Browsing Category

Thigh

Health, running, Thigh

Hamstring Injury and why Biceps Femoris gets a bad rap

June 27, 2016 • By

Hamstring injury happens frequently in running-based sports such as athletics, football and rugby – But over 80% of these occur in the outer hamstring when the leg is swinging through – why is that?

It is often thought that hamstrings are injured from changes in direction, pushing off and explosive movements but in reality, most hamstring injury happens when the leg is swinging through, just before the foot touches down.

Here is a quick few stats and anatomy refresher to ground you:

Hamstring injury

The hamstrings are made up of three muscles

  • The Biceps Femoris, which has two parts to it. The long head which cross’ both the hip and then knee joint and the short head which only crosses one joint
  • Semitendinosus
  • And Semitendinosus at the inner thigh

There is a huge difference between how much each these muscles get injured. The Biceps Femoris long head (BFlonghead) is involved in a huge 80%hamstringirng injuries.(1)

As well as this, most hamstring injuries are thought to happen in late swing phase of running, just before the foot lands. So how does the BFlonghead taking the brunt of injuries and this mechanism of injury link in? Check out the video below first of all to ee how the hamstring works in walking:

 

As you can see in the video, the hamstrings fire into action before, during and after the foot lands. At this point when the knee is extended, the muscle is working while at it’s peak length and at maximal force development working hard eccentrically to slow leg swing down.

Note: An eccentric contraction is where the muscle controls lengthening out, which is far harder on the muscle than a concentric contraction where it contracts to push-off.

Recent studies have shown that the Biceps Femoris is more active, along with the other hamstring muscles when the hip is extending, rather than the knee flexing. The semitendinosus, however, is more active in knee flexion where it works to bend the knee. This means that as well as the BFlonghead working harder with eccentrically slowing the leg down, it is also not often strengthened as well as the other hamstrings because of this.

nordic curls - hamstring rehab and strengthening exerciseA lot of hamstring strengthening is done at the knee (nordic curls, hamstring curls etc) which has been shown to be more the work of the medial hamstrings than Biceps Femoris.

 

 

 

 

Hamstring chair bridges

Credit irunfar.com

So there you have it, the BFlonghead of the hamstrings works harder eccentrically slowing down the momentum of the leg swinging forward and often gets missed in strengthening sessions – Stuck between a rock and a hard place! This gives athletes and health professionals better guidance as to what rehab exercises to add in post injury and also in injury prevention programmes depending on injury, leading to decreasing the nearly 30% re-injury rate.(1)

 

 


Health, Thigh

Hamstring exercises – How to prevent injury

May 4, 2014 • By

Hamstring strain - heal fast and strong with self treatmentHamstring strains are happening everyday AND over 12% re-injure within one year – That amounts to a lot of time if not the entire season out with injury.

Do not become a statistic.

I will show you how to keep your hamstring healthy with the best hamstring exercises that are quick and easy.

The worrying thing is that it is so easy to become another statistic. Hammy injuries happen all the time in sports that need high-speed running, change of direction and kicking. For example they make up a massive 37% of all muscle injuries in Footballers – This is far too much. Add to this the fact that; 12-43% of those re-injure their hamstrings… unfortunately you could be a statistic just waiting to happen.

In the first two posts in this hamstring series I told you:

What a hamstring tear is and how to treat it in the first 72 hours

And

How to heal strong and fast

Now this is how to keep you hamstring strong, flexible and pain-free. This is for anyone that has strained their hamstring in the past or doesn’t want to ever experience hamstring injury (so yes, every running athlete should be doing these).

Hamstring exercises for a healthy body:

1. Nordic Curls: This is the most important exercise in maintaining a healthy Hammy and should be done daily.

nordic curls - hamstring rehab and strengthening exercisePosition: Start on your knees, keeping your body straight from your knees to your shoulders.

Action: Bending at the knees slowly lower yourself forward (keeping your torso straight – do not bend at the hips) as far as you can – and then catch yourself with your arms.

Repeat: 3 sets of 8 reps.

Video: Here is a good video example.

Make sure to control yourself down as much as you can with your hamstrings – And yes they probably will cramp up so take a short break, stretch out and try again – it will get easier.

Hamstring stretch: A tight muscle is a weak muscle – You need your hamstring both strong and flexible so do this easy doorway stretch daily:

2. Hamstring doorway stretch

doorway stretchAction: Lying on your back place one leg up the door frame and the other straight out as shown.

You can adjust the stretch on your hammy by moving closer or further away from the doorway.

Tip – add more of a stretch by applying pressure to your knee.

Hold: For 1-2 minutes for each leg.

 

And that is it – Two exercises that you should be regularly doing to maintain a healthy hamstring. Not too hard is it? No, but it makes a huge difference.

 

Thanks for reading

Please comment, like and share!

 


Health, Thigh

Hamstring strain rehab – Heal fast and strong

April 14, 2014 • By

hamstring injuryRehabilitating a hamstring strain the right way means you heal faster, stronger AND re-injury is less likely. Following on from my first post in the series explaining hamstring injury and initial management, in this post we cover the hamstring strain rehab that:

  • Almost halves recovery time
  • Reduces re-injury by over 90%
  • And get you pain-free faster!

Just by doing the right rehab exercises at home!

Fortunately there has been some good research done on hamstring rehab in the last few years and one in particular in 2013 by Askling et al compared the effectiveness of two rehab protocols:

– The “C” protocol, which are the conventional rehab exercises

– The “L protocol” which is the eccentric Lengthening exercises

They found in this study that rehabilitating a hamstring strain using specific eccentric exercises has a significant improvement in healing time and there were no re-injuries in the year following by following the L-protocol and return to play guidelines.

This means:

  • Return to sport on average after 28 days vs 51 days for conventional exercises
  • Nearly 0% re-injury rate vs the usual 12%
  • Weeks off your recovery, not to mention the weeks if injured again.

So what are eccentric exercises?

Usually when exercising you may think about form, reps, sets and balancing out your routine but not always about what kind of muscle contraction you are doing.  And fair enough too, so here is the difference between concentric and eccentric muscle contraction:

Concentric: This is shortening of the muscle, where all the muscle fibers are drawing together. This is what most people would think of as a muscle contraction, eg a biceps curl.

Eccentric contraction: This is controlled lengthening of the muscle – putting the brakes on.  So the muscle has to work to control the muscle lengthening out – like lowering the weight back down after the biceps curl. This type of contraction actually creates a lot more force and acts and when used in rehabilitation acts to re-align the muscle or tendon fibers along the correct line of pull.

Hamstrings are most often injured during when slowing down your foot/leg swinging forward (putting the brakes on it before your heel touches down). During this action, your hamstrings are working eccentrically. So wouldn’t rehabilitating the muscle eccentrically be best to address the hamstring strain and the obvious weakness that was there? Yes!

 

So, let’s get to the rehab, to get you recovering faster and stronger with less re-injury:

*Before you start the L protocol: In the first 48-72 hours directly after an injury you should RICE it – see this post for more details

The L-protocol:

Note: The “L” stands for lengthening.

The following three exercises should be started 2-3 days after injury – Below they are demonstrated in videos (they may take a short time to load but, it is worth it to do the exercises right!) and photos as guidance courtesy of the BJSM website.

1. The Extender:

 

2. Diver

 

3. Glider:

 

 

Reps, sets and timing:

  • Extender: Two times daily, every day, 3 sets x 12 repetitions
  • Diver: Once every second day, 3 sets x 6 repetitions
  • Glider: Once every third day, 3 sets x 4 repetitions

 

How do you know if you are ready to return to sport?

When these two tests are negative then you can return to play:

hamstring lift off test1. Hamstring lift-off test:

Place your heel on a chair with knee bent as shown with your un-injured leg straight in the air. Pushing through your heel lift your bottom off the ground.

Compare to the other side

Negative test: Pain-free and equal on both sides.

ASLR2. Askling H-test:

Lying on your back , lift your injured leg up as fast as you can through full range.

Negative test: No pain OR apprehension. If there is apprehension, the rehab exercises need to be done for a further 3-5 days and re-tested.

 

 

 

So, if you have a hamstring strain – Get started on your rehab now, and get back to what you love faster. This isn’t just showed to work in the research, I have prescribed this protocol to my own patients, including football players and international level sprinters, and it does work.

 

Stay tuned for my next post on preventing hamstring strains – Because prevention is the best cure!

Please Share, like, follow and let me know how you get on!


Thigh

Hamstring Injury explained – Heal fast and strong!

April 6, 2014 • By

Hamstring tear - how to heal is strong and fastRehabbing a hamstring injury the RIGHT WAY means a fast recovery, drastically less chance of re-injury and most importantly getting back to what you love, faster!

In this series I will tell you:

  1. What an acute hamstring strain involves, why it WILL get better and what to do it the first 72 hours
  2. How to treat it yourself with an accelerated rehab program, backed by research.
  3. How to prevent hamstring injury in the long-term, because you do not want this happening again.

Starting with #1:

You may know it by a different name:

  • Hamstring tear
  • Torn Hamstring
  • Pulled hamstring
  • Ohhhh I’ve done my Hammy!

How common are they?

Very, very common – I have had two myself paying rugby.

Hamstring Injuries are common in sports that involve high-speed running, change of direction and kicking, including; track, rugby and football. It is the single most common injury in football making up a huge 37% of all muscle injuries in elite footballers and on average there is five hamstring injuries per squad, per season(1). This adds up to a lot of time out from sport

Given this high injury rate and that 12-43% re-injure their hammies – It is important to rehab properly to get back faster AND prevent re-injury(2).

Hamstring injury - how to heal it fast

Mechanism of hamstring injury: 

Hamstring strains generally happen at the end of swing phase of running – Just when your heel/foot is about to touch down. This is because the hamstring is:

  1. On stretch
  2. And contracting hard to slow down your foot

This is when your hamstring is working hardest – to really absorb energy to slow your leg swinging forward while eccentrically contracting (controlling the muscle lengthening out).

The hamstring is so prone to injury because it crosses two joint – the hip and the knee. This means at one end of the muscle it is contracting and the other end it is lengthening out. This along with the fact that athletes all too often concentrate on strengthening their quads (the opposite muscle) – leading to a mismatch and increased injury risk.

How bad is it?

Muscles are graded simply into three categories:

Hamstring muscle tear grades - heal fast and strongGrade 1:

  • Tearing a few muscle fibers
  • Mild pain and minimal loss of strength
  • Pain brought on with passive stretching and resisted contraction
  • You may be able to continue playing and very unlikely that you would go down

Grade 2:

  • Partial tearing of the muscle
  • Some strength loss
  • Significant pain on resisted contraction and stretching
  • Limping is very likely
  • You may go down
  • Bruising may appear after 2-3 days

Grade 3:

  • Severe or complete rupture of the muscle
  • May be a large lump in the muscle above a depression (hole) where the tear is
  • You will go down and generally lie on your back, holding your thigh, feeling like you’ve been shot
  • Walking is very difficult and crutches are needed for a short period
  • Bruising will appear after 1-2 days
  • May need surgical repair

Note: If you fit the Grade 3 criteria – Go and get it checked out by your local Physio as these do need surgery at times if there is a complete rupture

Quick anatomy: 

hamstring injury - how to heal fast and strongThe hamstrings are made up of three muscles as shown to the right with the Biceps femoris having two heads. The biceps femoris also gets put under more stretch  when running – which is why this is injured the most.

The most common place for a hamstring injury is the Biceps Femoris muscle (the most lateral/outer hamstring), most often at the musculo-tendinous junction. This is where the muscle attaches/blends into the tendon, making it a weak spot – There is a muscle-tendon junction both towards the top and bottom of the muscles.

Recovery time:

With the great hamstring rehab regime I am going to give you the average time to return to sport is 28 days. Injuries sustained while sprinting can take a little longer (about 43 days Vs 23 days) meaning they can take generally 3-6 weeks(3).

Initial self – treatment:

In the first 72 hours it is very important to follow the RICE and HARM principles – This will take weeks off your recovery.

Do: RICE

  • Rest – From running etc.
  • Ice – 10 minutes at a time, no more, every hour you are awake.
  • Compression – Eg Tubigrip.
  • Elevation – Get your foot above your heart when possible.

Don’t: HARM

  • Heat
  • Alcohol
  • Running
  • Massage

HARM increases blood flow to the area, worsening inflammation and so causing more secondary damage and a longer healing time.

Keep moving (within reason of course) – Start weight-bearing through them as soon as possible to normalize movement and decrease loss of muscle activity for grade 1-2 muscle tears. If necessary you may need to be on crutches for the first 24 hours (if very painful and you really have tried to walk on it) then move to partial weight-bearing and then full weight-bearing.

Footwear: Wearing good supportive footwear with heel and arch support(such as your runners) is great as this takes the pressure off the hamstring injury. Do not wear Flip-flops – please!

 

AND THEN: after the first 72 hours of doing this, you will need to start your rehab protocol

 

You might also be interested in:

Can’t touch your toes? Improve hamstring flexibility fast! – If you don’t have a tear, this is great to do.

Check out this quick balance and stability test when healing well to check if your hip strength is holding you back (especially if you have had a lot of lower limb injuries lately).