Hamstring Strain and Hamstring Tendinopathy

Hamstring strain in runners is one of the most common injuries that not only occur often but have a high risk of 30% for re-injury and a long recovery period. The biceps femoris(shown above)(1) is most susceptible to injury because it undergoes the most negative work in the second half of a leg swing. With men athletes being more prone to pulled hamstrings during running than woman we should analyze the risk factors that are involved, how to prevent re-injury, treatment options, effects on performance, and finally more chronic cases.

Hamstring pain in running usually occur in athletes that are older due to their lessened quadriceps flexibility. Less flexibility in this area produces muscles imbalance which is the reason for most re-injuries. Physical performance along with, but not alone, assists with the risk for injury for the same reason, imbalances in strength. However, previous injury plays the biggest factor for re-injury. This is because of the post injury changes that occur. If the injury were to happen again it is usually in the first week of returning to running. However, there are steps we can take to prevent re-injury.

If at any time you feel hamstring discomfort during running you need to pause and take precautions. Stretch and relax your muscles during long runs or fast runs. Stretching and deep tissue massages are among the best conservative ways to prevent scar tissues from forming. Scar tissues sometimes are indefinite and affect the tendons usual functions. Deep tissue massages can provoke tendon repair making re-injury unlikely. The scar tissues form because there is acute inflammation that is followed by muscle and collagen regeneration. In the MTJ (muscle-tendon junction) of the upper biceps femoris, scar tissue can cause hypersensitivity which is why some people experience pain while seated on firm surfaces or accelerating while running. This is because the sciatic nerve is sending painful sensations along the backside of the thigh. Changes within the muscle happen immediately and are related to re-injury so it is important to address this issue right away. The damage occurs in the muscles tissues adjacent to the MTJ. This damage causes impaired coordination and lessened flexibility. Upon returning to the sport it is important to stay consistent with the at home exercises and wearing light shoes because heavy ones will increase the strain in the upper hamstring during the second swing of the leg. Injury affects can be prolonged for as long as two years so treatment must be started immediately.

The most important step before starting hamstring strain treatment is to determine if and where the injury is. There are three stretches that indicate hamstring strain if pain is felt at any time during the three stretches. The standing hamstring test, hamstring stretch with assistance, and the last one is similar to the second test except an assistant quickly straightens the knee.(shown above)(2) MRI scans are the most precise in determining injury so it is a good idea to do so if the three tests do not seem to work. After diagnosis and before determining specific treatment we need to assess core strength, flexibility, and pelvic stability. Numbers will vary, but on average the at home exercises will consist of 2-6 sets of 15-20 repetitions once daily. The exercises will include gentle stretching and simple workouts such as glute bridges. Once there is no pain felt during any of these exercises we can ease into hamstring injury running recovery. These will consist of eccentric strengthening, core strengthening, and trunk stabilization. These include Nordic Curl exercises, forward pulls, and loaded lunge drops. The goal is to provide the MTJ the ability to function at longer lengths and decrease the stretch absorbed by each sarcomere and strain. While exercising we need to target neuromuscular control of the muscles in the lumbo-pelvic region. This is due to helping create balance by focusing on muscles surrounding the hamstring. Coordination techniques can include cycling, ankle pops, and marching with high knees. Avoid running in water until all eccentric exercises can be completed without experiencing pain. It is a good idea to consult on a regular basis with a physical therapist and orthopedist. We also recommend that hamstring strain in runners is treated with care of the following, determining readiness for returning to sport, warm ups and stretching during, including neuromuscular control and trunk stabilization workouts, and eccentric strengthening.

There are other hamstring strain treatments such as injections and surgery but these are prone to possible weakening of the tendon. Corticosteroid injections can result in decreased tendon strength. Now if an MRI shows that the tendon has less thickening then you might consider a cortisone injection. Surgery is rare, but in situations of the sciatic nerve experiencing high tension is surgery recommended, and only if all other conservative treatments above do not relieve this tension. After surgery it is possible to return to sport, but there is approximately a five month recovery period. Hamstring injury running recovery is initially a month or two before returning to running so we have the difference of three months if surgery is considered. Also, another therapy to consider for pulled hamstring during running is ESWT (Extracorporeal Shockwave Therapy). There are acute and chronic cases of hamstring injury, but they can make the patient vulnerable to tendinitis at the place of injury. This is very rare. Hamstring tendinitis treatment is very difficult and long. Tendinopathy affects the junction of the hamstring tendons and the ischial tuberosity. Hamstring compressions are very helpful for relieving pain ad aiding in hamstring tendinitis treatment process. As we have discussed it is important to focus on preventing injury and especially re-injury by tending to the muscles and tendons not only of the hamstring but also ones that surround it.

We provide an advantage to our patients when treating hamstring strains. At Dynamic Neuromuscular Rehabilitation our success lies in our integrated approach of conventional examination with high-tech technology to give the most precise diagnosis. Our methods begin with a dynamic evaluation and Gait Analysis. Using Gait Analysis we asses which exercises are best for the injury and prevention of re-injury and the pace we should go to allow our patients the most success when returning to the sport. We focus not only of the hamstring injury but the muscles that surround it as well. For example, we focus our attention to trunk stabilization, muscles and core coordination and balance, and the lumbo pelvic region. This will give the athlete the ability to perform as well as he or she did initially. When coming across core and pelvic imbalances it is important to incorporate eccentric exercises into the treatment. Scar tissues that form along the tendon while healing are also a big factor for re-injury and decreased performance. We have had much success and experience in ESWT (Extracorporeal Shockwave Therapy) and recommend it highly. This therapy is useful for degenerating tendons and aiding in the healing process. We like to use a variety of diagnostic and treatment methods. We incorporate treatment of the overall muscle surroundings of the initial injury and focus on neuromuscular balance. We also aid in post-surgical recovery in extreme cases along with tendinitis. With the use of MRIs and the diagnosis methods mentioned above we start with a specific at-home exercise plan designed for a natural healing process to prevent scar tissue. Our treatment is at an advanced standard and we offer not only this but also prevention of the initial injury reoccurring. We are the first outpatient Gait Analysis in New York City and aid with hamstring injuries not only in runners but other sports such as dance, sprints, and much more.

PREVENTING HAMSTRING PAIN AND HAMSTRING TENDINITIS

  • Always warm up before exercising
  • When stretching learn how to achieve balanced symmetrical muscle flexibility
  • Do not overstretch
  • Strengthen you gluteus maximus muscle
  • Stretch hip flexors and achieve symmetry
  • Do not overstride
  • Strengthen your hamstring eccentrically
  • Learn how to pull through when you are running