Dealing with running hamstring injuries, part two

Acute hamstring tears for runners
Unfortunately, a not infrequent sight in a 100m sprint running event is the athlete who leaps into the air in obvious pain and comes to a complete halt clutching the back of the leg. The diagnosis of a hamstring tear can usually be made from a distance. The runner will have felt a sharp pain in the middle of the hamstring area followed by painful spasm. Often this occurs during the 'pick up' phase, as the runner's stride lengthens.

Later it may be possible to detect an area of swelling or even a gap in the muscle. Bruising may appear on the surface or remain deep within the muscle. It may be several days before the bruising becomes visible.

For an acute injury such as this, the immediate treatment is RICE:

• Rest. Rest the muscle (but not the rest of the body) for 48 hours.
• Ice. Apply ice to the running injury as soon as possible but not directly to the skin.
• Compression. A properly applied compression bandage may help but don’t try this unless you are sure that you can apply it correctly.
• Elevation. Finally, keep the leg elevated as much as possible. This may help to limit swelling.

After the first 48 hours, depending on pain, some gentle stretching exercises may be started. If at all possible, visit a physiotherapist at this stage.

Chronic hamstring pain for runners
Repeated episodes of pain which seem to arise from the middle of the hamstrings muscles may actually be due to irritation of the main nerve to the leg (sciatic) producing 'adverse neural tension'. The source of the problem could well be in the lower back.

True, chronic hamstring pain, occurring in the muscle belly, is really more often recurrent minor tears as a result of a return to intensive running training before the underlying problem has been properly addressed. If the cause of the original tear has not been dealt with then further injury is almost inevitable. Treatment here should be directed towards the underlying problem.

Hamstring origin problems for runners
This really is a pain in the butt. Pain is felt in the region of the bony part that you sit on (ischial tuberosity) as this is where the hamstring muscles are attached. This usually develops as the result of repeated overloading of the muscle over a period of time. It is especially likely to occur when there is a sudden increase in the intensity of running training, such as speed work, and at this time of year it may also be seen in relation to excessive activity of the hamstrings when running on treacherous surfaces. Pain may be felt on running, particularly at speed, whilst sitting on hard surfaces and sometimes even whilst driving.

Hamstring tendon problems for runners
This less common type of hamstring problem is felt as pain in the tendons behind the knee joint. This is an overload type of injury. It occurs if the tendons are the weakest link in the chain and too much is being asked of them.

Bearing in mind the knee stabilising actions of the hamstring muscles when they work individually, pain here may occur after prolonged activity on uneven surfaces. Track runners may also develop painful hamstring tendons related to bend running. Often the pain will diminish during running activity, as the runner warms up, only to return later in the session or even some time afterwards.

Improving running strength and flexibility
Healthy muscles are strong and flexible. They are also balanced in strength with the muscles working in the opposite direction. Almost always, the occurrence of an injury indicates that all is not as it should be in one or more of these departments.

There is currently a fair amount of controversy surrounding the pros and cons of stretching. What everyone would probably agree on, are the benefits of a warm-up prior to undertaking strenuous activity. If nothing else, it seems to help psychologically in preparing for the effort ahead. Stretching the major muscle groups within the range in which they will be working, and for a short duration, is also a sensible precaution before attempting anything too drastic. What is not certain (although it used to be!) is the value of prolonged and more extreme stretching before running. It is even possible that excessive and prolonged stretching of a muscle before activity may increase the risk of injury.

On the other hand, developing a discipline of gently stretching muscles after a hard running effort makes sense as the muscles will often have become gradually tighter as the session progresses. General flexibility work can also be carried out, if required, at a time separate from running activity.

Many specific stretches are described for the hamstring muscles. My advice would be to avoid any stretch in which the body weight is being supported by the leg in which you are trying to stretch the hamstring (i.e. bending forward to touch the toes).

It makes more sense to be sitting down with the leg to be stretched straight out in front and the other one bent at the knee, perhaps with the sole of the foot flat against the inner thigh. Another acceptable stretch can be done by standing on one leg whilst the leg to be stretched is straight out in front and supported at a suitable height (the open boot of the car seems to be the right height for my pre-race stretching).

In both of these stretches you should gradually lean forward bringing the chest closer to the knee. The stretching feeling may be slightly uncomfortable but should certainly not be painful.

The hamstring muscles need to be strong in two different situations during the running action. Firstly, with the foot in contact with the ground and supporting body weight as it produces extension at the hip joint to propel the body forwards. Exercises to strengthen the hamstrings in this activity would include half squat exercises either with no or a relatively light weight, hill running, step-ups (or a step machine).

The hamstring machine in the gym can be used if the weight used is light enough to allow 15-20 repetitions and if this is done as part of the overall strengthening regime rather than as the only exercise.

The other important action of the hamstrings is working eccentrically, by applying the brakes to control the forward movement as the unsupported leg swings forward. The hamstrings can be conditioned to make it easier to cope with this action by various running-related exercises involving swinging the leg back and forward whilst standing with the body weight supported on the other leg (a hand can be placed on an adjacent wall for balance if needed).

Start by swinging the leg forward and back with the knee bent then progress to the same exercise with the knee straight. The final version is a combination which produces a sort of bicycling motion. Swing the bent knee forward then straighten the knee, followed by bringing the leg back straight and then bending the heel up towards the buttock before the knee swings forward again. Try ten slow ones to begin with then gradually increase the speed and number.

Running tips to remember...
There is always a reason why a particular injury should strike at a particular time. Examine the period of training leading up to the injury and consider also where flexibility or muscle strength and balance may be an issue. At least one initial visit to the physiotherapist should help with starting you on the right path to correct running rehabilitation and recovery.