BULLETPROOF YOUR HAMSTRINGS
Hamstring injuries are a common nemesis for runners, whether you’re grinding out miles on the road or the trails or exploding off the blocks on the track. Hamstring injuries can plague or sideline even the toughest, strongest, and fastest of runners. And once you’ve sustained a hamstring strain, tear, or tendinopathy it can be a frustrating recovery process. To ensure longevity in your running and peak performance, it is crucial to bulletproof your hamstrings to prevent these issues before they arise.
Understanding Hamstring Injuries
The hamstrings consist of three muscles: the biceps femoris, semitendinosus, and semimembranosus. These are multi-joint, acting on both the hip and the knee joints to flex the knee and extend the hip. Due to their anatomical structure and the high demands placed on them during running, hamstrings are prone to injuries, particularly as speed increases (ie. sprinting or interval sessions). During the terminal swing phase of running, as the knee extends while the leg is in front of the body, the hamstring is stretched maximally while also contracting to pull the leg back underneath the body before the foot strikes the ground. This means running, especially fast running, requires the hamstrings to be LONG and STRONG.
Flexibility limitations can increase the risk of hamstring injury, as limited muscle length has been correlated with hamstring strains or tears during sprinting. Additionally muscle imbalances will increase the risk of overuse injury in the hamstrings. If the gluteal muscles are weak or inhibited, the lower body will excessively rely on the hamstrings to extend the hip during running. Especially when combined with flexibility limitations, this can lead to overuse injury such as tendonitis or tendinopathy in the proximal hamstrings -- a real pain in the butt. Muscle imbalance may also be seen in a runner’s gait pattern. For example, if the quadriceps and hip flexors lack strength and power, a runner may compensate by “pulling” using the hamstrings and might display a high heel lift signature in their running form. Over time this can load the hamstrings excessively relative to other muscle groups, predisposing the runner to injury. Some behavioral factors influencing the onset of hamstring pathology include training error and inadequate warm-up prior to running. Improper training may involve doing too much volume too soon, or too much intensity (speed work) without adequately recovering between sessions.
Strategies for Bulletproofing Your Hamstrings
To prevent injury, we have to understand the balance between tissue capacity and training load. Tissue capacity depends on the strength, length, and overall health of our muscles, tendons, cartilage, and other connective tissue structures in the body. Training load is a function of volume or mileage and intensity.
Load management with smart training structure is essential for prevention of injuries before they arise – sudden increases in volume, intensity, or speed can overwhelm the hamstrings and other tissues. Implementing a gradual progression in training ensures that the muscles adapt without being overstressed. If the tissue capacity is insufficient to handle the training load, one is at risk for overuse injury. One short term solution in this case is to decrease our training load until it is no longer exceeding our capacity. But what if we have ambitious goals? What if we are driven to train longer, harder, or faster? In this case it is essential to strategically improve our tissue capacity, to build stronger and more resilient hamstrings that can withstand high demands. Here are some strategies for bulletproofing the hamstrings:
Strength Training
Incorporating targeted hamstring strengthening exercises is crucial for increasing tissue capacity. Specifically, eccentric training, where the muscle lengthens under tension, is particularly effective in preventing hamstring injuries during faster running. This type of training also helps remodel tendons, making them more robust and less prone to tendinopathy. Specific exercises might include slider bridges, RDLs (Romanian deadlifts), good mornings. Because running is a single-leg sport, we can apply a more specific strengthening stimulus by making some of these exercises unilateral (single leg RDLs or split squats). Nordic hamstring curls are particularly effective, as studies show they can reduce the incidence of hamstring injuries across a variety of sports by up to 51% . This exercise eccentrically loads the hamstrings, improving their strength and resilience.
Cross-Training can also be implemented to create a well-rounded system. Incorporating low-impact activities such as cycling, swimming, or yoga into your routine can augment your running performance, enhance overall muscle balance and reduce the stress on your hamstrings. Cross-training also allows you to maintain cardiovascular fitness while giving your hamstrings a break from repetitive running stress.
Flexibility and Mobility Work
Regular stretching and mobility exercises can help maintain hamstring flexibility. PNF (Proprioceptive Neuromuscular Facilitation) stretching, where the muscle is stretched, contracted, and then stretched again, has been shown to improve flexibility more effectively than static stretching. To apply PNF techniques to the hamstring, try laying on the floor with your straight leg elevated against a door frame; push against the wall, hold for three seconds, and then relax while increasing the intensity of the stretch gradually.
Additionally, foam rolling and massage can aid in reducing muscle tightness and improving tissue quality, which can further protect against injuries. These are forms of SMR (Self Myofascial Release) techniques which can improve tissue mobility, increase blood flow, and facilitate lymphatic drainage to flush out metabolic byproducts (ie. lactic acid). Be aware that SMR applied correctly should be mildly uncomfortable, but not a test of one’s toughness.
Dynamic Warm-ups
A proper warm-up is essential for preparing the hamstrings for the demands of running. Dynamic stretches, such as leg swings, high knees, butt kicks, A-skips, and B-skips increase blood flow to the muscles and improve flexibility. These warm-ups can even include introductory plyometric drills, such as pogo hops or jump lunges. This primes the hamstrings for both the repetitive, sustained contractions seen in distance running and the explosive movements required in sprinting. Consider the warm up to be revving the engine at the starting line, ensuring that all systems are a-go before going from zero to one-hundred. This is especially essential prior to a faster workout or tempo run.
Recovery and Injury Management
If you do experience an acute hamstring strain injury, prompt and appropriate management is key to preventing further damage. RICE (Rest, Ice, Compression, Elevation) remains a good strategy for managing acute injuries by reducing pain. However, it’s important to note that rest does not equate to inactivity. Early mobilization in pain-free ways will promote faster recovery and healing. Compression and elevation can be combined with mobilization of the hamstrings by applying floss-tape around the injured site while performing a dynamic 90-90 hamstring stretch. If running even short distances continues to elicit pain in the acute phase of injury, supplement with cross-training to maintain aerobic fitness while allowing the injured site to heal.
For chronic issues like tendinopathy, isometric holds like a long-lever bridge or isometric lunge hold have been shown to be effective in reducing pain and restoring function. Tendinopathy is characterized by abnormalities in the collagen matrix of the tendon, however loading these tissues isometrically has been shown to promote re-organization of these fibers and healthier tissues. These exercises can be progressed to eccentric loading gradually, implementing some of the exercises mentioned above. Rehabilitative exercises should be gradually reintroduced, focusing on both strength and flexibility.
If pain persists despite individual efforts, it is recommended to seek care from your local health care provider or physical therapist, preferably one who specializes in treating runners.
References1. Mjolsnes, R., Arnason, A., Osthagen, T., Raastad, T., & Bahr, R. (2004). A 10-week randomized trial comparing eccentric vs. concentric hamstring strength training in well-trained soccer players. Scandinavian Journal of Medicine & Science in Sports, 14(5), 311-317.2. Opar, D. A., Williams, M. D., & Shield, A. J. (2012). Hamstring strain injuries: Factors that lead to injury and re-injury. Sports Medicine, 42(3), 209-226.3. Sharman, M. J., Cresswell, A. G., & Riek, S. (2006). Proprioceptive neuromuscular facilitation stretching: Mechanisms and clinical implications. Sports Medicine, 36(11), 929-939.4. Petersen, W., & Holmich, P. (2005). Evidence-based prevention of hamstring injuries in sport. British Journal of Sports Medicine, 39(6), 319-323.