Hamstring Rehabilitation and Running Mechanics – Part 2

– Derek M. Hansen – December 8, 2008 –

(Continued from Hamstring Rehabilitation and Running Mechanics – Part 1)

By the end of Week 2, we were in very good shape. The runs were getting faster, and we were moving further out in distance for each workout. By the end of Week 2, we were running out to 30 meters at about 85-90% of top velocity with only very minor extension issues with the left leg. After a number of nights with the athlete wearing the light wrapping with Tiger Balm, along with our continued soft-tissue work before, during and after workouts, it seemed we had turned the corner on any hamstring stiffness or discomfort and his natural stride seemed to return. Now it was a matter of working into maximum velocity and getting a good number of repetitions under his belt so that we could be assured that the hamstring would be ready for the rigors of and duration of competition.

The video clip below shows the athlete at the end of Week 2, with some apprehension still visible in his stride. This was before we had him doing the nighttime wrapping of the hamstring.

There are a couple of questions that arise from this scenario. Is the athlete’s stride pattern affected because of weakness or an inability to contract properly? Or, is the stride pattern affected by the pain, irritation and discomfort, resulting in inhibition and muscular coordination issues? I would argue in favor of the latter argument. How do I know this? Well, the evidence is really quite striking. One day, the athlete is obviously struggling with his stride, and the very next day after trying the overnight wrapping process he is running smoothly. The explanation can only be that the muscles were loosened, the tightness dissipated, the pain and discomfort removed, and natural motion and coordination is restored. Is he stronger? Most certainly. But not because he underwent a magical adaptation process overnight. He is simply allowed to be as strong as he should be. The shackles have been removed.

By the third and fourth week of rehabilitation, our goals were to refine sprint mechanics and accumulate a foundation of sprint work to strengthen the hamstring and consolidate technique. The athlete had felt no stiffness or irritation in the hamstring, and his stride pattern looked smooth and unforced. Thus, we were able to assign runs of intensities between 90 and 100 percent of top velocity, over distances of 30 to 60 meters. We also maintained regular hands-on therapy throughout the workout as part of the warm-up routine and in between sets. The manual therapy not only helps to fend off fatigue and keep the muscles supple, but also serves as a psychological boost, letting the athlete know that you are staying on top of things.

Speed work with flying 20’s and speed change drills (i.e. fast-easy-fast over 60m) also help to strengthen the hamstring. The stress of the speed changes will not only test the hamstring, but also further enhance it’s abilities to coordinate high intensity flexion, extension and co-contraction. With all of these drills, I emphasize the work of the upper extremities in initiating the speed change. If the arms become lazy, extra stress is shifted to the legs resulting in a higher incidence of fatigue, and possible flaws in running mechanics. The arms help to initiate, steer and assign rhythm. If you are a person that always looks to find a silver lining whenever the injury cloud rears its ugly head, you can sometimes use this time to correct technical problems that may have typically been unnoticed. Experience has shown me that rehabilitation runs are predominantly performed at sub-maximal efforts and lend themselves to technical intervention and refinement.

So, what else is going on during the rehabilitation progression? In the weight room, we are staying away from any lower body work in the first week. The work on the track is providing enough of a controlled stimulus. We are, however, having the athletes continue their heavy bench press workouts to ensure that some very high intensity work is maintained by the athlete. The stress of the bench press translates into stress adaptations at a nervous system level and on a hormonal level that will benefit the athlete when they are able to run at higher speeds.

By the second week, we are doing some lighter squatting movements, but also working on power movements – such as power cleans and power snatches from the hang position – over shorter ranges of motion. By the end of the second week and entering the third week, normal heavy lifting workouts have been restored. We are not doing any isolated resistance training work in the hamstring region (i.e. hamstring curls, romanian dead lifts) as we are trying to avoid any exercises that may lead to stiffness or soreness that could impede our progress on the track. By the third week of rehabilitation, our full weight lifting programming is resumed. This return to normal training coincides nicely with our resumption of normal sprint workouts.

One final method that we used throughout the rehabilitation process was the application of Electronic Muscle Stimulation (EMS). In the initial stages of rehabilitation (Weeks 1 to 2), we used EMS for increasing circulation to and from the injury site. In the first few days of the rehabilitation process, we place the EMS pads away from the injury site (regions above or below the site) to pulse the muscles and enhance overall circulation to the site. By the end of the first week, we had placed pads on either end of the hamstring to lightly pulse the entire hamstring muscle. Although the main purpose was to enhance circulation, there are other side benefits of using EMS including general stimulation and strengthening, as well as pain management. We did not intend to rely on the EMS for the strengthening benefit, as our needs were being met by the on-track sprinting. Additionally, there are problems of coordination with hamstring strengthening. Although EMS will strengthen individual muscles, the coordination and sequencing issues must be developed through actual sprinting. Strength without coordination can be problematic.

In summary, coaches and rehabilitation specialists must do everything in their power to allow an athlete to resume normal sprint activities (even at sub-maximal speeds) as soon as possible in order to effect a successful hamstring recovery. This includes everything from massage, stretching around the injury, wrapping, electronic muscle stimulation and appropriate rest periods. Every training session must be an information gathering opportunity. Your next move will be based on what you see and what the athlete tells you. Shooting video is also useful so that you can compare one day to the next to identify improvements and changes in stride patterns. As in regular training, if improvements are not being effected, steps must be taken to ensure that the athlete continually gets better.