Hamstring injuries…pain can linger on
An interesting article written by
Drs. Tim Flynn and Dr. Terry Gebhardt
In last month’s article, we discussed some of the most effective treatments for chronic hamstring injuries.
Despite being pain-free with typical daily activities, many athletes continue to have pain with their sport for several months and even years after a hamstring injury. Unfortunately, there is a high recurrence rate of hamstring strains because of incomplete rehabilitation or returning to sport too soon. Residual scar tissue and persistent muscle weakness are two common reasons for the persistent pain and high recurrence rate following a hamstring strain.
Fortunately, regardless of how long the injury has persisted, trigger point dry needling and instrumented massage treatments such as ASTYM (www.ASTYM.com) can help break up scar tissue and knots in the muscle called trigger points. These hands-on treatments combined with the appropriate exercise routine can help resolve even the most chronic hamstring strains.
Considering there is such a high recurrence rate of hamstring strains, many people ask what can be done to prevent these injuries from recurring, or better yet prevent them from happening in the first place. Although hamstring stretching is commonly advocated for injury prevention, a hamstring flexibility program has not been shown to reduce the incidence of hamstring injuries. It might even lead to what is called stretch weakness where the muscle is highly flexible but weak and prone to injury.
In contrast, several studies have found the incorporation of specific strengthening called eccentric exercises into a training program can significantly reduce the incidence of hamstring strain injuries. Eccentric exercise involves slowly straightening your knee against resistance to work your hamstring muscles so that the muscle is engaged while it is lengthening.
If you are recovering from an acute or chronic hamstring strain, your physical therapist can help you determine when it is appropriate to begin eccentric training. It is important to start slowly when beginning an eccentric strengthening program, as there tends to be greater muscle soreness associated with this type of strengthening.
In addition to eccentric training, exercises that focus on neuromuscular control of your core muscles and lower extremities have been shown to accelerate injury recovery and prevent re-injury. Think of neuromuscular control as the system that creates coordinated movement. This control system frequently shuts down following injury. Simply strengthening the muscles is usually not enough to restore neuromuscular control.
Exercises to re-establish the motor control are critical in preventing injury recurrence. Examples of such exercises following a hamstring strain include high knee marching, skipping and explosive running starts with a focus on leg power development.
Finally, a program emphasising varying trunk movements during running (e.g. upright posture, forward flexed and forward flexed and rotated) has been shown to reduce hamstring injury recurrence by 70 percent.
So, if you participate in sports where hamstring injuries are more common such as running, soccer, softball and tennis, remember to include exercises similar to those listed above to reduce your risk of injury.
Your physical therapist or personal trainer can help you develop the optimal training program.