Rehab for Hamstring Pulls and Strains (Part 4)

Part 1 started with the article Hamstring Injuries, the Iliopsoas and Imbalances.  Part 2 was titled Controversial Hamstring Workout for Rehab (Part 2).  Part 3 was titled More on Stretching and Movement (Part 3)

So this is Part 4 of Part ?… Thoughts of Lyle McDonald somehow come to mind…

You know that silly expression, “Once a cheat, always a cheat”?  Same rule applies with hamstring pulls. 

Once you pull or strain it, the chance for re-injury is high.  But it doesn’t have to be that way!!!  There are several reasons for this.

Recurrence in Hamstring Injuries

First question, why do we reinjure our hamstrings?  (we talked about why we injure it in the first place)

I have several theories, and none are proven:

1. adaptive changes in stride biomechanics
2. decreased flexibility of the muscle tendon unit (MTU) as well as reflex inhibition
3. decreased strength (absolute, elastic, speed strength, etc) on the muscle as well as surrounding musculature
4. decreased tensile strength (tensegrity) in scar tissue of muscle and/or fascia
5. blah blah blah (any Ke$ha fans out there?)

In Part 2, I mention briefly about hamstring injuries occurring during “backside mechanics” and a reader (Mike) made a good point in the comments about this. Hamstring injuries from the running cycle standpoint usually occur in the late forward swing of your stride and the push off (some researchers call this the “toe off”, but I dislike this term, because you don’t run on your toes. There is, however, force applied during contact time and that includes your toes)

Why is this the case? Because in this phase of the cycle, the hamstrings decelerate hip flexion and knee extension resulting in large eccentric loads. (look up the definition if eccentric contraction, and you’ll know why)

So before I get into Specific Exercises for rehab, we need to look at the entire Injury Life Cycle Chart and the progressive steps required to get “back on track”.

Injury Life Cycle Chart

Logical Steps

NOTE: Stretching alone is not sufficient! So here are my first 3 goals in rehabbing the hamstrings:

1. restore health
2. restore ROM (range of motion)
3. restore strength

And here are my 6 steps that I prescribe to my athletes for proper rehabilitation of a hamstring injury

1. Initial treatment
2. Restoring ROM
3. Initial strengthening
4. Low-velocity eccentric strengthening
5. High-velocity eccentric strengthening
6. Sport-specific progressions

Specific Exercises

Here is a sample of exercises that we do, but you can come up with a lot of variations, depending on your weight room or physio clinic.

1. hamstring stretch
2. RDL
3. Nordic hamstring exercise
4. hamstring bicycles (with foam rollers, physio ball)

You can check out the series on How to Improve Acceleration Part 6 as I discuss a lot of these same exercises

I hope this series of articles helps you (or your athletes) get back on the track as soon as possible from this unfortunate injury!