Since we’ve already covered hamstring sprains and strains in a previous post (click here), we’re going to change up our format a bit for this post. We’re not going to go through all of the steps for treating it in terms of ice, stretching, strengthening etc. All of that will stay exactly the same! The big thing to remember when treating a tendon versus a muscle is this- the tendon is what attaches the muscle to the bone. To fix the tendon, you have to fix the muscles and loosen them up so that the tendon doesn’t keep getting pulled. Just focusing on the tendon alone will help with the symptoms, but until you take the pressure off it, it probably won’t heal.
So how do we do that for the hamstrings?
- We work on hamstrings themselves. This is a big muscle group with three muscles turning into one common tendon to attach up on the sit bone. That means we need to work all three, not just the middle muscle belly.
- We work on the muscle chain itself. The hamstrings intersect with several muscle groups from the foot all the way up into the hip. All of these groups work together when the leg is working properly. If one shuts down, that workload gets picked up by the others. Since this process doesn’t usually produce pain or any other kind of warning, we need to loosen up the whole chain.
- We work on the joints that will impact the hamstrings- a) the hip and b) the ankle. There are two ways to propel ourselves forward. We either push off that leg using the quads and then the glutes or we pull the leg back using the hamstrings and adductors. We want to get back to that push off so we need to make sure that the joints that allow that motion aren’t blocking the way.
- Flexibility work! Gaining motion back is the easy part. Maintaining it is another story. The only way to do this is through frequency. Forget all of the arguments about performance and focus on function. If a muscle or joint is tight, it can’t work right. As athletes we set ourselves up to have chronically tight muscles because of our training. Unless you’re a pro or have a live in massage therapist, the reality is that you need to be stretching to maintain the mobility that you have. This is especially true for the hamstrings because we’re either working out or sitting on them!
- Strength work. Whenever you make changes to your mobility/flexibility, you can expect a lag in strength. Use that as your chance to build it up the right way! By working on the big muscles to get to good joint alignment and position and then progressing down the chain to the smaller muscles. For the hamstrings in particular, core strength is critical. It’s what sets us up to get to the glutes. Without it, we become quad/hamstring driven and then it’s just a matter of time until injury.
As I said above, click here to read the full write up and treatment plan for this injury. In the post is a PDF download that will walk you through the full plan with links to everything you’ll need.
Here’s a quick run down of what the treatment plan looks like:
Step 1- Traditional R.I.C.E. treatment:
When a new muscle injury occurs, the first and most important goal is always to decrease pain and any swelling that may be present. In other words, we want to decrease inflammation. That means ice is mandatory. Absolutely no heat no matter how good it feels. Don’t short cut this stuff. It’s boring but it works, especially if your symptoms worsen as the day goes. It’s now easier than ever to smuggle an ice pack into the office fridge and wear compression gear under your dress clothes. Use that to your advantage when working to heal an injury!
Rest: This may sound obvious, but I’m going to say it anyway. An injured muscle/joint will require a decreased activity level to fully heal. The severity of the injury will determine if this is a full rest or more of an active recovery.
Ice: while heat may feel better on stiff and sore muscles, ice only during the first 7 days following injury. This will help to decrease swelling, inflammation and pain. 10-15 minutes is sufficient and you can perform every hour as needed. Avoid direct ice to skin contact.
Compression: thanks to the recent explosion of compression sleeves, tights, shorts, etc, you have several options in this department. Ideally you want something that is snug without being uncomfortably tight (think recovery tights if you’ve ever worn them). You can also use a store brought ace wrap to accomplish this. Start the wrap below the injury using good tension on the bandage and move up above the injury. This will help keep swelling from moving down the leg.
Elevation: This is critical in the early days following acute injury where swelling may be present. In the case of an ankle injury for example, elevate the leg so that it is above chest level. This can be accomplished by laying down and propping for your foot up on the arm of the couch with pillows.
Step 2- Kinesiology taping:
There are two applications that you can use when healing up the hamstrings. The first is geared towards decreasing swelling/bruising. Use until that is gone. Then you can switch over to the second.
1) Taping application to decrease pain and swelling. Click here.
2) Taping application to protect the hamstring muscle from being overstretched to allow for healing. Click here.
Step 3- Getting mobility back:
The second goal is going to be to loosen up the injured area. Below I have the treatment techniques set up in levels. As a rule, you must be able to complete #1 without pain to progress to the next level. Be smart! Healing a muscle sprain/strain isn’t about no pain, no gain. The muscle needs to heal! Don’t overdo it in an attempt to speed up your recovery.
1) R.I.C.E. + gentle stretching. There should be no pain with stretching.
2) R.I.C.E + foam roller work + gentle stretching.
Here’s a video to help modify your foam roller work specific to problems at that upper hamstring tendon insertion (sorry for the crappy viewpoint. Was using my phone and tripod and if I got any further away the audio suffered. Will re-shoot with a better view.) Please watch the initial self massage video first for the basics!
Work your way up to that upper muscle insertion point. Start down low at the knee, move up to the middle, and then start to work on the tendon itself. When sitting on the roller, the middle portion and the inner portion are the most important and will be the most sensitive. Use your chest position to determine how much pressure you have on it. Leaning back = less; leaning forward = more. Lastly, don’t skimp out on the other muscle groups! They’re all connected and tension in any one of them will keep the strain on that hamstring group.
** No deeper work with the tennis ball in terms of cross friction or trigger point release.
How long do you need to R.I.C.E for??? Until it’s 100% gone.
Step 4: Strengthening
We’ve broken the exercises down into three levels based on pain levels. This stuff should NOT hurt. If it does, go back a level or ease up on the resistance. Only progress as pain free.
What you’ll need: 1) resistance band/tubing. This is easy to find in any sporting good store these days. You can probably even get it in walmart or target.
Optional equipment: 1) a balance disc. Always good to add difficulty to your strength exercises. Affordable too at $20. 2) a stability ball. Same story as the disc. You can find these cheap and just about anywhere.
Video’s for each level are here. Please note, in the PDF download (above) you will find details for reps and difficulty progression, as well as, benchmarks you should meet before progressing to the next level. The video’s show you the basics for each exercise and what they look like.
The number one thing to remember is that these exercises should be pain free. If you’re getting discomfort, go back a level. You can’t force this injury to heal, but you certainly can make it worse if you over do it.
How often should I be doing all of this?
Daily! Mobility work and flexibility are the priority as your injury heals. Shoot for 1-2x/day for the foam roller/tennis ball work. Flexibility can be 3-5x/day. Like I said- even one 20 second hold is better than nothing. Strength work can be every other day while still painful. As pain subsides, every day is fine.
Hope that helps, and fire away with any questions in the comments section!
1) Capobianco, Dr. Steven and van den Dries, Greg. (2009). Power Taping, 2nd Edition, Rock Tape Inc, Los Gatos, CA.
2) Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
3) Hyde, Thomas and Gengenbach, Marianne. (2007). Conservative Management of Sports Injuries, 2nd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.
4) Kase, Kenzo, Wallis, Jim, and Kase, Tsuyoshi. (2003). Clinical Therapeutic Applications of the Kinesio Taping Method.
5) Michaud, Thomas C. (2011). Human Locomotion. Newton Biomechanics, Newton, MA.
6) Muscolino, Joseph. (2009). The Muscle and Bone Palpation Manual. Mosby, Inc, St. Louis, MO.