Hamstring injury advice for runners — part 2

Improving your hamstring strength and flexibility

Hamstring injuries require proper attention, to ensure full recovery and avoid the injury recurring. A hamstring injury can be extremely painful and debilitating, so strengthening and flexibility work become even more important if you want to enjoy pain-free running for a prolonged period of time. Here's part 2 of our hamstring injury advice guide.

It is not uncommon for us to see some of the top athletes pull up clutching the back of their leg — victims of  the dreaded hamstring injury. This is most common among sprinters who usually suffer the injury during the 'pick up' phase, as their stride is lengthening.

A diagnosis of a hamstring injury can often be made from a distance, even by the most casual of watchers. The runner will have felt a sharp pain in the middle of the hamstring area and then a painful spasm. Later, there some swelling or even a gap in the muscle may appear, and much later again, bruising may appear on the surface or remain deep within the muscle. It could be several days before bruising becomes apparent.

For an acute injury such as this, the immediate treatment is RICE:

  • Rest — the muscle should be rested for 48 hours.
  • Ice — apply to the injury as soon as possible, but not directly to the skin.
  • Compression — apply a compression bandage but seek advice to ensure you do this correctly.
  • Elevation — keep the leg elevated as much as possible to limit any swelling.

48 hours after the injury

Depending on the level of pain, it may be possible to start some gentle stretching exercises. Try and see a qualified physiotherapist at this stage.

Improving your hamstring strength and flexibility

A healthy muscle will be one that is strong and flexible. The muscle should be balanced in strength with the muscle that is working in the opposite direction. Nearly always, the occurrence of an injury is due to one of these factors being absent.

Whether to stretch before a run is a contentious issue. What everyone would probably agree on is the benefits of a warm-up of some description, prior to undertaking strenuous activity. If nothing else, it gets you prepared psychologically for the effort that is to come. Stretching the major muscle groups within the range in which they will be working, and for a short duration, is also a sensible precaution before attempting anything too drastic.  Prolonged and more extreme stretching before running may possibly increase the risk of injury, although the jury is still out on this school of thought.

What is generally agreed is that thorough stretching AFTER a run session make perfect sense. The muscles become tighter usually as a session progresses. Many specific stretches are prescribed for the hamstring muscles.

Avoid any stretch in which the body weight is being supported by the leg in which you are trying to stretch the hamstring (i.e. bending forward to touch the toes). Instead, carry out a hamstring stretch in a sitting position with the leg to be stretched straight out in front and the other one bent at the knee, perhaps with the sole of the foot flat against the inner thigh. Another acceptable stretch can be done by standing on one leg whilst the leg to be stretched is straight out in front and supported at a suitable height.

In both of these stretches you should gradually lean forward bringing the chest closer to the knee. The stretching feeling may be slightly uncomfortable but should not hurt.

The hamstring muscles need to be strong in two different situations during the running action. Firstly, with the foot in contact with the ground and supporting body weight as it produces extension at the hip joint to propel the body forwards. Exercises to strengthen the hamstrings in this activity would include half squat exercises either with no or a relatively light weight, hill running, step-ups (or a step machine).

The hamstring machine in the gym can be used if the weight used is light enough to allow 15 to 20 repetitions and if this is done as part of the overall strengthening regime rather than as the only exercise.

The other important action of the hamstrings is working eccentrically, by applying the brakes to control the forward movement as the unsupported leg swings forward. The hamstrings can be conditioned to make it easier to cope with this action by various running-related exercises involving swinging the leg back and forward whilst standing with the body weight supported on the other leg (a hand can be placed on an adjacent wall for balance if needed).

Start by swinging the leg forward and back with the knee bent then progress to the same exercise with the knee straight. The final version is a combination which produces a sort of bicycling motion. Swing the bent knee forward then straighten the knee, followed by bringing the leg back straight and then bending the heel up towards the buttock before the knee swings forward again. Try 10 slow repetitions to begin with then gradually increase the speed and number.

Other causes of hamstring pain

Repeated episodes of pain which seem to arise from the middle of the hamstrings muscles may actually be due to irritation of the main nerve to the leg (sciatic) producing 'adverse neural tension'. The source of the problem could well be in the lower back.

True, chronic hamstring pain, occurring in the muscle belly, is really more often recurrent minor tears as a result of a return to intensive running training before the underlying problem has been properly addressed. If the cause of the original tear has not been dealt with then further injury is almost inevitable. Treatment here should be directed towards the underlying problem.

Hamstring origin problems for runners

This really is a pain in the backside. Pain is felt in the region of the bony part that you sit on, at the point where the hamstrings are attached. This usually develops as the result of repeated overloading of the muscle over a period of time. It is especially likely to occur when there is a sudden increase in the intensity of running training, such as speed work, and it may also be seen in relation to excessive activity of the hamstrings when running on treacherous surfaces. Pain may be felt on running, particularly at speed, whilst sitting on hard surfaces and sometimes even whilst driving.

Hamstring tendon problems for runners

This less common type of hamstring problem is felt as pain in the tendons behind the knee joint. This is an overload type of injury. It occurs if the tendons are the weakest link in the chain and too much is being asked of them.

Bearing in mind the knee stabilizing actions of the hamstring muscles when they work individually, pain here may occur after prolonged activity on uneven surfaces. Track runners may also develop painful hamstring tendons related to bend running. Often the pain will diminish during running activity, as the runner warms up, only to return later in the session or even some time afterwards.

Things to remember

There is always a reason why a particular injury happens at a specific time — it is not just down to bad luck. Take a look at the period leading up to the injury and think did you have any warning signs which might be due to lack of flexibility or muscle strength and balance. A visit to the physio before the injury occurred would have been best, but equally a session or few sessions during the recovery period should get you on the road to a good and long lasting recovery.

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