• Pulled Hamstring (Hamstring strain)

Common Running Injuries
•
Page 5 of23
Pulled Hamstring (Hamstring strain)
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o
o
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Hamstring is a group of 3 large powerful muscles (biceps, semimembranosus,
semitendinosus) that span the back of the thigh, from the lower pelvis to the back of the
shin bone. Extends the hip joint and flex the knee joint.
Pulled hamstring (strain) is a stretch or tear of the hamstring muscle fibers or tendon.
Injury commonly with sprinters, sudden accelerations.
Also can see injury from a direct blow to the muscle. Contusions are different from
pulls, but may cause similar symptoms.
Grade I injury: tearing is microscopic, muscle fibers are stretched too far, some bleeding
occurs within the muscle.
Grade III injury: the hamstring muscle can completely rupture, may require surgery to
repair the tom ends of the muscle.
Causes of pulled hamstring:
o Most commonly occur when these muscles are contracted forcefully during activities
such as running or jumping. If the force is strong enough, it will tear the muscle fibers.
Symptoms:
o Depend on the severity of the injury. Often have a burning feeling or a popping when
the injury occurs. Injury is usually sudden and painful.
• Bruising - small tears within the muscle cause bleeding and subsequent bruising.
Begins in the back of the thigh and as time passes will pass down below the knee
and often into the foot.
• Swelling - swelling in the thigh from accumulation of blood. Wearing a
compressive bandage can help control the swelling.
• Spasm - common and painful. Because of trauma to the muscle, signals of
contraction are confused, and the muscle may be stimulated.
• Difficulty Contracting - flexing the knee is often painful after a pulled
hamstring. If unable to contract the hamstring, the muscle may be completely
ruptured.
Diagnosis:
o Examination: tenderness at the site ofthe injury.
Treatment:
o Ice pack to hamstrings for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the
pam goes away.
o Elevate leg by placing a pillow underneath it.
o Control swelling by wrapping an elastic bandage around your leg for compression.
o Anti-inflammatory medications, if prescribed.
o Crutches may be necessary if walking is painful or if spasms are severe.
o Physical therapy / chiropractic can help to realign muscle fibers and develop a stretching
and strengthening program for your hip and thigh muscles.
o May need to wear an elastic thigh wrap to give extra support to your hamstrings.
A common sports injury, seen mostly in sprinters. Treatment is important for a speedy recovery.
httn://www.checkersac.org/Common%20Running%20Iniuries.htm
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Common Running Injuries
Page 6 of23
Prevention:
o Warming up properly and stretching your hamstring muscles prior to your activities.
http://www.checkersac.org/Common%20Running%20Injuries.htm
412512008
7
The Big BodyBreakdo""'~
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Hamstring Issues
The muscles that run down the back of our thighs bend our knees, extend
our legs, drive us up hills, and power finish-line kicks. So when our hamstrings are too tight or weak to perform well, we notice it. Seven percent
of poll respondents say their hamstrings have bugged them this past year.
WHO'S AT RISK?
Hamstring issues usually arise because
these muscles are weak---often from being too long or too short. Counterintuitive as it might seem, very flexible people
are prone to hamstring problems because
their overly stretched-out muscles are
more vulnerable to damage, On the flip
side, people who can barely touch their
toes or who sit for long periods of time
are also at risk. Tight, short muscles are
under greater tension. Another factor is
Hamstring Signs: How to Proceed
STOP! Sharp, sudden, strong
pain and possibly eVl!na snap or
pop sound while running. The
area is bruised.
WITH CAUTION Chronic
achiness and tightness that
forces you to slow your pace
and shorten your stride.
GO RUN! Pain-free while
climbing hills and doing
speedwork, even after long
periods of sitting.
muscle imbalance: Many runners' quadriceps overpower their hamstrings,
which sets them up for injury.
CAN YOU RUN THROUGH IT?
If the pain comes on suddenly and strong
and the area bruises, you may have a true
pull and you'll need extended restmonths-before you can run again. If it's
a less severe, chronic overuse injury, you
can usually run, but it'll take some time
before you're back in the green zone.
"Hamstring issues stink," Price says. "It
takes a long time to heal them." Running
a slow, easy pace is usually less bothersome than attempting intervals or hill
repeats. Bicycling, pool running, and
swimming are good alternative activities.
REHAB IT
Strengthen your hamstrings with onelegged hamstring curls (raise the bar with
both legs, then slowly lower it one leg at
a time) and one-legged deadlifts (see
"Glute Strength," page 42). Use a foam
roller to alleviate tightness before and
after a run, Merrill says. In chronic cases,
active release technique (ART)and deeptissue massage may be necessary.
PREVENT A RELAPSE
Stay strong with bridges: lie on your back
with your feet on a chair or exercise ball.
Raise your hips,
then lift one leg
into the air. SlowBridge
ly lower your hips
back down to the
floor, using the
supporting leg. Re-.
turn that leg to the
ball. Repeat with
the other leg. Also, compression tights
(see"Home Remedies,"page 55)during or
after running can aid blood flow.
ELITE TREATMENT
When U.S. champion miler David Torrence felt his hamstring tighten up, he
took the next day off and went to his chiropractor. "My pelvis was misaligned,
causing my hamstring to do extra work, "
he says. "I took it easy for a few days, iced
the hamstring four times throughout the
day;and was improved within a week."
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Injuries to the hamstrings are the most common soft tissue injuries to
the thigh. Symptoms of a hamstring strain include pain, muscle spasm,
swelling, and inhibition of movement.
Treatment
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IiEI Time-to-Run
•
Main
of acute injury
stop running, especially in the case of severe pain
if pain is mild, then reduce training load and intensity, and avoid
running on cambered surfaces
take a course (S - 7 days) of non-steroidal
anti-inflammatory
drugs (ibuprofen/voltaren/cataflam/mobic)
available from your
general practitioner
or pharmacist
.
apply ice to the hamstrings - for 10 minutes every 2 hours, in
order to reduce the inflammation
self-massage,
using arnica oil or an anti-inflammatory
gel, to the
hamstrings
stretching of the hamstrings.
SONIC'
iiltUEF
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Heal Running Injuries
Ultrasound Massage Kit
Optimal
IiEI Mechanism
IiEI Treatment
It
IiEI Injuries home
1) Lying on back. Pull leg to chest with hands under the knee. Keep your
@ Injury
leg as close to your chest as possible, and straighten
your knee as much
as possible. 2) Lying on back, wrap a towel around your foot. Straighten
your knee and use the towel to raise your leg and to pull your toes up
towards you. Hold each stretch for 30 sec. Relax slowly. Repeat to
opposite side. Repeat stretch two - three times per day. Remember to
stretch well before running
guide
IiEI The BIG 5
IiEI Leg & Foot Cramps
IiEI Injury Comeback
IiEI Injuries links
is important
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Advil® Sample 8. Save
~
to stretch
both the top and bottom
return to running gradually
full recovery is usually between
three
of the hamstrings.
to six weeks
Stretch
•
wwwAdvil.com
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physiotherapy.
Soft tissue massage, dry needling (acupuncture),
and eletrotherapy
modalities will speed up the rate of recovery
from a hamstring injury. Progressive stretching and strengthening
of the hamstrings will enhance the recovery process
orthotist or podiatrist for custom-made
orthotics to control
overpronation
in the case of severe strains, surgery is usually not indicated. The
use of crutches, as well as a supportive brace may be necessary
for pain relief
Alternative
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Preventative
Fluid Replacement
Fluid and
Electrolyte
replacement
during and
after
activity ..
more
Medical treatment
Advil® works wherever
you hurt Advil®, the
Every Pain Reliever,
Nutrition
necessary for
the body that
is
exercising ..
more
Routines
routines to
assist in the
avoiding of
injuries ..
more
exercises
swimming
pool running
cycling (in low gear)
measures
http://www.time-to-run.com/iniuries/hamstring/treatment.htm
1/2412007
Treatment of recurrent hamstring strains - Time-to-Run Injuries and Treatment section - d... Page 2 of 2
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stretching of the ITB, quadriceps, hamstring, and gluteal muscles. Hold each stretch for 30 seconds, relax slowly. Repeat
stretches two - three times per day. Remember to stretch well before running. Remember good flexibility must be
obtained before effective strengthening
can occur
strengthening of the hamstrings
correction of muscle imbalances (quadriceps: hamstrings ratio)
strengthening of the "stabilisers" (the transversus abdominus, rectus abdominus, gluteal and adductor (groin) muscles
correct shoes, specifically motion-control
shoes and orthotics to correct overpronation
avoid cambered roads (stay on the flattest part of the road)
gradually progression of training programme
incorporate rest into training programme
Other factors
Recurrent hamstring
injuries
may also develop after a number of removed causes. These causes may include:
•
referral of pain from the lumbar spine. This may occur due to disc bulges at the L4/5 or L5/S1 levels, or due to joint
stiffness of the lumbar spine or sacra-iliac jotnts, which may result in nerve root irritation. The irritation of the nerves
may cause local muscle pain, spasm or a more prolonged, generalised increase in tension of the hamstrings. Local
treatment of the lumbar spine and sacra-iliac joints is necessary
•
meniscal (cartilage) problems at the knee. The hamstrings work to stabilise the knee joint during the running cycle. An
alteration in the biomechanics of the knee joint due to meniscal tears or degeneration may lead to excessive loading of
the hamstrings, and recurrent injury. Restoration of full knee function is required to avoid recurrent strains of the
hamstrings
•
adhesions (tightness) of neural tissue. The loss of mobility and subsequent increased sensitivity of neural tissue
(particularly the lumbo-sacral nerve roots) may predispose runners to recurrent hamstring strains. This is especially
relevant when sprinting or changing pace. Mobilisation of the neural tissues by a physiotherapist
and stretches are
indicated to reduce the incidence of neural tension
•
postural variations. An increased lumbar lordosis (curvature of the lumbar spine) causes an increase in the resting
tension of the hamstrings. This results in the hamstrings being functionally tighter, and more inclined to fatigue early.
Postural abnormalities should be addressed through the correction of muscle imbalances by stretching and strengthening
•
poor running style. As mentioned previously, the hamstrings work strongly throughout the running cycle. A running style
which is poorly co-ordinated may result in early fatigue, and injury. An altered stride pattern may be necessary. Overstriding should be corrected, especially when running uphill/downhill
•
loss of the normal quadriceps/hamstring
ratio. Excessive quadriceps development may produce an abnormal force in the
hamstrings, particularly when there is a loss of co-ordination due to fatigue. This is more of a problem in athletes who
mix cycling with running (e.g. triathletes).
Cycling results in increased quadriceps development which may predispose the
athlete to hamstring injuries, particularly when running. There may also be a pre-existing weakness of the hamstrings.
The imbalance in the ratio of strength between the quadriceps and hamstrings must be corrected to avoid recurrent
injury. Isokinetic strength testing and an effective rehabilitation programme are essential
Isokinetic testing
Isokinetic strength testing is widely used as an indicator of recovery following muscle injuries. The testing is performed using a
machine known as an isokinetic dynamometer.
This equipment is available at the Sports Science Institute of South Africa, and
at biokinetics practices around South Africa. The machine allows the hamstrings to be tested through the full range of knee
movement, and concentric, eccentric, and isometric (static) strength in assessed. The muscle endurance of the hamstrings may
be assessed, which together with the eccentric strength and the quadriceps/hamstring
ratio, is particularly relevant for runners.
Isokinetic testing allows for specific weakness to be identified. This will allow for an individual strengthening
programme to be
drawn up to treat your specific problems, and will assist in effective rehabilitation.
Finally, once all the various factors have been identified and you have completed
back onto the road slowly and steadily. And remain injury-free!
the rehabilitation
process, remember
to get
View the articles relating to the hamstring:
•
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Hamstring injuries home
Mechanism of injury
Time-to-Run
Injuries
and Treatment
section
----------.
htto:l /www.time-to-run.comliniurieslhamstrin2:/treatment.htm
1/24/2007
TRICKS of the TRADE
Release 2.0
A new way to loosen tight muscles and
sidestep injuries is at your fingertips
than just how
to swim and bike. Ask one how he stays injury-free, and
there's a good chance you'll hear about Active Release
Therapy (ART),a specialized massage technique that reduces
soreness and tightness and speeds recovery. ART practitioners
have been a staple at the Ironman World Championships for the
past 20 years. Now,thanks to a new do-it-yourself technique developed by sports chiropractor and l l-time Ironman Rob DeStefano, you can reap the benefits of ART without qualifying for
Kona. DeStefano's method, called Facilitated Active Stretch Technique, or FAST,involves applying pressure around a restricted
or damaged area while moving the muscle through its range of
motion. Use it before, during, or after a run or race on these five
common trouble spots. -Beth Dreher
Y
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With your other hand, push ori the
ridge-like muscle between your neck
and your shoulder. Then place your
" _free hand on your lower back.
",2, 'Maintaining the pressure, tilt your
head in the opposite direction. Then
straighten your head, extend your arm,
and move your fingers a few inches
closer to your neck. Repeat the
progression, moving pressure
from your shoulder to your neck.
HAMSTRINGS
ILIOTIBIAL BAND
CALF
Relieve tight hamstrings
1. Sit with one leg straight, the
other bent with toes pointed.
1. Lie on your back with both
legs bent. Grab one leg with
both hands and press your
fingers into the top third of
your hamstring.
Relieve iliotibial-band
syndrome, knee pain
1. Sit with one leg bent.
1. Sit and bend one leg 45
degrees, keeping your toes on
the floor. Starting above your
knee, press into the outside of
your thigh with both thumbs.
2. Grab your calf with both
hands, thumbs on your shin,
fingers on your lower calf.
Apply pressure, then straighten your leg and flex your toes.
2. Maintaining that pressure,
extend your leg. Then bend
your leg, move your thumbs
up, and extend your leg.
Continue bending your leg,
moving your thumbs up, and
extending your leg until your
thumbs are at the top of your
IT band, near your hip.
3. Bend your leg and move
your fingers to your midcalf.
Apply pressure, extend your
leg. Repeat on your upper calf.
2. Maintaining that pressure
and keeping your leg bent,
extend your foot toward the
ceiling. Hold for two seconds.
3. Bend your leg, move your
fingers to the middle of your
hamstring, and extend your
foot toward the ceiling. Repeat
again, putting pressure on the
bottom third of the hamstring.
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tension
Relieve Achilles tendinitis
3. Release your toes and move
your hands to the inside of
your calf. Repeat the motion,
applying pressure and flexing
, your toes. Then move your
himds to the outside of your
calf and repeat.
.• __
Relieve upper-body
1. Raise 'one arm in front of you.
ACHILLES TENDON
2. Grab your bent leg's calf
with both hands, thumbs on
your shin and fingers on your
midcalf. Press in and pull up
slightly with your fingers as
you flex your toes.
SO
SHOULDERS
CAN LEARN MORE FROM A TRIATHLETE
,
2010
.------------------
--
Relieve shin and foot pain
4. Repeat the three-part
progression (press into the
bottom, middle, and top of
your calf) on the inside and
the outside of the muscle.
.
'
--------
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by Russ Ebbets, DC
The Foot
Over the last decade I have had the good for:une to lecture on track and field and distance
running tl).roughoutAmerica'and the World., The
topic ofthe dftY'coiIWbe sports psychology, training theory or biomechanics but I always try to
slip
a comment
the i.i1ipoltance of" the six
foot drills. In many instances it may seem totally
unrelated but ifperforrnance is one's ultimate goal,
and if only one thing is remembered from the
day's lecture - I hope it is the six foot drills.
Igot the idea for the foot drills from my study
in East Germany in 1987. Quite honestly there
was little value to that study tour. The East Germans seemed confused by OlD' questions and their
presentations were disjointed and generally pointless. They did show us one Super 8 film on foot
drills for high jumpers. It didn't register at the
time.
I've subsequently studied several people's
work, including Edgar Cayce, who have discussed
the benefits and virtues of doing daily foot exercises for prevention ofa multitude offoot and leg
problems. In 1987 the six foot drills were integrated into my team's daily training plan and the
~dexperimentbegan.
,
We did the six drills at the start of each practice. Five of the six drills are done in barefooted or
stocking feet. The distance covered for each drill
is about 25 meters, Each drill is done once daily.
The walking is done at one's own pace. Total time
for the drill with shoes off to shoes on is about
, four minutes. Pretty simple.
The six drills, illustrated in figure I are to simply walk on the outside of the foot (invert the
foot), walk on the inside of the foot (evert the
foot), walk with a toe-in or pigeon-toed gait (adduct the foot), walk with the toes pointing out (a
la Charlie Chaplin) and with the shoes back on,
walk on the heels - this protects against bruising
'the heel.
Done daily these six. drills will eliminate shin
in
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me daily or every workout
ich r'
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" done once for 25 meters
ills,
ne in the stocking feet or bare footed
"face ,~ preferably grass but any flat, Clean surface will do
suits will be subtle but should be noted in about 2·3 weeks
include: decrease in injuries, improved "cornering", improved
jumping ability
Insistent use of the foot drill will decrease or elirnlnate shin
~Iantar
fasciitis, Achilles tendinitis and knee problems
tal time to do the. drills is about 3 minutes
on
splints, Achilles' tendinitis, plantar fascitis, lessen
the chance of a severe ankle sprain and virtually
famous Rice Study done
in the early 90s found that 79% of running injudes are from the, knee down. One ofthe reasons I
had successful teams is that my athletes made it
to the competition day healthy and ready to compete. Season after season was completed
with
virtually no injuries.
It should be noted that there are three problems with the foot drills: they are simple, they are
easy and they Me free. It doesn't involve more
than taking off one's shoes and putting one foot in
front of the another. But that is easier said than
done,
Why do the foot drills work? There is very
little muscle in the foot. This presents a problem
because most of the balance and proprioceptive
sense we get comes from our muscles. A second
point is that the neuromuscular pathway (the communication line) from the brain to the foot is the
all knee problems. The
longest and slowest in the body. This leads to
bad, or at best, poor coordination of the foot. If
you doubt that put.a pen between yourlees and
try to write-your name. ,"
: .~.'.'''' .
': The demands ofathleticparticipitioh,
be it
running.jumping or quick-starts and stoPsplaces
tremendous stresses on the foot. In facttlte foot
must sustain seven times the body's weight with
simple running and up to 20x body weight in
some jumping activities. Done repeatedly this is
how an overuse syndrome such as shin splints,
plantar fasciitis or Achilles' tendinitis develops.
By challenging the foot with various gaits one
develops a clearer pathway from the foot to the
brain. Clearer pathways are faster and more responsive This gives one better balance and proprioception. Each foot strike becomes more'tsure,"
the foot contacts the ground Without a wobble,
however slight that wobble might be. It isbecause
of this "sure foot stride" that the overuse syndromes (Achilles' tendinitis, plantar fascritis or
shin splints) are eliminated.
It has been said that running is a ground contact sport. It is this repeated micro trauma of
ground strike, repeated 1000s of times th.at can
lead to injury. Other factors such as running surfaces and proper shoe selection can influence the
incidence of injury. But I will contend, with a
great deal of assurance. that the six foot drills,
done consistently, will have a tremendous positive benefit on one's athletic participation and
performance. Applying the si mple, easy and
free.
The last note. The foot drills will also make
you faster. I mentioned the slight "wobble" of
each foot strike. More accurately described a
wobble is lateral side to side motion. Speed is
generally straight ahead. If, on each foot strike
there is the wobble or lateral motion before there
is the forward motion, there is lost time, not much,
but some. If one's ground contact time can be
reduced 111 00'" ofa second (ittakes 14flOOths to
blink an eye) the cumulative effect can drastically
improve one's performance.
Consider this - if one takes 50 steps in the
IO0m,50x 11100=50/100 seconds or Y: a second.
One-half'second is the difference between the 91h
place spectator and the Olympic Gold Medallist.
In a mile H11sreduced ground contact time translates to an 8-10 second difference and in the 10K
it means between 50-60 seconds. An improvement made in the blink of an eye, one step at a
time. Simple, easy and free.
Russ Ebbets, DC lectures extensively as a lead
instructor for USA Track and Field and is the
editor of Track Coach Magazine, the technical
journal for USA Track and Field and the author
of the novel Supernova, on the famed running
program at Villanova. Copies are available for
10.95 plus 1.50 SS&H from PO Box 229. UniON
Springs, NY 13160. 0
Common Running Injuries
Page 21 of23
Proprioceptive Exercises (the sense of knowing where the body is in space)
So much proprioception occurs without conscious thought. When you lose proprioception of, for
example, an ankle joint after a sprain, patients often complain of an unstable sensation of the joint.
Proprioception training re-teaches your body to control the position of an injured joint. These exercises
are not only good following an injury, but are important in prevention.
• Wobble board
• Balance disc I pillow
Ankle Drills: (see handout)
• Perform daily, preferable barefoot on grass (may do inside in house during winter months if you
live in Buffalo).
o Walk 75 feet forwards with feet externally rotated (toes pointing out)
o Walk 75 feet forwards with feet internally rotated (toes pointing in)
o Walk 75 feet forwards with feet inverted (on outside edge of feet)
o Walk 75 feet forwards with feet everted (on inside edge of feet)
o Walk 75 feet forwards on heels
o Walk 75 feet backwards on toes
Tips on How to Buy Shoes
• Have both feet measured by a salesperson; stand up when measuring your feet.
o Shop for shoes at the end of the day after you have been up walking for a few hours, your
feet will be slightly larger.
oRe-measure your feet each time you buy new shoes.
o Always try your shoes on, never buy them based on size alone.
• Shop for the larger foot; if needed, buy an insole to fill space in the other shoe.
• Make sure the shoe fits your heel and toes (wiggle room in toe box and no slipping in the heel).
• Go for a walk I run.
• Shoes do not "break in." Shoes should fit when you buy them.
It is important that before beginning any rehab program, you have a firm understanding of your
diagnosis.
As with any treatment program, always talk with your doctor before initiating any specific treatments .
.~
Sources:
hhtp://orthopedics.about.com
hhtp:/ Iwww.med.umich.edu
http://www.checkersac.org/Common%20Running%20Injuries.htm
4/2512008