Wednesday, January 30, 2008

Hamstring Strains

Don't have anything organized to post right now. The off-season, for many of our teams here, is in full effect, so life is pretty busy to say the least. So I am pulling this from my notebook where I jot down notes and ideas. Sorry if it is scattered...

Some notes I've made on some of possibilities as to why the hamstrings can become strained. Something I've dealt with personally on numerous occasions. It amazes me the simplistic approach people still take with these nagging injuries... the hamstrings are not necessarily weak! And leg curls and "you need to stretch more" are not the answer!

-The quad-to-hamstring ratio is a bunch of bull.

-The hamstrings are almost always NOT weak, just overworked. They now not only the flex the knee, extend the hip (overworked here), eccentrically control the knee, but also are being looked to for stability at the hip.

-Need to check if the glutes work (synergistic muscle), however we need to take it steps further than this because it is always much deeper. Sometimes the glutes are active, just in an inefficient position to help.

-Question needs to be asked: Why don't the glutes fire; why are the hip flexors tight, short, and/or overactive or even tight, short, and underactive?

-Check motor patterns (what are the athlete's habitual patterns; this is the key).

-Could be and most often is, poor stability and motor control in the lumbar spine.

-Jammed joints, arthrokinetic reflex inhibition of muscles, capsular adhesions.

-Poor thoracic mobility/extension with over-activity of upper trapezius, levator scapulae, scalenes; this creates faulty head position which often times affects eye position. (this all helps to create an extensor reflex, throwing off the mechanics of proper sprint pattern.

-Ankle mobility/motor control. Foot strike position which can be caused and usually is, by lumbopelvic positioning and rhythm.

-Internal vs. external rotation balance in the hip. A good balance is need between the two, but lack of controlled internal rotation will not allow the glute to get a pre-stretch to allow it to concentrically produce force. This is how quality movement is made; muscles need a pre-stretch to work efficiently.

-Quality hip internal rotation consists of adequate hip abductor activation and again, lumbar stability.

-Lumbar instability is usually greater on the same side as the affected limb (Functional Movment Screen rotary stability test).

-Contralateral rotation of the torso from affected limb (arises from habitual patterns).

-Motor skill as it relates to stride mechanics: chasing or pulling center of gravity when at absolute speed.

-Athletes with chronic pulls need continual reinforcement of efficient motor patterns, "cueing" exercises, along with soft-tissue work to release some of the fascial restrictions that have been built up over time.

-Foot strike patterns; striking the ground with the midfoot as opposed to the forefoot and rearfoot. Midfoot striking creates efficiency in running/sprinting. Allows for elasticity, reducing the need for concentric work. Is it because of an ankle issue or is it because of bad lumbopelvic positioning?

And these are just of few of the possible reasons.



Mike T Nelson said...

Awesome post!

Yep, you are right on and you need to look at the WHOLE body. Everything can affect everything, you just need to figure out how.

As you mentioned, if you have a hamstring "issue" , the hamstring is almost always never the cause. It is normally referred from somewhere else. I've found a manual muscle test for the hamstrings in the standing position as an easy check in addition to watching the athlete's gait/sprint mechanics.

Many times I've found the solution as a active mobe of the talocalcaneal joint (due to foot strike timing) or even elbow circles (opposite elbow due to arm movement in gait). Sometimes visual, vestibular and hands on work is needed too (Z Health I Phase and T phase work). I always like to combine any hands on work I do with an active mobility drills also to facilitate learning.

What have you found that works?

Excellent post!

Rock on
Mike N

Aaron Schwenzfeier said...

Thanks for the comments Mike!

Main thing, like you said, is looking at the athlete's gait and sprint mechanics. Also just watching them lift and looking at the posture says a lot.

Screen for movement inefficiences and program exercises to attack those in every workout and on their own. (i.e. ankle, thoracic, hip mobility)

The common theme I have seen with chronic hamstring athletes is the lack of stability and/or motor control to stabilize the lumber spine/pelvic floor. Their hip/leg musculature is not only working to move the body, but also provide stability to the lumbopelvic area.

Constant cueing to continually reinforce new and correct motor patterns.

Teaching the athlete how to posterior weight shift when doing hip dominant movements. A lot of these athletes just don't seem to have the awareness of how to move correctly.

From there, being sure to get the person strength training using total body movements which require a tremendous amount of torso stability. Squatting movements, lunging, hip dominant movements, both 1 and 2 legs.

-Making sure the athlete is on their feet in all the exercises they do, with complete awareness of body positioning. (primarily pelvic position) Many times the athlete needs to be manually put into the correct position, because they just don't know how to get there themselves.

-Getting the athlete to be "tall" when training.

-postural awareness

-plenty of sprint training, both acceleration and absolute speed work. Making sure the athlete understands sprint mechanics and giving them lots of opportunity to practice the skill and re-groove the pattern that injured them in the first place. (SAID principle) PLUS the opportunity for regaining confidence to "open it up" again.

-head and visual positioning

Lots of re-education of the entire system.

A lot of work, but a fun challenge.


Mark Reifkind said...

great post, I agree. excellent points and information allround although I do think more hamstring strenghtening is in order for most athletes. There must be a reserve built and the higher the daily workload allround the higher the capacity of these workhorses must be.
All done with the correct amount of work for the current level of development.
good stuff.

Aaron Schwenzfeier said...

Thanks for dropping by Mark!

I agree, lots of posterior chain work is critical.

Mike T Nelson said...

Yep, posterior chain work is great assuming movement/efficiency is unchanged at min and ideally improving.

Rock on
Mike N