Check, so then you have the single leg power speed options available to you which allow you to keep the affected limb fully extended. Not being able to flex at the hip is surely a limitation; however, you still have the single leg options.
Thank you for such a detailed response. Regarding the early stage, you recommend isometric hamstring work. Is the glute bridge you mention a few points below that appropriate isometric hold to start with? I just want to make sure I read your approach correctly. I can currently hold a single leg glute bridge, but the reverse plank is a different story. One of the things that hurts the most the day after training is removing my shoe only using my other foot. Not a fun experience for what should be a basic activity of daily living.
Given the fact that you experience significant discomfort removing a shoe it is clear that the discussion shift to passive means for the affected limb and that you get the most out of the cross over effect from working the other limb via a host of movements including sub-max yielding (lengthening) on the order of 4 x 4-6 with a 4-6 sec lengthening phase each rep for both quadricep and hamstring exercises.
As for passive therapies, you’ll have to asses what you have access to and in such a case stim may prove to be highly useful and the contraction is isometric.
I have kept upper body work present throughout the last half year. I’ve brought back depletion pushups for the positive hormonal response. I figure I’ll do everything I can around the injury to keep the recovery environment optimal. Focusing on the healthy leg is an interesting notion; I haven’t done much there (more of an upper body focus via heavy bench for CNS stimulation). I do not own a stim machine, but have considered buying one in the past. At this point, I will try anything. This has been a stubborn injury. I’ll feel great–pain free–only to run sub-standard and feel like crap the next day.
James, what are your thoughts on when to bring in tempo runs? I should be able to handle these sooner than speed work due to the lower intensity, but I also don’t want to put a bunch of meters of that kind of running in without the complementary speed work. That is, unless, speed substitutes like hurdle hops are enough to keep the right properties in place even with higher levels of slower running.
You can do isometric or active glute bridging. I did isometric standing hamstring curl and then GHR. I progressed that into eccentric GHR, negative accentuated with control concentric GHR to explosive GHR. All progressions were done to tolerance. Eccentrics were initially too much for the injured area.
I can’t speak highly enough about STIM. I’ve had a Globus unit since 2007 and I integrate it into all programs for my consulting and distance coaching clients, and it was very popular item when I was at PITT then later the time I spent with Lloyd Cowan’s group prior to London.
As for tempo, It will be up to your particular discretion and tolerance; however, you might consider the running A graduated intensity progression that I spoke of in the stepping down thread. In this way, you’d get the added benefit of quality muscle contractile dynamics at lesser volumes than tempo.
After a few days of just doing glute bridges at home, I hit the field and gym for my first actual workout. Here’s what I did today as per everyone’s recommendations:
A Skips
2x4x50m (around 30 seconds per rep)
These were pain-free. In fact, I didn’t even notice that anything was supposed to be hampered.
Bench
3x4x85%
Isometric Glute-Ham Raise
7x20 second holds
Mid-range position
Once again, these were pain-free. But, wow, these are challenging just from a strength standpoint even if I were healthy.
Consider graduating the intensity of the A-skips every two weeks by working long to short. Since you’re starting at 50m/~30sec you may gradually reduce the distance/time and increase the intensity of your method of execution in terms of more explosive hip flexion/hip extension. consider reducing 10m every two weeks. So 50m again next week (2-3 times per week per tolerance) then 40m for two weeks, 30m for two weeks, 20m for two weeks, finalizing with 10m. Every week increasing the intensity of the action according to tolerance
Good to hear you can do these exercises without pain. If possible, I would also include some double-leg vertical plyometrics such as reactive depth jumps. Maybe you could also do some single-leg hopping on the unaffected side with more of a horizontal component. If you’re not used to doing these exercises build up intensity and volume very carefully, so you don’t end up adding achilles problems to the mix. They are very useful for maintaining explosiveness while you are unable to sprint.
Is yours fixed yet
I like that approach. Each 50m segment included around 46 total skips, making my rate 1.5 skips per second. As I bring down the total distance and time, I assume increased intensity should lead to a higher frequency.
My initial thought, in accordance with your book, is that I would progress to Running A’s / High Knees at some point. Of course, everything is based upon my tolerance, but when would these enter in your above progression? Can I bring them in while still progressing through A-Skips or would you wait until this section of strengthening was completed? My thinking: I could do lower intensity Running A’s when the skips are becoming of a high intensity. As the skips drop out, the intensity of the A’s should increase (kind of a vertical integration concept). The overlap could then be applied to the introduction of sprinting, all while letting my body tell me if it’s ready using the 24-hour test (If worse than yesterday, you did too much).
As there is no seasonal urgency for you to get in top form with any immediacy, my suggestion is for you to complete the Skip progression void of any other drills. In this way, you allow the organism to focus on less total similar targets for adaptive purposes and may continue to compliment this work with any jump and tonic/strength movements you find of benefit. In this way, the skips function as a quasi substitute for sled/hill sprints a GPP and by the time the dynamics of the skips really get up there via the short distances you may then be ready to swap them with the Running A and work the Running A back on up the ladder to the longer distances; albeit, at faster horizontal velocities to transition you smoothly back into sprinting.
In summary, the A skips decrease in distance yet increase in intensity of execution- you then switch to Running A’s at the 10m length at a relaxed movement intensity and every two weeks the running A distance increases by 10m and so does your horizontal velocity. By the time your performing running As out to 50m you should be well prepared to begin sub-max sprint work.
I agree with James regarding the progression. It makes sense and progressively prepares you for sprinting. I also agree there is no point to push too fast since this is not a career. Better to take it slow and continue to progress vs. moving too fast and limiting training even more. The only thing I would add is watch for pain well after activity. In my experience and from hearing others, tendinopathy pain is often not felt during activity but later.
Today’s Workout and Rationale
Hurdle Hops
With A-Skips taking the place of speed work, I figured there will be plenty of CNS capacity to perform plyometrics the following day. Instead of performing true hurdle hops, I placed cones on a soccer field and focused on moving my COM vertically instead of actually clearly hurdles to minimize hip flexion. The surface and lower height requirements allowed me to perform 48 total quality hops.
Single-Leg Bounds with Good Leg (L)
I felt an immediate awareness in my bad leg (almost a grabbing or seizing feeling) on the second bound. I was unable to perform a full cycle of the jumping leg a la the second phase a triple jump; instead, I performed some very low intensity single leg hops with the bad leg hanging nearly straight just for some additional stimulus.
Isometric Hamstring Curl
I performed 2-leg holds at the lowest weight for a total of 2 minutes. I was surprised at how prevalent the injury was during these. There was no pain, but there was a clear awareness of the weakness.
Question Going Forward
Overall, I felt good today (i.e., yesterday’s work was within tolerance). My main question during today’s session centered around, “How much awareness / discomfort is appropriate, and how much is too much?” The grab I felt during the single leg bounds felt like a natural protection mechanism, which could be the result of a lot of negative reinforcement over the last six months. I determined that this sensation was too much. On the other hand, I felt that the feeling during the hamstring curls was ok to work through. As I sit her five hours later, I feel no oncoming of pain or reduction in range of motion, so my take is that the load was fine. Thoughts?
My suggestion is to stay away from the bounding, for now, as the ground impact forces are far in excess of anything else you’re currently doing and clearly exceed tolerance. Stick with reactive/elastic endurance methods of execution (rolling hops, ankling, possibly stiff leg hops) in order to first re-establish the integrity of the soft and connective tissue. The proportionality of your entire workload should be primarily split between the A skips and the tonic weights.
Yes, it sounds like you are not ready for single-leg bounding yet. Some discomfort during isometric or eccentric work is ok, as long as things are not worse one or two days later.
Why wold you stimulate or stretch inflamed area to the point where it actually hurts the next day?
Making suggestions it’s great, you are responsible for FA. I like the stuff such as If the stretch is hitting the painful spot that probably means it’s the right stretch to do or do this or this if is hurting next day you have definitely done too much, lol, Cut the red wire if it explodes in your face next time instead of red go for blue. wtf?!
Michael Fredericson, et al. High Hamstring Tendinopathy in Runners. Meeting the Challenges of Diagnosis, Treatment, and Rehabilitation [Internet]. The Physician and Sportsmedicine 2005. Available from:
http://www.agilept.com/downloads/high-hamstring-tendinopathy-in-runners.pdf of evidence 2A, grades of recommendation B
Angelo Cacchio, et al. Shockwave Therapy for the Treatment of Chronic Proximal Tendinopathy in Professional Athletes [Internet]. The American Journal of Sports Medicine, Vol. 39, No. 1 2011. Available from: http://www.dolorclast.com.br/humano/downloads/tratamento_pela_terapia_por_ondas_de_choque_no_tendao_proximal_do_isquiatico_cronico_em_atletas_profissionais.pdf
Level of Evidence 1B, grades of recommendation A
Daniel Lorenz and Michael Reiman. The Role and Implementation of Eccentric Training in Athletic Rehabilitation: Tendinopathy, Hamstring Strains, and ACL Reconstruction [Internet]. Sports Physical Therapy Section 2011. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105370/?tool=pubmed
Level of evidence 2A, grades of recommendation B
Mike Walden. Hamstring Origin Tendinitis / Tendinopathy. Sportsinjuryclinic.net 2011 http://www.sportsinjuryclinic.net/cybertherapist/back/buttocks/hamstring_tendinitis.htm
Level of evidence 5, grades of recommendation D
“Running again:
High hamstring tendinopathy is known as a disease that takes a long time to recover from. Fredericson et al. estimates a recovery of 8-12 weeks. It’s likely that cross training doesn’t stress the legs until the bent-knee stretch test can be done without pain.
The moment that you can do the exercise shown on the picture below, you can begin with the return-to-running program described here:
Week 1: Walk 5min/jog 1min, build to sets on alternating days (ex. 2x5min/1min, off, 3x5min/1min, off, ect)
Week 2: If no pain, walk 5min/jog 5min, build to 5 sets on alternating days
Week 3: If no pain, advance to 20min jog, no more than 5 days per week
Week 4: If no pain, advance to 20min run at normal training pace, no more than 5 days per week
Week 5-8: If no pain, gradually increase running speed, volume, and acceleration as tolareted”
I think, the discussion should be about therapy, and in my opinion this is what have been missing in many programs.
Kind regards
Wermouth
An interesting discussion so far.
Many excellent points made by all.
Several helpful specific exercises have been outlined for your injury. ALWAYS use pain as your information tool of what to do. You be the judge. Learn from what others say but judge yourself if need be.
My points to add.
1. A new baby! Congratulations are in order. You mentioned that as far as you knew nothing had changed. LOL. ( male perspective I guess ;). This is your acute event. Loss of sleep could be the single factor that changes everything and especially something that is under lying as James has pointed out.
2. It never hurts to have photos (MRI) but don’t wait on this. Get it if you can but move ahead now as there is lots you can do.
3. How is your water intake? What about your nutrition. If you can improve them do so NOW and if you don’t need improving good work but I bet you could benefit from a reminder on healing 101. Hydration and fuel are two things we tend to take for granted in our routines.
4. Tissue and tendons have compromised blood flow due to the density of the tissue. Any promotion of overall circulation benefits the entire organism. Training in the water accelerates circulation as you are promoting blood flow greater than normal as you are exercising without compression. Water heals.
5. Tempo must continue as it’s circulatory, it helps vascularize muscle and tendons and it promotes overall recovery and mobility. Run in the pool or do laps with push ups and sit ups out of the pool alternation the same way you might out of the pool. Are you able to do bike?
6. Contrast baths heal and regenerate the nervous system. Soft tissue work and or acupuncture are amazing but choose what you can perform daily and at home for best results. Having a baby, life’s inevitable ups and downs are stressful even when they are good and more so when things go wrong. The nervous system must be in tact routinely for daily healing and repair.
7. You do not need volumes of exercises to replace speed. You do need to replace speed. Mock and or replicate drills or exercises in ways that mimic the exercise without creating pain. Use the guidelines you already have that are discussed but don’t stop thinking yourself as you are doing the feeling and your situation is unique to you.
[QUOTE=wermouth;252242]Why wold you stimulate or stretch inflamed area to the point where it actually hurts the next day?
Making suggestions it’s great, you are responsible for FA. I like the stuff such as If the stretch is hitting the painful spot that probably means it’s the right stretch to do or do this or this if is hurting next day you have definitely done too much, lol, Cut the red wire if it explodes in your face next time instead of red go for blue. wtf?!
Wermouth you have hit some nails right in the head.
[b]
I watched Charlie work with a few people with very serious asthma. He worked well underneath any point of any issue what so ever. For example. He was more careful than normal. Watching more intently than normal if that was possible. Tons of feedback and if and when there was any issue what so ever the session was stopped right then and there.
The comments I read about any tugging or pulling make me cringe. If I were coaching you I would stop you right then and there. I would send you home to rest, drink water and do tepid bath or epson salt bath and come back ( maybe) the next day.[/b]
One comment made by Charlie closer to the end for him than in the beginning.
Most people have to do more therapy not less and less training ( providing it’s excellent ) to stay at an even point.
I am a big supporter of self therapy because this is what I was taught, this is what was available post 1988 and long term it’s sustainable. If you have more or different, excellent for you. But for most that will be reading this it’s simply not the case. In fact, for most, excellent therapy happens once you have reached the very highest level not on your way to trying to get there.