Pop goes the hamstring

[Phaedrus49er]

I'll just answer the questions. My stomach's still a little queasy from this three hours later. Note: this is not the same leg that had the earlier issues.

1. When did the pain begin?

Today.

2. What were you doing at the time? Or did the pain come on gradually over time?

I was finishing up a sprint training session with 100-yard cruise sprints (jog 60, sprint 40). This morning, I'd done a 5x5 Bear complex workout in the gym. In the sprint session leading up to the cruise sprints, I performed:

--2x30 diagonal duck-unders (15 each leg)
--2x20yd knee-high run
--2x50yd crossovers (25yd each direction)
--2x100yd calf walk
--2x50yd skips
--5x50yd ladder sprints (alternate 10yd sprint and 10yd jog)
--10x100yd cruise sprints (planned, almost finished 3 reps)

My right hamstring felt a little fatigued as the workout went on, but it's not unusual for one or both to feel that way after a couple weeks' hiatus from this workout. On the third cruise sprint at about the 90yd mark, it popped like a finger knuckle (with obvious extras involved), and I managed to hobble/hop to a stop before going to all fours rather than immediately collapse like I wanted to do.

3. Where, anatomically, is the pain?

The area label "1" and possibly "2." The most dynamic pain is right smack in the middle of "1" and maybe a tad toward the knee, but achy along the entire length.



4. What does the pain feel like? Sharp? Dull? Aching? Stabbing? Shooting?

As I lie here with an ice pack on the affected area, the pain is mostly dull and throbbing slightly. When I walk, I can manage a 2/3 stride on a very slight incline with minimal discomfort. Anything beyond that brings sharp, shooting, almost debilitating pain. Same for level ground if I attempt beyond a 3/4 stride. The worst pain only comes if external (including bodyweight) resistance is placed on the hamstrings (bending at waist/hips is blindingly painful past, say, 10 degrees from vertical, regardless of whether my legs are straight or bent). If I bring my knee toward my chest, there is no extra pain. I can extend my knee to a straight leg with no extra pain while sitting/lying down. If I lie on my stomach and bend my knee, the achiness increases, but the movement is doable; otherwise, the straightened leg in this orientation just throbs a bit. I can actually ascend a staircase with no extra pain. I can also reach the floor (to pick up stuff) via single bent-leg deadlift movement (load on the left leg, of course) and flex my right knee so that foot clears the floor on the descent with no pain (bodyweight is too heavy, but weight of the leg alone is doable).

5. Is the pain constant, or intermittent, or only on certain motions?

See above, and if I'm off my feet, the pain subsides to general achiness with a bit more tenderness in the middle of the affected area. If I'm up and moving, regardless of how careful I'm being, the achiness increases but is nowhere near debilitating. As I lie on my stomach, I'm also noticing that the pain is worse if I try to relax everything, but if I tense my glutes and rotate my pelvis back (shortening the hams, I'm guessing), the pain lessens.

6. What motions make your pain worse?

See above.

7. What, if anything, makes your pain better?

The sharp/shooting pain is absent when no external load is placed on the hamstrings. The dull/throbbing pain remains constant.

8. Does your pain radiate to any other part of your body?

Nope, pretty localized to the area pictured above.

9. What things could you do before, that you cannot do now because of your injury?

See above.

10. What is your main concern regarding the pain and its consequences?

Resuming running as soon as possible, sprint or distance. I'm not optimistic about competing in an already-registered 5K this weekend, and I can handle being out of commission for a couple months if need be. I just want a timetable.

11. Have you ever injured that part of your body before? If so, how?

Nothing beyond the rare cramp.

12. Is your pain getting worse over time? And if so, how much worse over what time period?

No, it's subsided significantly from when it first happened. The pain was excruciating for about a minute when it first happened, but after sitting with knees bent for about ten minutes, I was able to hobble back home (three blocks) and shuffle through a shower and settle into a recliner where I sat while writing most of this.

[Phaedrus49er]

Hey, look what I found! Guess you beat me to it, Bill

The rehab clinic: quit your gimping and get back in the game. This month: how to deal with hamstring pain

Bill Hartman

PROBLEM A stabbing pain in the back of your thigh, starting below your glutes and running down to the back of your knee. It may or may not have been preceded by a "popping" sensation.

TRIGGER Most often, pain in this region is the result of straight-ahead running, especially if you were attempting to accelerate to your top speed. But it could also be the result of single-leg exercises, such as lunges.

DIAGNOSIS Hamstring strain. The hamstring is made up of three muscles that originate at the ischial tuberosity (the bone you sit on) and run down the back of your thigh to attach at the middle and outside portions of your knee. The hamstrings work in two ways, helping extend the hips (as in a deadlift) and bend the knees (as in a leg curl). When you run, the hamstrings perform both actions.

WHAT YOU SHOULD DO NOW The severity of strains can vary, but in general, you should look for swelling, pain, and discoloration. For the first two days after you notice the pain, ice the area for 15-20 minutes every few hours to soothe it and prevent the injury from getting worse. (Note: Not icing it will make it worse.) If you notice an area that looks like a large bruise, see your doctor--it could mean you've torn the muscle and may need surgery.

WHAT YOU SHOULD DO LATER If the pain subsides after 48 hours, stretch your hamstrings--but don't do static stretching. Research shows that athletes who use standard sit-and-reach--style stretches to rehab hamstring injuries often take longer to recover end have a greater incidence of reinjury. The alternative: dynamic stretching, which increases flexibility by gently moving muscles through their natural range of motion. Start with simple side-stepping, backward walking, crossover stepping (side-stepping with one foot crossing over the other), exaggerated-length (giant) steps, and exercises like the golfer's bend--in which you stand on one leg and bend forward like you're retrieving your golf ball from the cup. When you're comfortable with these, you can gradually begin to lengthen your step, increase the speed at which you perform the steps, and throw in some stepups and squats.

If the pain persists after 48 hours, see your doctor or physical therapist.

HAMSTRING OK FOR NOW? Figure out why you strained it in the first place. If your injuries were the result of high-speed activities like sprints, your leg muscles may not be conditioned to handle the high forces that fast runs impose, and you may need to adjust your training program. More often, however, injuries are the result of tightness in other muscles, which causes an overload in the hamstring--hence the "pop." For example, tight hip flexors (the muscles that raise your legs out in front of you) tend to inhibit your glutes from extending your hips. The lack of help from the glutes then forces the hamstrings to work harder to extend the hips, setting you up for an overload injury when you sprint, stepup, squat, or lunge. To avoid the problem, change your training routine so that it includes Romanian deadlifts, hyperextensions, good mornings, and high stepups--all of which will strengthen the hip-extension component of the hamstrings.

Indianapolis-based Bill Hartman is an expert in the rehabilitation of sports injuries.

COPYRIGHT 2005 Weider Publications
COPYRIGHT 2005 Gale Group

Based on this and a couple other articles I've read, I'm hoping for a Grade I strain, but I'm more likely looking at a Grade II, meaning 8-12 weeks off from full throttle. Geez, and I had just gotten started, too. A couple more days will tell, but pretty safe to say I'm not racing this weekend, I'd imagine.

[cappuccino]

ouie. hope you find it gets better in a couple of days

[Phaedrus49er]

Now that I've had a chance to sleep (read: cool down and stiffen up) and move around this morning, I need to edit some of my above observations:

--I cannot bring my right knee toward my chest in any body orientation without significant pain.
--I cannot sit upright with a straight right leg without significant pain. I can sit up with a bent leg (either sitting on the floor or in a chair), but this only slightly increases the overall achiness rather than skyrockets it.
--Also, when sitting upright, I have to slightly recline my upper body to alleviate additional pain in the leg. I guess that goes along with the whole hip bending thing.

I think it's pretty obvious (pending an expert's opinion) what's happened here. I suppose now my only concerns are what exercises I can still do and what kind of rehab progression I should follow based on the 8-12 week timetable.

[finboy]

That's a real freakin' bummer. Injuries SUCK! Take care, man.

[Phaedrus49er]

Morning #2, swelling has decreased significantly (I'd almost say back to normal size), and there still doesn't appear to be any bruising, just a constant achiness toward the knee and a high sensitivity to just about any kind of direct pressure (including sitting the wrong way). Will continue to alternate ice and compression as well as stretch and test ROM as far as pain will semi-comfortably allow. The two biggest ROM (and pain) issues right now are sitting/standing with a chair and making a full walking stride, though I'd say my stride has lengthened by an inch so far.

[Lisa~]

You found some good info. Just keep taking care of it. Hope you're better soon!

[Phaedrus49er]

Something I'm starting to realize is that for two years, I had relatively poor running form, and when I was advised on how to visualize my stride, I applied that first to my distance running, which worked out great and with no problems since it was a less-than-maximal effort. However, when the injury occurred, it was the first time I'd applied that visualization to speed training, and of course, my poor form hadn't targeted the musculature needed to properly execute a maximal-effort running stride, hence the very quick and acute failure of the muscles involved in the new stride. Perhaps dead- and O-lifting didn't carryover quite as much as I'd thought. At any rate, thanks for the replies, folks. Not meaning to continue bumping this up. Just trying to work through this in my head and on-screen.

[MuscleGuru]

good luck on the recovery

[Phaedrus49er]

Morning #3, no swelling or bruising, so I'm guessing that's not going to happen as long as I continue alternating ice and compression. Latent pain has subsided to nearly nothing (I was able to sleep through the night), overall ROM continues to increase (can now get to about 30 degrees from vertical bending at the waist with locked knees and straight back), and walking stride ROM and pain continue to improve. At this point, a doctor's visit seems only precautionary, plus I can get a more informed opinion on a proper rehab schedule. I don't want to say I was being a little girl about the grade of this injury (still assuming a Grade II strain rather than Grade I), but I'm guessing I can begin a little more concentrated stretching and mobility work next week, again pending the doc's recommendations. Thanks again, folks.

[BamaDave]

Phaedrus, here is a link to a video that Lisa the Link Queen sent me for dynamic lower body warmup exercises along the lines of those Bill H. mentions in the article you found. I do these before almost all of my runs and lower body workouts:

http://college.holycross.edu/departm...%20Warm-Up.mov

[Phaedrus49er]

BD, that was awesome, thanks. I may have to make that my warm-up for any lower-body activities when I regain that ROM.

[Phaedrus49er]

Interesting realizations at the gym today. I went in to do an upper-body routine, and just for kicks, I decided to test my ROM and flexibility on various unweighted (and assisted) movements, letting pain dictate the range. The only movements that produce anything beyond minor discomfort were:

--initial hip flexion as if starting the eccentric phase of a deadlift (this pain is absent during lower half of eccentric and full concentric phases)
--medial hip rotation (rotating knees together, notable pain here)

Close-stance bodyweight squats were fine if done slowly. Single-leg lunges were the same, if maybe done with more assistance that necessary just in case. I didn't attempt any abduction or adduction movements. Honestly, it feels more like stretching a sore/tight muscle than any kind of lingering injury. Of course, all this was done while my body was warm, and I'm not going to push anything, and I'm still seeing my doctor on Monday. However, once there's a prognosis and timetable set, I'll be dealing with this. Go team

[Phaedrus49er]

Doctor's visit today confirmed the tear, interstitial-only considering there was no deformity of the muscle shape, more of a severe Grade I bordering on (but not quite) Grade II (at least my complaints were legitimate) A more in-depth analysis comes Friday when I start physical therapy (some mental therapy would be nice, too), initially for 2-4 weeks depending on progress, so this still means missing a May race, but I tentatively could be back running in time for my June races. In the meantime, I'm going to start putting a neoprene sleeve on my right upper leg in the mornings to promote heat and circulation, then ice the affected area immediately after any substantial activity (as insignificant as spending a few hours running errands or just messing around at the gym). Pending any major turns, I'll update after my Friday morning appointment.

[Phaedrus49er]

First rehab session today, mostly evaluation, but a lot of good came of it. Overall, my hip and knee mobility, stability, and flexibility are above average of what the PT usually sees, which I suppose has to count for something. Also, oddly enough, any pain I was experiencing has almost completely subsided unless I forcefully contract my hamstring and hold it there for a couple seconds. However, there is noticable right-side hip weakness according to various unilateral comparisons (step-ups, single-leg squats, balance drills), so I have a small battery of things to be doing over the coming week before my next session. He even said that if I felt confident enough in my condition that I could jog--not run--a previously planned 5K this coming Friday before seeing him that morning (of course, I had to stifle a laugh and tell him I didn't do much more than jog those races anyway)

Right now, we're taking it week-to-week evaluating my condition, and he's giving me ultrasound therapy on my leg during these sessions (first time I've had that, and boy did that feel weird). I very well might be able to swing some short, slow running within a month, which is great, but in the meantime, the rehab work I can do on my own not only will address my hamstring problem but also work on overall stability, which I was lacking anyway. With any luck, this could be a case of being better after an injury compared to before. At least I have some direct, face-to-face, hands-on CSCS guidance.

[UConnJulie]

Glad to hear it. Most hamstring problems are really weak glute problems in disguise ... good that your PT recognized that.

[Phaedrus49er]

Originally Posted by UConnJulie

Glad to hear it. Most hamstring problems are really weak glute problems in disguise ... good that your PT recognized that.

I was hoping that CSCS after his name meant something useful

[Phaedrus49er]

Rehab #2 today. Didn't think I was going to be put through the wringer today, and for as long, at that; otherwise, I would've brought another shirt to wear to another doctor's appointment (that I was ten minutes late for) right after the rehab. At any rate, was given a battery of dynamic warm-up and exercise movements as well as being made to play catch with medicine balls while standing one-legged on the rounded part of a half foam roller, something I told him I probably couldn't've done well even before the injury and why I think I'll be better after recovery than I was before injury--balance has never been one of my strong points.

I was cleared to jog, not run (what the difference in my case?), a couple miles at a time, pulling an 11- to 13-minute mile. Good thing since I'd already signed up for a 5K tonight Pain has certainly given way to occasional discomfort and a relatively (to my left leg) limited ROM, but only slightly. I'm not worried about strength as it seems to still be there. Two more scheduled sessions. Ultrasound therapy is gooey.

[Phaedrus49er]

Rehab #3 today. Another sweat session, but no complaints. Pain is gone (unless I really wrench on the hammy, but then, that extent would hurt most anyone). My PT gave me a sheet--page 120--from a study that I managed to find full-text online here. I did Phase 1 last week, Phase 2 today, and will do a hop test next week in addition to whatever else he has in mind.

Something interesting he pointed out about the study was that, while statistically insignificant, strength-only rehabbers returned to sport in an average of 37 days with a nearly 50% re-injury rate soon after whereas the dynamic rehabbers returned in an average of 22 days with a 0% re-injury rate. Suffice it to say that I don't want to disrupt that 0% track record

I put together my own progression sequence that I ran through this past Monday (attached to this post), and it kicked my ass (in a good way). PT said I should do the "Phase 2" sequence five out of seven days before I see him again, but I'll probably substitute in my own setup a couple times. It was also recommended that I continue pushing my running a bit more and even attempt some forefoot (sprint form) running, though at less-than-100% intensity, of course. No ultrasound today, so I'm guessing that's a good thing.

Slowly but surely...

[Lisa~]

Thanks for the link Phaedrus, very interesting and good stuff. Your program looks good too. You did a great job putting it together. I'm happy to hear you're pain free. Keep up the good work!

No fear!

[Phaedrus49er]

Speaking of fear...

I thought it was an interesting article, and since it's out there in the public domain--I was afraid I was going to have to dig through my college's periodicals to get a hard copy--why not share? Plus, you get to add to your link collection I have to keep in mind that I didn't get started on rehab until two weeks after the injury occurred, so I have to tack on at least a few more days to the expected recovery average--today is four weeks from the injury. Feels like a lot longer.

[Phaedrus49er]

Rehab #4 today. Oddly short session, only 30 minutes. I was due for a hop test but never got around to it since I still have some noticable tenderness around the injury when direct pressure is applied. Instead, I got another round of ultrasound followed by some ART, went through some of the usual dynamic mobility work, and finally a (positive) assessment on my overall strength recovery--basically I'm supposed to start doing unilateral leg curls on a Swiss ball rather than the bilateral ones I had been doing. Also, while I'm still not cleared for 100% max intensity in forefoot running, I'm supposed to start increasing the distances of my stride work (30-50yds after a 50-70yd ramp-up rather than the 10-30yd cold "sprints" I've been doing).

Looking at another two weeks at least of rehab appointments, possibly a month or more, but aside from all that, my conditioning SUCKS as again shown to me during a four-mile course yesterday that ended up being intervals totaling three miles run and one mile walked. One week until my next 5K. I did buy The Stick today (24" version), and I have a nefitco.com order of $150 waiting until next payday (BOSU ball, foam half-roller, Thera-band stuff). Too bad I like going to the gym too much to, well, stop going

[Phaedrus49er]

Rehab #5 today. It's been almost six weeks since the injury, so after the usual dynamic warm-up, ultrasound, and ART (which still tingles during treatment), I was given my hop test, basically a single-leg standing long jump comparing relative strength. I was also tested on comparative flexibility and isometric strength between legs, and oddly enough, the injured leg performed slightly better in all areas. After reviewing my previous week's work, suggesting additional exercises (mostly bonding variations), and discussing a few body form questions I had (plus a lengthy discussion on various professional sports), I was cleared to resume rehab on my own with no additional PT sessions unless I had other questions or an injury recurrence. I was advised to continue the rehab I'd been doing (I've since tweaked my own setup) for 2-3 months while gradually increasing load and intensity. He also cleared me to start doing glute-ham raises to the best of my abilities (either floor-anchored assisted with push-ups or on a back extension stand) after doing a quick set of ten reps--he anchored my feet as best as he could, but he's a skinny guy Note: the eccentric loading on the downward movement of the GHR produced some popping IN the muscle, which I assumed and he confirmed was scar tissue breaking up (as long as there was no subsequent pain), but it still produced a brief but intense rush of panic since that's kind of how the original injury felt, ya know, just more so, and much more painfully.

At any rate, I suppose I'll conclude my main posting here except maybe to report if/when I return to full speed, which hopefully will be by the end of August. I imagine I'll be doing almost exclusively bodyweight work on my lower body for much of that time, especially those #$!@#$ unilateral Swiss ball leg curls. I also want to mention that the core stability work involved in this particular rehab program has significantly improved my core strength. I'm talking about going from being able to do zero bent-leg, unanchored curl-ups to banging out sets of ten with no problem, something that a couple years of doing sets of 10-second negative curl-ups didn't improve.

Thanks so much to everyone for your input and support. Next on the agenda: regaining my endurance conditioning and continued work on my improved-yet-still-there internal shoulder rotation imbalance

P.S. Of COURSE the latest NSCA Performance Training Journal deals with--what else?--speed development and avoiding hamstring injuries :p Though, after scanning the prevention article and comparing it to my rehab, I have to wonder if my rehab work shouldn't be a primary injury deterrent rather than this setup considering the study I cited before. Oh well. Cheers.

[UConnJulie]

Glad to hear that you are well on your way ... now keep that hamstring healthy ... and get those gluteals working hard!!