I’m looking for advice on how to appropriately recover from an injury to the proximal hamstring tendon. I’ve pulled hamstrings numerous times over the years and have returned to action quickly (usually within 3 weeks) using the CF approach of progressing acceleration distances. I thought I could use the same approach for this, but soon learned that even accelerating hurt. This was a different beast.
I first felt a throbbing pain deep in what I thought was my glute about an hour after a 60m race back in January. I ran the 200m later in the meet, which left me almost unable to walk in the days to follow. I tried to return to the track a couple weeks later, but was clearly favoring the leg during my warm-up. That was it for the indoor season. My training was less intense than usual over the next 2.5 months leading up to the outdoor season.
I felt great warming up for my first outdoor meet in April; however, it became clear during the maxV phase of the 100m that something was still off. I decided that I would only run 200s the rest of the year, aiming to hit and hold slightly sub-max speeds. Even when I felt great during the week, the added intensity of meets resulted in poor times and a sore hamstring/butt. I went from running consistent 21.9s in 2014 to races in the 22.4-22.7 range in 2015.
I took 5 weeks off from any kind of sprinting before I began my GPP phase for the 2016 season about a month ago. Things felt pretty good during the initial ramp-up of intensification, but the first 4-week block left me hurting in a similar fashion as the spring. I attempted flat speed work for the first time last night (only 25m of intensity), but it was far from “feeling right.” I’m darn sore today.
So as you can see, I’m kind of at a loss of what to do. The CF hamstring rehab protocol has worked wonders for me in the past, but the involvement of the tendon in this case seems to throw that approach out the window. I’ve tried to run it back; I’ve tried complete rest; I’ve done light lifting; but here I sit a half year later still unable to hit 100%. The most frustrating part is that I don’t even know what caused it; there never was a pulling-like event. My guess is that it was due to inadequate recovery during my winter training. With a newborn at home, I wasn’t getting much sleep. I must not have reduced my training enough to account for the lack of deep sleep.
I am all ears for ideas. If anyone knows how to recover from this type of injury, they’d be here. I really hope that this isn’t the end of my racing career (I’m 31 now). Thanks for your help.
I had a similar situation in the group.
We resolved the issue by doing two exercises.
In most of the cases hip flexors are not long enough consequently they can neurologicaly switch gluteus off. Power production going to be shifted from glutes (primary mover) to hamstrings (secondary mover) and problem is going to be there sooner or later.
hip flexor stretch like in Thomas test, leg drop for 2min, have to allow the gravity to do the work, 6x each leg. PNF is advisable in the further stages.
2)Clams with elastic band/ loop. Place the band just below or above your knees. Lie on your side propped up on your forearm. Place your feet together, one on top of the other. Bend your knees slightly. Lift the top knee open, keeping the feet together. Hold for a second at the top and then lower. Do not let yourself rock or rotate back as you open that top leg up toward the ceiling. Make sure to focus on just squeezing the glute to lift.
Or
Half squat position, elastic loop above the knee, side walk, 15-20m both directions x4
As I have stated on numerous occasions, in my experience and knowledge there are two either independent or combined reasons for injuries that do not involve some acute event involving a sudden movement obstruction such as a collision, fall, etcetera.
biomechanical inefficiency which equates to structural overload
programming and organizational inefficiency which also equates to structural overload
Aside from therapy discussion, you must determine if your situation is resultant of one or both of the reasons I listed; because by virtue of what you have described, there is a chronic issue at hand and any therapy solution will only serve a temporary role if the cause of the problem lies in biomechanical or planning inefficiency.
I’d think that if this were the case, I’d have had something occur in the past. I’ve been competing consistently (both indoor and outdoor) for 7 years and this is the first time something in this area went wrong. I should note that I consistently progressed during those years (11.39/22.49 at age 25 to 10.81/21.69 at age 30). I don’t feel like I’m doing anything differently than I’ve done in the past, but that doesn’t mean that a biomechanical inefficiency hasn’t always been there or hasn’t come about recently. Analyzing gait isn’t a strong suit of mine, so I’m just basing my thoughts on empirical data (no such injuries and consistently progression over 7 years).
Are you referring to the programming of the workload or neural programming/organization? If the former, I definitely can see that being the culprit. I had a two month stretch of pretty bad sleep with the new baby at home, but I kept my workouts pretty similar to past years. I thought this potential cause would take care of itself once sleep came around, which it did, but I’m still struggling.
Thank you for your response. I definitely don’t want this to be a recurring thing, so I definitely want to fix the root cause. #1 is a little tough for me to analyze–both due to my lack of expertise in gait analysis and due to my fairly healthy history.
The standard treatment for tendinopathies is daily pogressive eccentric loading for 12 weeks. There is not much research on hamstring tendinopathy, but it works for achilles and patella tendons. There is evidence from at least one paper as well as my personal experience that daily stretching (10x20s per day or so) can have the same effect.
Lower hamstrings are important at top speed because they control knee extension just before touchdown. It is usually at this point that they pull. Upper hamstrings work more as hip extensors which is why you can’t accelerate with a proximal hamstring issue.
You’ll have to find a way to eccentrically work your proximal hamstrings, so hamstring curls won’t do the job, for example. You need a hip extension type movement. Stretching would also have to be done by pushing into hip flexion with the knee flexed.
You can continue exercising as long as what you are doing is not making things worse.
This forum is the best. Thanks for the help. A couple questions:
What are the most appropriate eccentric exercises to perform? RDL, Glute-Ham Raise? Is knee flexion important in those (i.e., don’t lock out)? Or rather, is something like a glute bridge, where you have that hip extension the way to go (as you noted)? To this point, I’ve tended to stick with running as the way to strengthen a muscle to run, so using lifting and other exercises is a little out of my comfort zone. I’ve adhered pretty closely to CF’s “sprinting is specific to itself” when it comes to rehabbing.
When mentioning the daily stretching, should I just stick with putting the hip into flexion as you noted, or is there also benefit to doing some of the more standard hamstring related stretches? The stretch you described above nails the pain point–I have to be pretty conservative with it at times.
The glute bridge sounds like a good idea, as it targets hip extension, allows you to focus on the eccentric portion and can be done anywhere. You can use both legs to go up and then slowly lower yourself back down using the injured leg only. When you can do something like 3x15-20 reps like that you can start adding some weight.
If the stretch is hitting the painful spot that probably means it’s the right stretch to do. Slight discomfort is ok during eccentrics and stretches, but if the condition is worse the next day you’ve gone too hard.
Have you had any scans done? If there is an acute tear in the tendon you will have to be more careful with these types of exercises.
It may take 4-6 weeks before you notice much improvement, as tendon turnover is rather slow, so keep going for at least 6 weeks before you decide whether it’s working.
I had the same problem a while back. I will look through my notes later and share what was helpful along with some websites. James is correct about etiology. There is either a problem with biomechanics or too much overload. My accel volume had increased and was done to frequently for me to recover. My injury started with some stiffness/tightness that did not limit my sprinting initially. Eventually it became worse and sitting in the car was one of the most aggravating activities.
This is my story exactly! I’ve always been a maxV guy with really bad acceleration (went 10.81, 10.83, 10.87, 10.90, 10.91 last year with only 60m times of 7.06, 7.14, 7.17). I thought, “If I can improve my acceleration, I can get down into the low 10.7s.” I added a lot more acceleration-based reps during the fall and winter, and this was the result. So it sounds like #2 from James’s list is the most likely candidate.
No, I haven’t had any scans done, so I guess I don’t really know the true extent of the injury. I might have to go this route if things aren’t heading the right direction in 6 weeks.
What types of track workouts should be coupled with this protocol? I’m thinking smooth, sub-max acceleration zones to reach the allowed intensity. All-out accels and speed change drills seem to be the hardest on the tendon. There might be some capacity for special endurance runs, as well. Thanks again.
I know the feeling, except for me, it’s my low back. Ever since I have been changing up my mechanics this year, which they have improved, and I have lessened my anterior pelvic tilt, my low back pain has actually increased. Maybe due to the muscles are in a more stretched position upon contraction or working more eccentrically? I do not know.
Guessing you don’t have my book as I describe a few very useful substitutes that when used in combination provide very effective stimuli in leu of the real thing. I don’t want to copy and paste here so suffice it to say you may combine a host of viable acceleration substitutes based on tolerance (spin bike sprints with the seat lowered, hill sprints, sled sprints, double and alternate leg hops/bounds up hill, double and alternate leg hops/bounds up stairs) along with graduated intensity running A’s that I described in the stepping down thread the other day.
Normally I would agree that stretching would be helpful, but in this case I don’t recommend it. In my case, it worsened things every time until I allowed enough time for healing.
First, I want to let you know that this will be a slow process. Tendinopathy is different that a strain. Tendons do not have a good blood supply and I think that it is crucial to get blood in the area to promote healing. It is also imperative that you keep moving BUT you have to make sure that everything you do does not stress that area of your hamstring. I also tried to rush the rehab process a few times but to no avail. Plan to take it slow and it will get better and you will be able to run faster later. Just be patient. The process took me 2-3 months before I started back with running and acceleration work. I kept those early runs submax too.
Here is the general plan:
-Perform isometric for hamstrings daily aiming for 2-5min of total hold time
-Perform standing HSC for higher reps if no pain 3-4x/wk
-Perform massage and graston on the area, later on move on to deeper tissue work
-Perform core work to make sure those muscles are able to control pelvis
-Begin with glute bridges if no pain is reproduced progressing to hamstring bridges (i.e. reverse plank) and eventually single leg hamstring bridge/reverse plank
-Perform negative GHR progressing to negative accentuated and controlled concentric to explosive
A few key points in relation to the above:
-Do not do anything if it creates pain. In this case, pain will only set you back. Progress slowly.
-Hamstring curls are probably better performed standing so you do not stretch proximal hamstring. Also higher reps should be done to increase blood flow. This way we can get more blood to the area without working it directly.
-Isometrics seem to help tendons to heal
-Begin with gentle massage as that area does not typically respond well to aggressive soft tissue work initially. Graston did seem to help more than just using hands in this case. Later on I really liked rolling that area with one of the massage balls with the spikes on it. That helped loosen everything up in the latter stages.
-Proper exercise execution is key for GHR. You must make sure that you do not break at your hips. This will require activation of your core and you are working on some hip extension that will help get that proximal hamstring to work. This can be progressed from double leg to single leg as well.
-Once you are able to do the single leg hamstring bridge/reverse plank equally with both legs, you will be ready to start running again.
Those are the things that helped me get back to the track. I am sure other things could be added/substituted but this worked well for me and the equipment I had available. Let me know if you have any questions. I can also share more science behind the thought process if people are interested.
I actually do have your book. I may not post a lot here, but I consume almost every product coming from the minds of this site.
The tricky thing is that it was hill sprinting to 40m that caused this leg to start hurting again during my GPP. I also found that skips for distance are tough, while skips for height are pain-free. If unable to do true maxV work, I planned to use hurdle hops as my main elastic modality. I’ll have to revisit your book for some of those other alternatives; it might need to come back to double-leg hops.
Will do, as you know from the book then- the key is to disseminate the three foundational movement variables (biomotor, biodynamic, bioenergetic) and, when needed, perform a part whole system of activities that most closest satisfy what you need to get done (tolerance permitting).