Exactly my thoughts, I have made an appointment with my doc to see if I can get it scanned, the physio i’m receiving at the moment isnt on the nhs and I can’t afford to keep paying for it while its making little difference. Make that 5 weeks tomorrow by the way 
Again the problem is the cost of it, I can’t really afford to pay for it right now. Hopefully my doctor will send me for a scan so I can find out what exactly is going on.
A quick update…my hamstring isnt really a whole lot better. Interestingly though i have been doing some light stretches which do dramatically decrease the pain…temporarily 
I’ve been to see the doctor who says I have a leg length discrepancy of about 2cm, and has reffered me to a podiatrist. I’ve also noticed that my right hip, the oppsite side of the hamstring injury has started aching, a problem I had on and off throughout last season, I also told my doctor about this but he seems convinced its all due to this leg length problem. Im pretty sure the hip pain is from some sort of tendinitis, stretching my hip flexors out relieves the pain…
Is the referral with a view to fitting you with an orthotic?
I think so yes, he did mention it. I already wear insoles in my shoes due to collapsed arches, I used to have terrible trouble with shin splints. I dont understand why a leg length problem would manifest itself now though, ive been sprint training for almost 3 years and this is my first hamstring problem ever.
This is freakin’ ridiculous. No one should suffer through 5 weeks from a hamstring strain with no improvement. One of my favorite stories from Charlie is hearing how he was brought in by an NFL team to fix an athlete (very high profile receiver) who was suffering from a hamstring injury for almost a year. Charlie got in there and the receiver was good to go (i.e. playing and scoring touchdowns) after five days.
I wrote a few articles on a case study of the hamstring rehab process. One of my athletes, doing bobsleigh at the time, tore up his hammy pretty bad in pre-season testing. We had to get him back for the season which began four weeks later. This meant he had to be good to push at 100% on ice. There was no room for half-assed recovery. He had to be ready to push at 100% for numerous reps.
This particular progression took 3 weeks because we wanted to make sure we didn’t miss a step and he was absolutely ready to go once the season started. And we had four weeks - so why not take our time and make it For more minor strains, I’ve had great results (full recoveries) in 5-10 days. However, don’t artificially create a deadline. It may take as long as it needs to take.
The key point is that the muscle must be ready to do the work placed in front of the athlete. This means very progressive massage, a good understanding of running mechanics and good communication with the athlete on their status after each rep and set. You are not making them do something they are not ready to do. You are building on their successes and accumulating volume of work at a given intensity and distance.
If there is one thing you can learn from Charlie’s approach, it is you need to learn from what the athlete can has done in the previous rep/run and proceed from there. You constantly need to assess the status of the athlete from rep to rep. How did they look? Can they do more? Do not ask for more if they can’t maintain their technique. Do not change the intensity of the work too dramatically. If they look good running at 75% of top velocity, let them run a number of reps and sets at that velocity to accumulate competency at that velocity. Don’t get cute.
Needless to say, a whole book could be written on the subject of hamstring rehab. Hopefully these articles give a sense of progression and care.
When examining the video clips, notice the difference in foot placement and heel recovery as we progress through the rehab process (left side).
http://www.runningmechanics.com/hamstring-rehabilitation-and-running-mechanics-part-1/
http://www.runningmechanics.com/hamstring-rehabilitation-and-running-mechanics-part-2/
I will soon be posting some articles on managing muscle tone - which I believe is absolutely critical to the rehab process in all injuries.
I have long since corresponded with Number Two on the topic of rehab via massage techniques and his words should, in my view, be taken under the strongest advisement.
Of particular importance is something he touches on in the article he provided links to. Those of you, in particular, who work amidst the collegiate and professional sport ranks in CONUS must pay special attention to the following:
While many individuals will say that the prescription requires strengthening protocols, I would go much further to say that an appropriate coordination pattern must be restored. Obviously strengthening is part of the process, but it is a very specific form of strengthening (specificity of velocity, load and order of recruitment). This is why sprinting must be the primary source of work in a hamstring rehabilitation program. It is not a problem that can be adequately resolved in the weight room or physio clinic.
The hamstring rehab I perform on our players who sustain injuries in training camp and practices consists of a great deal of appropriately dosed power-speed drills and graduated sub-max accelerations
As Number Two infers, it is critical that the structures are appropriately ‘strengthened’ and this is not going to happen in the weight room. In fact, the only instance in which ‘strengthening’ via resistance training is needed, in the case of a hamstring pull, is in the event of a tear that causes substantial structural damage to the point that muscle function is inhibited enough to yield atrophy.
Most minor pulls, in which no structural defect or bruising appears, will not even cause a loss in tonic/low speed muscle lengthening strength in the athlete. They’ll only describe pain/inhibition during higher speed/force field based maneuvers. Thus it is the graduated re-introduction of many of the same field based movements that is critical to the rehabilitation.
What’s key here is whether the leg length discrepancy (lld) is structural (eg bone is actually longer) or an acquired compensation (possible through injury or trauma). Did your doctor discuss this? How was the lld assessed?
Edit: Have you had any falls, injurys, knocks, accidents in the last few months?
To build on what James has conveyed, for any of you who want to successfully work in collegiate or pro environment - where results are paramount - finding out the “right” way is absolutely critical. I will be honest - I do not work in a high pressure environment as James does - in terms of wins and losses - however, I do spend the entire week (10-12 hours per day) finding ways to give athletes a chance to play and contribute on Saturday. In some cases, your job depends on it. Those of us that have the passion and patience to find the “right” way will have success.
Charlie was adamant about the best way to learn how to massage and make a difference: don’t piss around, get in there and rub the muscles. I learn more about an athletes muscles by working them with my hands. You can feel the tonal variations throughout the muscle. You learn how to bring the tone down without beating the hell out of the muscle.
It is sad to hear these stories about individuals with injuries that have carried out over months and have not been addressed properly. James and I do not have the time to rely on the private sector to resolve the injury problems we are faced with. We just have to get it done.
For the past few weeks, massage has solved the following problems:
- Back spasms
- Muscle contusions
- Hamstring strains
- Shin-spints
- Shoulder separations
- Knee problems (MCL, alleged meniscus tear)
- Patellar tendonitis/jumpers knee
- And many more…
I would say we have cut recovery times by 50-80% - and I’m not exaggerating.
muscles compensation pattern…
Number 2 and James have made some great logical points. I agree that massage and specific sprint drills have incredible results in rehabbing a ham pull.
It’s a shame to see the glute ham raise epidemic spreading around the world. It’s sometimes now the first exercise prescribed for hamstring rehab, usually with disastrous results.
He didnt mention anything about it being structural or acquired compensation, he assessed it by measuring from the my hip to my ankle, and no, I havent had any injurues or anything like you speak of.
I’ve taken onboard alot of the advice given here and looked at the links that numbertwo provided, thanks for those. I did a rehab session today following those guidelines, some sub max accelerations over about 15 - 20m. The good news is I felt no pain whatsoever while doing them 
definetely a difference from before, so I am starting to make progress! I guess the best thing I can do now is listen to my body and not push it too far while continuing the rehab
Obviously the volumes and types of drills used must be individualized per each athlete relative to their condition.
to give you an idea, however, of what a session could look like:
Last week I worked with two 1st string skill players (one with a hamstring strain, the other with an adductor magnus strain) Both of them were in a condition that impaired their ability to accelerate and change direction and were given the week off of practice by the medical and coaching staff.
Along with what I’ve had them do, they receive various therapeutic modalities in our training room.
Tuesday
Marching A 10x10yd
A Skip 10 x 10yd
Running A 10 x 10yd
Wednesday
Marching A 10x10yd
A skip 10x15yds
Running A 10x15yds
Marching B 10x10yds (used as a test for my hamstring guy and he felt good)
B Skip 10x10yds (hamstring guy felt good)
*note- the B versions are something that are not introduced for a while, depending on the grade of hamstring pull; however, I’ll use the marching version as a test to see where we are at and then if that goes well we see how the skip looks.
Thursday
A skip 10 x 20yds
Running A 10 x 20yds
*I instruct and ensure that all power-speed drills are performed to near perfection (relative to what the athlete can do)
Friday and Saturday Off
Today they both ran ~1000-1200yds of tempo absolutely pain free with confidence. Both athletes told me they felt very good running.
We have a bye week before our game with Miami so I have ample time to ramp them back up with sub-max accelerations and positional maneuvers unless they are required to practice instead.
Understand that I do not use pre-set volumes. All of this sort of work is individualized according to the athlete and the situation. So as Charlie would say, those drills and volumes are history not philosophy.
Interesting to hear that Revis has a slight hamstring issue. I’ll look forward to watching how they manage that. I have heard pretty good things about the Jets strength and conditioning coaches.
I wasn’t impressed with what I saw in the Hard Knocks episodes. I do understand that it was a small piece of what actually occurs, but watching a guy pull a tire up a dirt hill said it all for me after episode 1.
James and Number 2,
I understand that you both view sprinting and power-speed drills to be the primary means of rehabilitation in the case of a pulled hamstring but I am interested in how you go about reintroducing weightlifting exercises that yield significant stress on the hamstrings (RDL, hypers, etc). How does the reintroduction of these lifts fit in with the power-speed and manual therapy aspects both temporally and physiologically?
Number 2- your article says full lifting is resumed in week 3. Is this common for your athletes with hamstring pulls? How, if at all, are the intensities/volumes/frequencies altered when first getting back to it?
Thanks
One thing to ask your doctor…Is your leg length discrepancy (LLD) functional or structural? A structural LLD requires a lift, a functional usually doesn’t. You are right, your LLD (if it is structural) probably did not cause your hamstring tear. Your body has probably made some great adaptations to make up for the difference. Now that you are injured though, the LLD may be the factor that keeps your hamstring from healing. Adding a temporary heel lift under your insole to the short side would only cost about $5 to $10 so why not give it a try?
In my experience, we have been able to undertake full intensity lifting earlier than full speed running. These lifts include cleans, snatches, squats, lunges, etc. I am a bit more careful with RDL’s, hypers and lifts of this type - but they are never doing maximal lifts with these types of movements anyways. My feeling is that the hamstring will generally recover strength rather quickly - assuming the appropriate steps have been taken in Week 1. High velocity running, however, places more unique and complex demands on the hamstring including rapid stretching, contraction, relaxation and co-contraction, within a window of a few tenths of a second. Hence, the predominance of acceleration work in rehab - with all other training elements following from the results during these sessions.
In terms of ordering activities and adjust volumes, obviously upper body work takes on an increased role - with bench press providing the main stimulus. This may be the case for 7-10 days. Squatting may be introduced rather early - but we will start with a low to moderate low and squat to a fixed depth (i.e. bench squat). Much of the lower body work depends on the feedback I’m getting from the athlete. “Does it feel stiff, does it feel weak?” In some cases we can introduced muscle cleans or muscle snatches early, and then get into short range cleans or snatches from the hip to minimize tension on the hamstring. Pretty soon we are back to Olympic lifts from the floor.
I’m not a fan of any loaded knee flexion work (i.e. ham curls, glute ham raises) for sprinters or anyone who wants to run fast beyond 10 meters. Anecdotally, any athletes who I witnessed spending a lot of time on these types of exercises tended to have more problems with hamstring strains than those who didn’t. And, knee flexion in sprinting is a low load (or no load) function. Leg recovery is the result of the foot folding up under the body following hip extension.
For athletes who are not pure sprinters (football, soccer, basketball), I also incorporate some co-contraction work into the rehab program (i.e. deceleration, direction change, cutting, etc) to strengthen the hamstring in that regard.
Thanks for the thorough answer.
In my system, it depends on where we are in the year. We only perform RDL’s the first three weeks in Winter and Summer off-season and the rest of the year are back raise variations on a 45 degree or GHR device.
I have a great track record of keeping my skill guys healthy during off-season training even though we do a great deal of speed work. The most I’ll encounter with my guys during those periods is ‘tightness’ not pulls.
It’s during training camps where the pulls occur due to the overload.
Since the hamstring work is already much less structurally demanding at that point, because it’s performed in an auxiliary capacity, most players won’t miss a beat even with a minor pull (no structural defect) because we rarely see a significant hamstring pull even during those times of year.
Obviously it follows that each individual is different and must be treated accordingly and T&F is unique in that the maximal outputs/velocities reached in the sprints are unrivaled relative to the operational outputs seen in the team sports (most of which are in the early acceleration zone) so the severity of pulls sustained in the team sports will rarely rival those of a track athlete.