start to call out to me....hey you!  I'm coming to haunt you. Take that My Pretty I call back as I yank out my monster walk band.  I'm one step ahead of you and you can't catch me.

I bought the most resistant and best value band that I could find which happened to be a roll of dark grey Thera-Band. I bought the box a couple years ago, have given some to friends and have broken some too.    Since like any rubber band consistently stretched, they are bound to snap. You can also use the band for stretching or clam shells (band around the knees and open/close the knees like a giant clam)

Stand feet slightly apart and measure out a length to go around your ankles and include the knot too.  (note my cute kitty socks)

With knees over your feet squat low, pushing your butt out, move your foot to the left, feeling the band tension and then bring your right foot to meet it.  Repeat. Move across the floor for 10 -20 feet; now do it again moving to the right.

Next step is to move forward. In a speed skater fashion move your foot forward bringing your other foot to meet it with each step; now go backwards. 

I do an L shape at home and do three sets.  If you have space to do a large square go for it.  Just make sure you do equal left/right/front/back to work the butt muscles and keep your squat low too. If you aren't feeling the burn in your glutes you either already have buns of steel, aren't squatting low enough or your band is wimpy and you need more resistance. Try doubling it if their isn't enough resistence.

The great thing about the monster walk is you don't have to have work out clothes on so there are no excuses to make about changing your clothes.

Chorus

Let's do the Monster Walk again

Let's do the Monster Walk again

RunnerIt's just a squat and a step to the left

Chorus

And then a step to the right

Runner 

With your hands on your hips

Chorus

You push your butt out alright
But it's the deep lower squat
That really drives you insane

Let's do the Monster Walk again

Let's do the Monster Walk again

Teamless Relays

Remember the awkward moments in elementary school standing in a line hoping to be picked for a team. Unless you were a jock or training to be a cage fighter, you weren't selected right away and hoped you wouldn't be the last person.  Then you didn't want to be the slowest person on the team.  

Oh the joy of teams.

That's why you need to do Teamless Relays.

At track last night I had an opportunity to run the workout and we did Teamless Relays running 400's (one lap) and then I threw in a twist.  Purple batons were handed out to a couple people and they started running their 400. The others waited in line and the first person that came in, handed off to the next person in line. Each person in line, would take the baton from the next person coming in. The recovery time was while you waited in line until it was your turn to run again.  The recovery time was dependent on how many people were running and how many batons were in use. More baton, less recovery. We had about a 2 minute recovery.

The twist to the relay was the silver baton, which meant running an 800 (two laps). It was fun watching the people try and figure out where the silver baton was and if they were going to be the person to get it. At one point I had it, didn't realize it until 1/2 way through my first lap.  I slowed my pace down so I wouldn't burn out on the second lap.

One funny thing, the batons are newly purchased from an Amazon seller and are metal and this was the first time being used.  The purple came off on everyone's hands leaving them looking bruised. Even the next day with a couple washings, my hand still has purple on it.

Everyone seemed to enjoy the workout and suggested next time the workout includes 400's, the teamless relay should be run.  It made the 400's not as monotonous and the workout go quicker. This is great to do with any size group, any age and any skill level. There are other distances you can run too with the relays. If you're interested in seeing some of the other workouts, let me know.

Happy Running!