Oh My Hammy!
Dr. Norene Christensen, PT, DSc, OCS
At some point in our athletic endeavors, we have experienced a high hamstring strain (at the base of the butt) or mid muscle strain. Hamstring injuries may occur after accumulated repetitive microscopic trauma or in response to a single event exceeding the limits of the muscle-tendon unit. This means that we can have a low-level chronic pain due to ongoing decline in tissue integrity from poor mechanics or poor training (ie running) or we can have a one-time event that tears the muscle or ruptures the tendon (waterskiing accident). In sporting events, a common mechanism of hamstring injury is with sudden sprinting or kicking. In daily life a common mechanics of injury is slipping (on loose dirt or ice) or falling forward and trying to catch oneself. Unfortunately, a history of previous hamstring injury increases your risk of another hamstring injury by 2.7 times.
For chronic “base of butt” or mid hamstring pain, it is important to rule out other possible causes such as adductor muscle injury, lumbar spine radiculopathy or proximal hamstring tendinopathy. For acute high hamstring injuries x-rays may be necessary to rule out avulsion fracture of the ischial tuberosity (where the hamstrings attach to the pelvis) or an MRI to evaluate tendon rupture(s) and retraction.
To best care for yourself after a hamstring injury can be multifactorial and dependent upon the mechanism of injury.
For high velocity injuries which result from sudden sprinting, hard kicking, falling forward skiing (or water skiing) or slipping on ice that results in a significant amount of pain at the base of your buttock. Do not stretch as you will want to be evaluated by your orthopedist to rule out avulsion fracture and or avulsion of the hamstring tendon(s) which may require in surgery. If you avulse 2 or more tendons and they retract more than 2 cm from the bone, it is best to have this repaired sooner or later for best functional outcomes. From there you will see your favorite physical therapist to begin the rehabilitation process to return you to sport or the activities you love to do. This rehab process can take up to 6 months depending on your post-surgical outcomes, pain levels and activity levels.
For chronic high hamstring pain with running or other activities, you may need to work on different areas of your body as well as your hamstring. You may need to address loss of mobility and flexibility in your spine, hips and legs which may contribute to your hamstrings overworking. Addressing strength imbalances or dysfunctional motor patterns that have developed over the years may help take some of the strain off the hamstrings.
The body is a beautiful compensator and sometimes you just don’t realize that you may be weak in key stabilizing muscles. Have your running mechanics assessed by a professional that will video tape you and work with you to change your mechanics to improve efficiency and reduce microtrauma to the area. Our hamstrings are important pelvic and core stabilizers so utilizing exercises geared towards stabilization in functional patterns will help tie the hamstrings into your core. Finally, will need to train eccentrically for tendon health but also for the function of the hamstring during running, sprinting, and kicking (Askling L-Protocol and more).
For return to running or return to your sport it is wise to implement different running or movement drills into your rehab. Lower-level drills can be implemented immediately as long as they are pain-free with advanced drills being performed as pain reduces.
As with most injuries, stretching may be done with a sensation of “strain” not “pain”. Hamstring pain will dictate whether you can progress your program to the next level. Once you can walk without pain you may begin a graded running program. There are many programs out there to follow but an example of a return to running protocol accounts for greater acceleration distances and gradual intensity increases at high percentage of maximal velocity over time. These programs include walking, at 50% max velocity, 80% max velocity towards 100% while varying distances and may be progressed if pain-free.
At Four Pines Physical Therapy, we have PTs that are certified in running rehabilitation and will take the time to properly rehab you back into your sport utilizing appropriate therapeutic techniques, exercises, video assessments and more. Our PTs will help you with your return to a running program or general fitness program that achieves your goals.
Hamstring injuries are common in runners and other athletes as well as the general community due to chronic stress to the tissues or due to a sudden high-speed injury. Whether you have surgery to reattach tendons that have torn off and retracted or want to address the nagging pain with activity, the therapists of Four Pines Physical Therapy will develop the most appropriate treatment plan for you.
Call us for a free 20-minute consultation for more information on how we can help you.
Example of HS
Standing HS stretch with leg on bench
Supine hip flexion HS stretch
Eccentric Exercises – supine tband, Nordic hamcurls, reachers, glider