Hamstring Injuries – Part 3
In this post, I look at introducing running and a phased return to increase running intensity, which is usually the mechanism that strains the hamstring.
In our previous posts, we talked about how hamstrings occur, their severity, and how the location of the injury influences rehabilitation. We also looked at the initial first aid phases of rehabilitation where we talked about stretching and low-grade strengthening activities that stress the traumatized site in a controlled way. These are precursors to get back into doing some kind of running.
This post focuses on protocols for introducing running.
On grade one and two of hamstring injuries, you can start getting back to running in a week or so.
My usual starting point is when a one-legged bridge is comfortable to do without pain, then I will try and introduce something more dynamic in the form of running.
Jogging on the Spot
The first incremental starting point is jogging on the spot. There are a couple of advantages of jogging on the spot and the length of the hamstring does not have to change excessively.
Even when the hip and knee are bending on the spot, the injured hamstring is not put through a full stretch. This is a nice way to introduce some dynamic load on to the lower hamstring safely.
Jogging on the spot can be done at intervals of twenty to thirty seconds, in five to six blocks. This has an advantage as you can build up the intensity through increasing speed. The build-up helps to find the point at which people start to feel the discomfort to identify a person’s threshold.
This provides a good starting point and you will notice the differences between jogging and sprinting on the spot, and moving forward in a way that involves making strides as you change the distance on the hamstring.
This stage of moving from jogging to sprinting can happen in one week or ten days, or it may last longer in the case of a severe hamstring. When the hamstring injury is severe, dynamic movement can be introduced.
The best way to introduce this type of movement is through arbitrarily picking a jogging pace which maybe 25% of full running speed. The best way to work on this is running at 40m-50m intervals, using a rolling start and a rolling finish.
This means that you gently break into the stride, and slowly stride out into the jogging pace for the 40m, and finish with a walk-back recovery. The walk back ensures that fatigue is not part of the challenge, which only involves loading the hamstring muscle.
On the other end of the run interval, rather than putting the brakes on fast, the movement involves tapering off into a slow stop.
It is important that you sandwich the start and the finish so there are no sudden changes in loading.
In terms of intensifying this, people will recommend that you add an extra 10% running intensity. This is impossible, as you cannot physically gauge it.
Rather, my preference is to record the jogging time taken for a 40m-50m interval and make a 10% increment attained on that time. This offers a more specific target and it is a systematic and progressive strategy for increasing load.
In general, it is important to distribute the build-up of your intensity during different sessions. This involves making a judgment call where you make increments based on how easy you feel a session is. The most important thing is to gauge where your starting point is, or you may re-injure the hamstring if you start vigorously.
It is recommended that you make one incremental change in pace during the session and then re-assess over 24 hours. As we said in our previous post, one of the reasons is that when the tissues are warm and elastic, the blood flow is increased and you can stretch them more as compared to when your body is cooled down. Running on a straight line is the first natural level of progression.
With regard to your sport, you may want to include some changes in direction. Putting asymmetrical stress and load on the hamstring is the next natural level of progression, followed by changes in body position and where there might be jumping or reaching down to the ground. Obviously, these activities do not happen while you are at full speed, but they are some of the milestones to achieve with a return-to-running protocol for a hamstring or any other lower limb injury.
In the next post, we will look at some of the specific strengthening drills that we incorporate during the return-to-running protocol where we take the basic- level we looked at in our previous posts and add some more incremental steps.