2 Approaches To Hamstring Rehab That You Need To Know

2 Approaches to hamstring recovery e1375350093606 2 Approaches To Hamstring Rehab That You Need To Know

It is no secret that a successful return to sport will involve hamstring strengthening. But, how often should you exercise your recently injured hamstring? And what exercises should you do?

The first question you need to answer is – why are you doing the exercises?

Answer this before you tackle “what exercises to do?” and “how often?” [Read more...]

How To Successfully Build Fitness When Returning From A Hamstring Injury

Exercise bike e1375349785252 How To Successfully Build Fitness When Returning From A Hamstring Injury

There is a reason that hamstring injuries have such a notorious name. Research has shown almost a third of athletes experience a recurring tear in the year following the first injury. This recurrence  rate is higher than most other soft tissue injuries. But, it doesn’t have to be this way.

Returning successfully is about taking the right steps at the right time and maintaining patience as you build back to your best.

A lot of athletes are incredibly stubborn (myself included); returning from injury is just another goal that has to be achieved and the quicker the better. The problem is it’s not that simple. [Read more...]

Getting The Timing Right

Timing e1375350018377 Getting The Timing Right

The best determining factor for a future hamstring strain is a previous hamstring strain. Bleak but true!

What’s more interesting is the debate of when to return to sport with the least risk of injury.

This editorial provides an analysis of the difficulty around predicting the best time to return to sport.

The editorial argues that there is a balancing act that must go on between allowing enough time for the injury to heal and not spending too much time away from sport in order to avoid significant muscle atrophy. [Read more...]

3 Strategies To Make Your Hamstring Injury WORSE

3 Strategies To Make Your Hamstring Worse 3 Strategies To Make Your Hamstring Injury WORSEAfter a torn hamstring there are of course a number of things that you do to make your hamstring better and a number of things you can do to make it WORSE.

If for some bizarre reason you are not interested in making you hamstring better, here are the top three strategies you can follow to make your hamstring injury worse:

1. Heat and massage in the first 24 hours – If you have just torn your hamstring then massage [Read more...]

Stress and Healing

These days stress is a common part of most people’s busy lifestyles. It is vital for human survival in a fight or flight sense. However, most of us could generally do with a little less stress.

When it comes to healing from a torn hamstring or any injury is it possible that reducing stress could speed up healing?

In a 2004 study scientists demonstrated that rate of recovery from a surface wound had a correlation with reduced levels of stress. The patients that had lower levels of perceived stress measured faster rates of healing.

These findings could also apply to injury recovery in general.

I have talked about the mental side of recovering from a torn hamstring and it can be a stressful time.  A lot of athletes may be anxious to get back out on the field as quickly as possible, might feel stressed about letting their team mates down or might feel stressed that the competition is getting a jump on them while they have to sit on the sidelines.

It might just be that the stress that the situation puts on the mind of the recovering athlete isn’t actually doing them any favours when it comes to healing and getting over the injury as fast as possible.

It is important to learn how to reduce your stress levels. This will again be beneficial for more than just a healing hamstring injury, it is a good life skill for everyone to learn.

So what are some of things we can do to reduce stress?

Extra sleep is a great place to start. Cortisol better known as ‘the stress hormone’ gets released when we are stressed; it was measured and compared to the rate of healing in the study on stress and wounds. Extra sleep helps reduce our levels of cortisol and is a great way to reduce your levels of stress.

Also you may try to find other types of exercise that can help with reducing stress levels while you are waiting for you injury to heal. Try getting on the bike or getting in the pool. Swimming can be very therapeutic and is great as a low impact alternative when you are recovering from a whole range of injuries.

So have a think about it, think about how stressed you are, and if you are generally a person who gets stressed easily it might be worthwhile looking to some forms of stress relief and it may just help you get over you injury faster and get you back on the park before you know it.

Pain Free Rehab

Once you have moved past the initial acute phase of muscle recovery for a torn hamstring, you will now be in the sub-acute phase where the body is starts to form and synthesize scar tissue.

The key at this stage of recovery is to start to introduce movement slowly and progressively to promote elasticity and suppleness of the newly formed scar tissue. This is best done by a hamstring rehab program, where you slowly add more challenging exercises overtime. The program should be developed to include exercises that promote range of movement and flexibility well as improve muscle strength.

However it is very important to ensure that you do not do further damage to the injured muscle during this phase. The best way to make sure this happens is to allow sufficient time for the body to heal and avoid pain in any exercise or movement that you are doing.

So what is pain?

This is an incredibly difficult thing to quantify as everybody sees it differently. Entire books, university courses and branches of philosophy have been dedicated to the topic. So to make it easy let’s talk about some of the things to look for during a rehab program.

The main idea is to try to differentiate between muscle fatigue and pain.

For example, remember the first time you attempted to do a set of push-ups or weighted exercise. Maybe you could get to 10 reps before your arms gave way underneath you and as you approached your last rep on the 8th or 9th rep you started to slow as you approached your limit.

This feeling is best described as muscle fatigue. It is generally symmetrical across the body (if you are doing exercises such as push-ups or squats) and you will be well aware that you approaching your limit.

Pain on the other hand, particularly when recovering from a torn hamstring, will tend to be asymmetrical and could happen suddenly and unexpectedly.

Say you have started your program with a simple double legged bridging exercise, it may be at say 3 reps you feel something that causes discomfort, something that only affects the injured muscle. If this happens then … STOP! It likely that you are experiencing pain around the injured muscle and should cease the set you were trying to complete.

Pain is a sign that your brain is telling you to stop as you have caused or may be about to cause damage to the body.

However, don’t fret, it doesn’t necessarily mean you have done further damage to the muscle, its more often than not a warning that you need to stop and wait a little longer before you can attempt that exercise again.

It is best to wait a day and try the exercise again. If you can’t do it without pain the following day, try again in another two days etc.

The idea is that eventually you want to build up to a point where you can go to muscle fatigue without pain!!!

It is also important to remember that the point of a rehab program is not to accelerate the rate at which the body is healing but to promote elasticity of the newly formed scar tissue that will reduce chance of re-injuring the muscle in the future.

The Mental Mountain

Recovering from a torn hamstring can be like climbing a mental mountain. Back in 2008 I climbed Mt Kilimanjaro with a good friend of mine.

100 2097 edit 300x225 The Mental Mountain

You need to take it one step at a time “pole pole” the guide would say in Swahili. This translates to slowly slowly in English. The point being if you go too fast you will be out of breath and will have difficultly catching it back again. Altitude sickness is also a real possibility and if you get it you will not be able to continue.

When you are there, you want so badly to speed up and make the process of getting to the top quicker. It’s cold, it’s windy, you’re tired, hungry and would do anything for a warm shower. You are frustrated and want it to be over as soon as possible. But the point is you need to continue at a slow and steady pace for a long and extended period of time if you want to be successful. This takes huge mental strength and patience.

Similarly, this same mental strength and patience is key to a successful return from a torn hamstring. You need to take it slowly slowly and you need to take it slowly slowly for a long period of time. You want nothing but to sprint towards the finish line but you need to be disciplined and stay working at it to achieve the goal of a return to the top of your game.

It is important to stick to a well defined rehab program that slowly adds load and complexity over time.

And only then, once you have taken it step by step for a number of weeks will you be confident and ready for a return to your sport.

Too many athletes give in to temptation only to return to another six week stint on the sideline. The temptation of a big sporting event such as state or regional championships can often be too much to bear.

You can ask professional athletes about recovery from an injury and they will tell you that doing rehab is harder than the main team training just purely from the mental challenge.

Many athletes fall aren’t willing to take on rehab from a muscle injury with the mental toughness that is required for a daily rehab program that gradually adds load and stress overtime.

However, if you continue to prepare, your body will be ready to play again. Acclimatize, adjust, adapt and remodel the injured muscle to give yourself the best chance for a return to full strength with the least chance of re-occurrence.

RICE

Rice Edit 300x200 RICE

In the last post I talked about how to ice an injured or torn hamstring. However, there are three very other important concepts to know about in the first acute stage of recovery.

The RICE method is what is commonly referred to and stands for:

R – Rest

I – Ice

C – Compression

E – Elevation

Again this needs to be the key focus during the acute phase of muscle recovery that typically lasts between 24-72 hours after the initial injury has occurred.

Rest

When we are talking rest we mean it is important to put as little load or weight through the injured muscle as possible. This can be in the form of lying on the couch, in bed or on the ground for the first few days. When you move around it may be useful to use an aid to help you such as a friend, crouches or even a wheel chair.

Ice

During this phase continue to ice, for further details on icing refer to the previous post Ice Regime.

Compression

For the compression component, between icing, you can use a compression bandage around the injured area to help reduce and alleviate swelling. It is generally not recommended to use a compression bandage when you sleep because it may be possible to cut off blood supply, which the last thing you want to do when trying to heal an injured muscle.

Elevation

For elevation you want to rest with the injured part of your body above the level of your heart. For example, if you have torn your hamstring, then you could lie on a couch or the ground and put your leg up on a chair or the back of the couch to ensure the hamstring is above the heart. This aids in reducing blood flow to the injured area and hence reducing the effects of swelling or inflammation.

Ice Regime

So you have just torn your hamstring, you’re in pain, the area around the hamstring hurts and is starting to swell. There is probably no secret that you need to apply ice to the area straight away, but why do we apply ice and for how long should we continue to ice?

Ice Photo Reduced 200x300 Ice Regime

When you pull or damage a muscle, the body will trigger an inflammatory or swelling response. This initial stage of muscle repair is called the acute stage.

But is inflammation a friend or foe? In reality the answer is both.

Inflammation around an injured site is used to tell the mind that the body has been damaged and to limit movement to reduce of risk of further damage. It also increases blood flow to the area which is used to start healing the damaged tissue. Unfortunately the body isn’t that smart and tends to send more blood to the area than we need.

Inflammation also produces scar tissue that acts like a scab to the muscle fibres around the torn section of muscle. Again, scar tissue is necessary to heal the damaged muscle but excessive scar tissue will reduce range of movement and increase the chances of reinjuring the muscle in the future.

Icing the injured site will help reduce inflammation and build up of scar tissue and is thus why icing or ice treatment is so important.

But how long should you ice for?

If you ice for too little time the area will not be sufficiently cooled down and hence the effect of reducing swelling and inflammation is minimal. If you ice for too long you risk damage to nearby tissue from potential ice burning or even frost bite.

It is normally recommended time that the minimum and a maximum time to apply ice to the torn hamstring is between 10 and 20 minutes.

It is also important to reapply ice for the remainder of the acute phase of healing. Typically this lasts between 24 and 72 hours depending on the individual and the severity of the injury. During this time the ratio of ice on to ice off is often debated in medical world but the ratio that I am most comfortable with is 1:2 (eg. 10 minutes on, 20 minutes off or 15 minutes on, 30 minutes off etc)

After the acute phase of injury has ended then further icing is unlikely to continue to accelerate the rate of repair. It is important, however, to consider icing if you have reached the point in your rehab where you are starting to run again and there is local swelling or discomfort present after exercise.

It is also important to continue to ice the injury if the injury becomes chronic with further inflammation being an ongoing problem. It is recommended that if this is the case to seek advice from medical professional. In the instance of ongoing inflammation it may be necessary to continue to ice for an extended period of time.

The Hamstring Jargon

The hamstring muscle…What is it? Where is it? What does it do? How is this information important to me?

The hamstring muscle is made up of three muscles … Semitendinosus, Semimembranosus and Bicep Femoris.

It is located in the posterior or back section of the thigh, between the knee and the Gluteus Maximus or Butt!

The hamstring is mainly involved in two movements:

  • Flexion at the knee, and
  • Extension at the hip.

Flexion at the knee means bringing the heel towards the butt. Extension of the hip is best understood by moving from the sitting position to the standing position and noting the change in angle of the thigh at the hip.

The most important role of the hamstring to understand is the deceleration of the thigh and shin as the leg swings in the motion of walking or running. Meaning that as your leg swings forward the hamstring will slow your leg down to stop you from kicking yourself in the face.

The hamstring is used for daily activities such as walking,running, jumping and standing up.

If you have just recently injured  or sustained a torn hamstring you will most likely notice that one all of these movements will be affected either through pain or resisted movement or both.

Is knowing the anatomy of the hamstring really that important?

Well, just knowing what the muscles are called is not going to fix them, if that was the case I would be putting up anatomy posters in the locker rooms to give my team the advantage when it comes to injury.

Understanding the anatomy of the hamstring helps diagnose the injury and also helps determine the potential cause so that next time you can take action to prevent the injury occurring again.

The main point and what is most important is that when you seek advice from a medical professional regarding your injury and they say that the prognosis is “A grade 2 tear of the semitendinosus” in a medical jargon voice, your instant reaction is not “does that mean I can play in the state championships this weekend?”

Instead you are ready to face the painful reality both physically and mentally that you will be spending the next few weeks warming the bench.