Recurrent Hamstring tear

[drlukemccabe]

Hi Ashley and team,

Im suffering from a recurrent hamstring tear (not significant – grade 1 really). Was doing well at the back end of it, full training again but yesterday training session I changed direction and went to pass ball off wrong foot (left foot) and felt it go again, which now is really depressing me!

Apart from rest, ice. stretching and some soft tissue work on it is there something I can do to help strengthen it up and ensure this type of injury doesnt happend again. Are there any good pearls of wisdom or something which you have picked up over the years which you can advise me on in terms of this type of injury. At the moment Im also seeing my chiropractor for quite a badly rotated pelvis, which increases the torsion on the hamstring..

I’ll be resting it now for 48 hours with ice etc.. but when is good time to start working it and if so what type of exercises.. once healed are there any specific things I should be working on the ensure/prevent further problems?

thanks

Luke

[imported_cinimod]

I’m not a physio – so seek advice from a fully qualified physician to asses the extent of the damage before commencing any rehab exercises, and to try to work out the exact cause of the problem – possibility could be neural problem if it is a reccuring injury although sounds like your doing the right thng by trying to correct your pelvis problem. Scar tissue build up from previous tears may also be causing a “weak link” in your hamstring – use of Deep tissue massage to break this down down could help. Foam rollers before and after exercise may help reduce tension in the area.

I have seen a large decrease in the occurance of hamstring tears and strains by introducing Nodric Hamstring exercises into a conditioning program. Essentially a eccentric hamstring exercise. If done correctly can really help strenghten the hamstrings to help prevent future problems. There is a short vid on you tube http://www.youtube.com/watch?v=16Uf7GSjw1w Key is keeping alignment from head through shoulders down to hips and into knees all the way through the movement. Break the alignment at hips and the focus will be shifted off the hamstrings.

Pilates/yoga may also be worth looking into for flexibilty increases and core strengthening, provided you are cleared to do so by chiro/physio.

Hope this helps a bit. Will be interested to see if others have had success with this exercise?

[tomwill]

Cinimod, I agree with you on the Nordic Ham Curls. Most injuries occur during the eccentric phase so these are great for both pre and re-hab.

An additional exercise which i’ve found to be useful in both pre and re-hab is (and i echo Cinimod’s comments about me not being a physio here) is stiff leg deadlifts, sometimes called romanian deadlifts.

http://www.youtube.com/watch?v=PnBREGM7pE0&feature=related

the strong eccentric element is important for injury prevention and they encourage strength through a full range of motion, another key area in preventing injury.

the progression from this is a single leg dumbell romanian deadlift.

http://www.youtube.com/watch?v=7eACTTzeh-E&feature=related

this arguably is a better choice as the unilateral element of the exercise has a higher cross-over to sport and the rotational portion of the movement (i.e. dumbell in right hand lowered towards left foot) places more emphasis on the bicep femoris which is, as i understand it, the most commonly injured of the three hamstring muscles.

hopefully you find this helpful!

cheers,
tom

[ashley]

@drlukemccabe 304 wrote:

Hi Ashley and team,

Im suffering from a recurrent hamstring tear (not significant – grade 1 really). Was doing well at the back end of it, full training again but yesterday training session I changed direction and went to pass ball off wrong foot (left foot) and felt it go again, which now is really depressing me!

Apart from rest, ice. stretching and some soft tissue work on it is there something I can do to help strengthen it up and ensure this type of injury doesnt happend again. Are there any good pearls of wisdom or something which you have picked up over the years which you can advise me on in terms of this type of injury. At the moment Im also seeing my chiropractor for quite a badly rotated pelvis, which increases the torsion on the hamstring..

I’ll be resting it now for 48 hours with ice etc.. but when is good time to start working it and if so what type of exercises.. once healed are there any specific things I should be working on the ensure/prevent further problems?

thanks

Luke

Hi Luke to be honest with you mate I leave this to my physiotherapist and he advises me what to do, I am blessed with working with a great physio who understands my role as well, but it sounds as if your back is the key if it is a recurrent issue, I would not like to comment further as I said this is not my area and I would prefer to get you to speak to someone with the background in the rehab area, cheers, ash

[ashley]

@cinimod 305 wrote:

I’m not a physio – so seek advice from a fully qualified physician to asses the extent of the damage before commencing any rehab exercises, and to try to work out the exact cause of the problem – possibility could be neural problem if it is a reccuring injury although sounds like your doing the right thng by trying to correct your pelvis problem. Scar tissue build up from previous tears may also be causing a “weak link” in your hamstring – use of Deep tissue massage to break this down down could help. Foam rollers before and after exercise may help reduce tension in the area.

I have seen a large decrease in the occurance of hamstring tears and strains by introducing Nodric Hamstring exercises into a conditioning program. Essentially a eccentric hamstring exercise. If done correctly can really help strenghten the hamstrings to help prevent future problems. There is a short vid on you tube http://www.youtube.com/watch?v=16Uf7GSjw1w Key is keeping alignment from head through shoulders down to hips and into knees all the way through the movement. Break the alignment at hips and the focus will be shifted off the hamstrings.

Pilates/yoga may also be worth looking into for flexibilty increases and core strengthening, provided you are cleared to do so by chiro/physio.

Hope this helps a bit. Will be interested to see if others have had success with this exercise?

Have used the “Nordic Hamstring” exercsie and never knew it was called that, a good eccentric hamstring exercise before you progress to a Glute Hamstring Raise, if you can be taken through range on this and build up slowly for me it is one of the best exercises, maybe warm up with this and do 50 reps before you start your main workout, in as few sets as possible, also reverse hypers, good mornings would be my picks, could not agree more with the yoga/pilates options if cleared by your physio to use these modalities, ash

[Getstrength]

Here is a article posted on Getstrength.com a few years ago.

Advanced Exercises with Eastern European Names: Part I
By Tony Boutagy
With regards to Romanian Deadlifts , Makes for some interesting reading

[fergus]

Hmmm …. I know I’m going to respectfully stir things up with this post – but hopefully we can debate and learn! 🙂

[I’ve spent a little time trying to understand hamstring injuries becuase I had 2 very early on in my playing career – once I realised the first rehab program was incorrect to emphasise flexibility – I focused on strength training I never got as much as a strain after that for the rest of my 10 years or so playing.]

I actually disagree with the emphasis on Nordic Curls.

While I agree they are useful as a hamstring exercise I actually think they are overrated.

As we know most of the hamstring action occurs around the hip – even during the so-called ‘eccentric phase’ as the athlete slows to change direction – the focus and action is actually around hip and knee stabilisation (to prevent an anterior femoral slide and protect the ACL) – but it’s primarily anterior knee stabilisation.

The reason some hamstrings tend to fail at is called the ‘eccentric phase’ is actually at the point where the hamstring is switching on again to extend and propell the athlete – it is NOT in knee flexion which a Nordic Curl empahsises. It is a neural issue (similar to reciprical inhibition) caused by fatigue and residual tension – most often in the quads.
It is still, though, a hamstring action that occurs around the hip.

My understanding of the biomechanical action is thus ….as the athlete slows they bend at both knee and hip – the hips and femur must be held stable by the hamstring group. Between VMO and Glute, knee rotation is prevented and the hamstrings prevent the femur sliding over and snapping the ACL – meanwhile the Quads are also working to stabilise the knee – then at a split second the hamstring must swtich from stabilisation to contraction to extend the HIP and propel the athlete again – it is this ‘switch’ from passive/stabilisation action to contraction that is the problem. If the quads are not able to work in unison and relax fast enough the hamstrings pull themselve’s self apart.

Any residual fatigue or nerual impingement will cause timing of relaxation and activation of the hamstrings and quads to compete against each other.

I have rehabbed players with hamstring problems never having done any Nordic Curls, Glute Ham work or minimal Hamstring knee flexion work. While I refer to those of you more experienced and better quailfied I have yet to see or justify the reasoning of strengthing knee flexion.

I focus on Good mornings, Romanian Deadlifts with slight knee bends and even with slightly greater than normal knee bends once the back arch is held. I occasionally will do 10 reps of light knee flexion hamstring curl just to maintain some strength and flush the muscle at the end of a session. Sometimes I use a theraband to do this trying to get the athlete to relax the hamstring and switch it on again just as the knee extends to 180 and teach it to fire again fast.

I believe that hamstring strength is critical and the most important factor in hamstring injury prevention – far more so than flexibility.

Also very important is adductor strength as EMG studies have shown very high activation of the adductors in sprinting and we can imagine the increase if we translate this to rugby with change of direction or even slight movements.
So wider or ‘not-to-narrow’ deadlifts, lunges and squats are critical here in my humble opinion.

As a rough guide … for rehab I work on hamstrings on a 2 or 3 day rotation – Strength & Endurance.
Day 1 – Strength, low reps, hip extension focus, Good mornings, RDL’s etc very slow eccentric
Day 2 – Endurance, High rep, low weight theraband-type work, hip extension, fast contraction & fast (but controlled) eccentric – teaching relaxation.

The reason for the very slow eccentric is, unlike some, not because I believe the hamstring goes during an eccentric action when it gets injured – but
(1) rather because there is far greater neural activation, rate coding and also
(2) becuase the greater the linear tension the far greater the chance of fibre realingment deep in the muscle belly – FAR more than any cross friction can achieve no matter what a physio might suggest.

I cannot see how fibres so small to the naked eye, deep in a muscle belly can be effected by X-friction no matter how strong the therapist.

Anyway … I think I attempted to kill enough sacred cows there for one post – but I’ll be interested in your thoughts and I hope you at least understand my (perhaps flawed) rationale!

[ashley]

Hi everyone I just purchased a great e book from EliteFTS, Gluteal Amnesia co-authored by Dave Tate and Alwyn Cosgrove, well worth the $14.95 USD, there will be something in there for each of us to take home and use maybe not as specific to what we are currently discussing and that Fergus has written about so eloquently, now how do I get you on my staff full time mate, but a good read from the trenches, enjoy, ash

[fergus]

Yes … I read an article Tate and Cosgrove wrote about Gluteal Amnesia a year ago and if the book is near as good it would be well worth looking at. Very interesting.

[simon]

Nice post fergus, I agree with your rationale. I would only add that the flexibility issue is important, it may not link directly to the incidence of hamstring injury but many athletes suffer from lack of mobility through the hip/lower back especially lumbar spine and SIJ. Increased strength through these areas is crucial however, if mobilty is lacking the effectiveness of the exercises being used can be significantly reduced.

[fergus]

I would agree that mobility is always an issue – and like you say very much so in the lumbar region… for groin injuries and longer term retirement issues also (hip replacements etc).

Here’s another secret cow about to be killed – stretching is overrated.

Personally I think flexibility should be promoted in the gym not as an isolated issue but in proper ROM when lifting and a proper balanced lifting program.
Flexibility alone is useless as control is always necessary towards the end of ROM’s – this is not always appreciated.

Now – that’s not to say if something is tight don’t stretch it. No. But perhaps ask why is it tight? Is the tightness hiding an underlying issue in the training program? If we look at tightness from a neural aspect we would see it more as a protective mechanism rather than a metabolic process.

However in my humble opinion many hamstring injuries are caused in the stopping phase of movement because of residudal tension in the quads.

[ashley]

I can not help but remember a famous lifter being asked by a novice trainee, I think it was Hepburn, “what do I do to improve my squat” and his rather terse reply was “SQUAT!”, a rather simplistic approach at it’s best but if we return to an old adage, “stretch or strengthen”, as applied to Fergus’ last post would you advise, a greater amount of stretching via neural, static/dynamic and also active via weight training for the Quads, and an increased strengthening emphasis on the hamstrings, via Good Mornings, Romanian Dead lifts, Reverse Hypers, Glut Ham Raise, cheers, ash

[drlukemccabe]

wow fab replies, thanks to all of you and good questions ashley! the things you have said so far fergus make so much sense, esp given how I did the injury too!

so how you recommend retifying the residual tension in the quads? physio deep tissue work and dyanamic/iso stretching or via some other exercise based things..?

this is really informative, thanks to you all!

[fergus]

A good balanced training program, go fully thru ROMs and always stretch the quads.

For years I wondered why people stretched quads as I never came across many quad injuries …. then I noticed more and more people who were forgetting to stretch them getting hamstring injuries!!!

Would I be wrong to say that the quads are the most often ignored or least attended to muscle group in terms of stretching?

[onspeed]

excellent thread

hamstring injury is of course the curse of competitive sprinters

interestingly as with Fergus’s comment most occur at the top end of the so called hamstring eccentric” cycle just as the leg is transitioning back to the so called “concentric” phase – this fits rather nicely with his hypothesis!

Many sprint hamstring injuries also occur within 48h of heavy compressional exercise (max squats etc) and there appears to be somewhat of a link between mild lumbar impingment and incidence – again clearly the source of neural input to the hamstring – and meeting the huge demands of coordinated action – are the nerves originating from this lumbar chain.

We have dramatically reduced the incidence by two simple practices – no maximum sprinting within two days of heavy compressional training and the use of so called decompressive exercise – ranging from reverse hyperextensions with an emphasis on the lower phase “hang” and light traction using bands. One of our scientists has done MRI studies on this and not surprisingly found that intervertebral spacing is vastly reduced for around 24h following heavy compression and that thee simple exercises improve this recovery time. In a far less scientific manner we measure the heights of our athletes every morning at the same time – if they have shrunk by more than 1 cm (very common) we dont use heavy compression nor do maximal sprints on that day – and yes I know that sounds like witchcraft but we have had an 80% reduction in hamstring injury so we dont give a damn!

On the other side with rehab – many good thing have already been said above – around 6 weeks into rehab we use Ham-glutes in the following manner – hold a 10 kg plate to your chest and very slowly perform the first 1/4 of the ROM – pause and hold – have someone take the plate away and then complete the movement – try and explode upwards — but very slow motion downwards … as you improve increase the ROM with the weighted resistance – always work within you ROM in any day – listen to your hams – back off or increase as they suggest – this builds very strong activation patterns “eccentrically” and great explosive patterns concentrically

perservere and undertrain rather than overtrain in recovery – hamstrings can be the bane of an athletes life but can be successfully rehabbed!

make sure too that you have a healthy lumbar and pelvis!

best of luck

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