Discussion: Hamstring injury prevention/rehab

With things more settled on the home front over the last year I've had a bit more time to run but at 45 I noticed I'm not recovering from strains anywhere near the same as at 25. After the recent hamstring problem I did some reading in an effort to get out ahead of a potential weak link and ran across this:

http://www.nydailynews.com/sports/more-sports/runn...

Basic idea is traditonal hamstring curl = bad

"Expert" here, lewis maharam, seems competent and the superior option presented is a several day per week ankle weight while hanging over bed curl.

Noticed a slight twinge today on the last mile and really not wanting to start the year off on a path to anything chronic. Anyone made the switch to this type of effort diligently and able to comment on prevention utility?

Browsing the logs and injury topics it seems like a lot of AP is doing traditional seated curl in weight routine and/or as rehab which is exactly what the article discourages.

I can't comment on prevention, since a hamstring pull the day after Christmas forced me to add some glute / hip / hamstring strengthening work to my regimen, but the exercises I've done really made a difference in injury recovery, and I'm ready to get back to running hard.

I incorporated the bed curl exercise you mentioned, plus a number of others. Most useful links:
http://www.irunfar.com/2013/08/hamstrung-hamstring...
http://speedendurance.com/2012/11/29/hamstring-pul...
http://www.udel.edu/PT/PT%20Clinical%20Services/Re...

I also used the US Army's Hip Stability Drills in their Training Circular (see Chapter 6), eventually adding ankle weights. Four for the Core is also really good: http://www.armyprt.com/special_conditioning_progra...

Results have been good - only had to walk one orienteering meet 3 days after the pull, ran one at about 70% two weeks later, 90% at 4 weeks, and 100% this past weekend. Can't blame my lost time on my hamstring!

Re-opening this one after another incident this week. Having taken the time to log these in AP I can now see I'm at 4 hamstring or groin issues inside the last 12 months. The commonality is all 4 of were soccer game sprinting. Admittedly I had fallen off the strength/flexibility prevention work wagon a bit but I'll get religion now.

The question is which religion.

Further literature search would seem to suggest the eccentric loading in hamstring strength work is a big deal. I'm taking that as a settled issue.

Here's a new one though- a suggestion that sprinters should minimize treadmill time as it is contributory to hamstring problems. No sources were sited nor any clinical data but presumably there is "anecdata" and the underlying assumption seems to be that even a high end treadmill can't match the acceleration of real time starting line, finish line, or game situations.

I do a fair amount of treadmill time (in hotels while traveling for work, late night at our work gym which is 24/7, or to maintain cardiac base in winter). Anybody have a thought on whether or not these are fundamentally incompatible with sprint work or ever heard of any data support for treadmill time being connected increased hamstring injury susceptibility while sprinting off treadmill? I'll buy that 1 day a week of super high intensity game sprinting needs something else layered in the week at pace but I struggle with the idea that treadmill equals detrimental.

Rich,

I don't quite see how running on a treadmill would be truly detrimental but it is very different from running off the treadmill and therefore might not work the same muscles that help stabilize the hamstring.

Off the treadmill you are pushing your body (all 150 lbs of it) forward with each step. On the treadmill your torso stays still and with each step you are simply bringing your leg (a lot less than 150 lbs) forward underneath your torso. I can't truly comment on the physiology of this but I can only assume that slightly different muscles will dominate.

Perhaps someone with more knowledge can expand on this?

"Sprinting". Does your treadmill go over 30kmh? That's a decent 12 seconds for a 100m, but of course wouldn't rate in an actual sprint.

I wonder if the treadmill time is an indirect effect and not the root cause of a hamstring injury. If one is traveling a lot, getting workouts in late, there may not be a lot of time for optimal rest and recovery. Also there may be an opportunity cost to a treadmill workout, working out in the gym means that you aren't getting other kinds of running.

I guess what I'm saying is that there are a lot of variables and the treadmill doesn't jump out as being so risky or detrimental.

Off the treadmill you are pushing your body (all 150 lbs of it) forward with each step. On the treadmill your torso stays still and with each step you are simply bringing your leg (a lot less than 150 lbs) forward underneath your torso.

No, on the treadmill you are only still relative to the room, but since the belt is what you are standing on, that is your reference point. it is moving backwards, and you are pushing forward relative to it. It might be a different story if you were also supporting yourself by the handrails or something.

With the exception of wind resistance, I think the mechanics of steady running are basically the same on the treadmill, so I agree that for sprinters it seems more an opportunity cost in terms of the dynamic accelerations that you can't really simulate.

After even more reading I think in my situation it probably does boil down to inadequate use of shorter intervals/explosive strength work/polymetrics to balance cardio base. In a game situation I'm probably quickly tearing through whatever fast twitch I have yet not feeling so fatigued overall thereby perfectly setting up the situation.

Here's an interesting one from further reading/sideline discussions- besides the sprint coaches indicting treadmills I also found a parallel tension in the soccer coaching community via some strident opponents of elite players also running cross country. The rationale is that it undermines explosive speed not that it creates injury. As I'm not trying for top class at anything right now I think I can find an acceptable balance point and mention it only given this group may have an interest in seeing more of the soccer/lacrosse/etc. folks not indict the organized competitive running.

With regards to treadmill physics I'm in Ken's camp, and consider it a settled issue for the most part. It's a pretty standard Newtonian physics reference frame question. Besides the wind resistance (which could be simulated) the other caveat is that I recall some verified by research slight differences in foot strike. I don't know if it was ever settled as to whether the foot strike question was driven by proprioception being altered with no moving background/needing to balance differently for some slight belt stretch/whatever but I believe for these purposes we could consider differences to not be material and it to be the same as running steady pace on smooth surface, too much of which is the my guess on problem.

Be careful not to be too dismissive with "just a pulled hamstring." Here's an interesting article about various hamstring injuries. They're not all the same. One injury that happened to me was a complete avulsion of the ischial tuberosity...the hamstring completely tore away from the hip bone. Three years later, I still suffer from an uneven stride, instability, and a much slower pace. But thankfully no chronic pain.

This injury can happen to young runners up to age 25...and to older adults whose bones have begun to weaken. The problem is that the avulsion is not immediately recognized by many doctors. As a result, if the standard advice of "ice and rest" is followed without further diagnostic effort, the delay may make the injury very hard to repair. So take care of your hamstring!

Oops, thanks for the correction Ken. I had got that from a very brief conversation I had with someone a short while ago and never thought it through properly. My mistake. :/

In relation to the actual hamstrings as a reference point, treadmill or ground running they are primarily doing a very similar movement - decelerating the extension of lower leg to create foot strike. It's this eccentric phase of movement that is where most hamstring injuries occur e.g. kicking a ball, sprinting fast - a fast velocity of movement of the body segment combined with the muscle lengthening as it's contracting. After heel strike the hamstring assists with extension of the hip - but preferably your buttocks do the hard yards here.

Clark, that's an excellent site link (eorthopod.com). Thanks.

The avulsion repair surgery description sounds horrific. So as not to develop an unhealthy fear of avulsions can you say whether the problem was running or trauma induced? Absent trauma or some predisposing weakness it seems like the muscle connections would fail first before you could rip the tendon off the bone.

I'd have to say it was the mildest form of trauma: dropping 2' from a sitting position on a platform to the beach at Lake Tahoe. Unfortunately an old nail at the edge snagged my pants as I slid off the platform, and caused me to land off-balance. As a result I landed awkwardly with knees locked, not bent.

Who would have thought such a minor mishap could cause such a serious, crippling injury? And unfortunately my orthopod in Chicago declared the injury inoperable because of the condition of my bones: thin. Which is normal for most 73-yr olds.

As you say, I don't think healthy runners in the prime of life need to worry about avulsions. It is only the young (per above article) and those over 60 that need to avoid a sudden wrenching of their hamstring, either by sprinting or by unfortunate falls.

I remember reading an article in Scientific American quite a good many years ago related to differences between fast twitch and slow twitch muscles and how to train them. I recall the comment that there were some forms of training that had some success in converting fast twitch muscle fibers to slow twitch, but not the reverse. I'm not a biologist, and it was long enough ago so that I don't remember enough details to be of any use even if I had the training to evaluate this written-for-the-lay-person article, but if this is the case, perhaps doing many miles of slow and steady running on a treadmill could gradually in fact cut down (irreversibly) on the amount of available fast-twitch fibers. I never figured it made much difference for me personally, since I have never seen much evidence for my having any fast-twitch fiber to begin with, nor of my deriving much pleasure from running on a treadmill.