Hamstring injury is very common in sports. The reason for excessive injury in this area isn't that the Hamstrings are a fragile group of muscles; most of the time, it is due to limitations in training and rehab.
Use this guide to appropriately rehab your Hamstrings so that you can stop that cycle of recurrent Hamstring injuries.
Our process for Hamstring injury rehab follows our 4 step process
This is our road map that we have formulated and that we follow to make sure rehab and recovery is complete. It is tried and true. So let's apply it to your Hamstrings.
There's a lot that can cause Hamstring pain. It can be an issue from the Hamstring itself, or it could be a referral from the back, instability at the hip, weak adductors, overpronation of the foot, bad positioning during running, or sciatica.
For the sake of this discussion, and to limit confusion, we are going to say that the problem of Hamstring pain is the Hamstrings.
When we evaluate the Hamstrings, we are going to look at 2 things
Active movement is how far you can move it yourself. The easiest way to look at this is prone knee flexion. To do this, lie face down and bend your knee as far as possible. This is your useable range. Then have someone else help you bend your knee; this is your available range.
How does that useable range compare to your available range?
It should be at least 90%. For most of us, this isn't the case. We often cannot control the muscle through the full range of motion, so when we are in those positions, the muscle doesn't work to its full potential. That is a problem.
Passive mobility is the amount your muscle can move - how "long" it can get. The 90-90 test is a great way to assess this. As explained in the video, we should see at least 70 degrees of knee extension in this position.
Again, this is a common limitation. If we don't have this mobility and a sport demands that mobility we are in trouble - Either a different muscle will compensate, or the muscle will be stretched beyond its tolerable limits. Either is a bad option that often ends in injury.
Those 2 tests do a very good job assessing the Hamstrings. Using this and the rest of the treatment will help you and your Physio create a plan.
Step 2 is to alleviate your Hamstring pain.
Pain clouds our judgement. It makes diagnosing and treating very difficult. So the first part of treatment is to decrease pain. The self mobilization methods in this video are a great place to start with chronic Hamstring strains or acute injuries that do not cause tissue disruption. Any high level strains or muscle tears will not do well with these. So go get an assessment before attempting these techniques.
Here's a brief synopsis. For a more thorough explanation of self mobilization for Hamstring pain, see the video
Yes, these are supposed to be uncomfortable; but not painful. You need to be able to breathe through the discomfort. If not, start with something else.
Pain is a problem. But let's be honest, none of us really care about pain. If it were just pain, it could be fixed with pain meds, ice, or rest. What I'm guessing you noticed is that the pain is interfering with training, is decreasing your performance, or is stopping you early. That is really why we want pain gone.
Here's the good news - whatever is causing pain is likely causing performance limitations. Fix one, fix the other. So we focus on improving performance and the pain relief is a natural byproduct along the way.
Because what we found is that the athletes who come to us to get out of pain do that. But they also hit new PRs - they get faster, lift more weight, and perform better.
2 primary causes of pain and performance limitations are the same things that we evaluated earlier.
Active movement is fixed by encouraging the muscle to move in the range of motion that it does not want to. Be creative with this one. The examples in the video are just two of the ways that we can get this to work. Find your active end range and passively get it into the available end range. Hold that position for 1-2 seconds, then in a controlled manner, get out of that position.
Passive mobility is not fixed by static stretching, but loading through the full range of motion. Specifically, loading at the end range of motion when the muscle is lengthened. Our goal is to lengthen the muscle, then load the muscle through the full range. That will encourage the muscle to relax so that it isn't "tight".
This is the fun part of Physio, when we blend rehab and performance training.
In this phase, we want variable loading. Often, we focus too much on sport specific training, when we should be focused on building a good foundation. Focusing on only sport specific movement makes us one dimensional. Resilience means that we are able to recover from tough scenarios. To do that, we need to train in tough scenarios and condition our body to accept variability.
In this video, we are utilizing not only quick , repeated movements, but also slow, eccentric motions. These are just two examples; but this is a very good place to start. You need to be doing heavy deadlifts, sled drags, sprints, and hamstring curls. The options are endless.
This is our basic blueprint to resolving Hamstring injuries and strains. Everyone is different. Every injury in unique, so don't blindly follow this guide. Be smart about it.
Our very first step is "Evaluate and Create".
No that does not mean evaluate yourself. You cannot accurately diagnose yourself; you need an outside perspective.
If you want NorCal Physio to help you with that phase, reach out to us and schedule a physio eval.