How to Treat a Hamstring Injury

How to Treat a Hamstring Injury
Written by Fritz Nugent

You set up for a sprint, take a few drive steps, and feel a tweak or pop in your hamstring. Could be on your muscle belly right in the middle of the back of your thigh, it could be down closer to the knee, or even up higher underneath your glutes. Or maybe one day it just starts hurting.

Hamstring Strain Severity Grades

Hamstring strains can be categorized by severity:

Grade 1 – a mild muscle “pull” or strain :/
Grade 2 – a partial muscle tear 🙁
Grade 3 – a full muscle rupture >:’&

Causes of Hamstring Strains

When the force exerted on any of the hamstrings (or any muscle, for that matter) is greater than the tissue tensile strength, damage can result. However, pinpointing the exact “how” or “why” of a particular hamstring strain is difficult. We do know from research that previous hamstring injury predisposes one to future hamstring problems. From personal experience, hamstring strains can be caused by many things. Below, I list a few potential causes:

• Misalignment of the pelvis which can produce uneven forces on the hamstrings
• Years of uneven use on hip and leg musculature
• Weak glutes, which may over time force the hamstrings to do more work than their fair share
• Moving the legs/hips at forces greater than trained velocities

Recovery Duration for Hamstring Strains

Grade 1 – 2-4 weeks
Grade 2 – 4-8 weeks of recovery
Grade 3 – 3 to 6+ months and may require surgery to reattach an avulsed hamstring

Recovery Modalities for Hamstring Strains

Optimal utilization of the following recovery modalities are suggested in the areas of rest, nutrition, lifestyle, and movement. Each injury is unique and requires an equally unique solution. Pick which combinations sound doable and worthwhile to you, and have at them:

Rest for Repair of Damaged Tissue

Rest is an often overlooked and underutilized WEAPON. Yes, rest is a weapon when used appropriately. Rest allows the body to repair damaged tissue. If you get back to movement too soon or perform movements which aggravate the injury, “return to play” duration will increase. Many consecutive days, weeks, and months of high quality and quantity sleep can have a profound effect on recovery.

Nutrition During Recovery from Muscle Injury

This can get complex quickly, so the assumption here is that the main goal of nutrition while you are healing is to help your hamstring recover. Consequently, I would give the same advice here if your goals were to improve performance, increase energy, regulate digestion, improve sleep, and recover faster:

• Eat enough total food to maintain your weight: don’t over or under-eat, and let the scale tell the accurate story, meaning you should stay the same weight).
• Consume enough protein (about 0.6 – 0.75 grams per pound of Lean Body Mass).
• Seek out a variety of micronutrients. These little buggers are found in the highest quantities in – you guessed it – vegetables and fruits.
• Drink enough water.

Lifestyle During Recovery from Injury

I say this to many of my clients – reduce your life stress as much as you can without getting fired, divorced, or starving your children. This translates to chill the &*$% out a bit. If something doesn’t matter much, let it slide. Drive slowly when you can. Taste your food. Smell flowers. Watch birds. Pet animals. You know, sunshine and rainbows. Seriously on the sunshine. Vitamin D will do your healing body well. And feel free (because it can be free) to tap into the parasympathetic to stimulate your immune system!

Movement During Recovery from Muscle Injury

When you begin to add movement back in, do so as quickly as possible without disrupting the healing process. I have had much success with rehabilitating injured athletes by asking them to stay below a 2 out of 10 (0 = no pain, 10 = PAIN) on their own internal pain scale when performing any task, both within and outside the gym environment. Going to see a physical therapist can be helpful as well. In a perfect recovery situation, your trainers and PT’s should be on the same page for what movements you should and should not be performing. There should also be a constant and gentle retesting of previously painful movements to assess progress and facilitate progression into previously painful movement patterns as rapidly as possible.

Mindset During Recovery from Injury

While the pain of an injury is experienced in the body, injuries almost always take a toll on the mind. I had my handful of injuries as a competitive athlete, and each one came with its own psychological challenges. When your performance is limited, especially if it’s significantly less than before your injury, this can be extremely frustrating. There are a few helpful tips here.

• Focus on post-injury improvement. Set recovery PR’s as you work back to healthy.
• Lean on your gym community and family for support.
• Improve physical capacities in areas that are less affected by the injury.

Customize Your Workout for Your Injury

Not everyone who reads the Invictus Blog is a CrossFitter, but many are. So here’s to the CrossFitters who have hamstring issues – or any issue for that matter. First, let your coaches know what’s going on with you. Begin to learn what customizations YOU need to make to be successful. The next paragraph may help you find ideas. Keep the 2/10 pain scale in mind. As you recover, you will be able to perform more volume and handle greater resistance, BUT this 2/10 number will remain in your mind as you work back to your fully recovered state.

Grade 1 & 2 Hamstring Strains – Movements that are Normally Painless

Fill your quiver. With a grade 1 or milder grade 2 hamstring injury, light hinging will be possible within days or a week or so after the initial injury. Squatting can cause problems, so tentatively feel this task out. Sometimes an isometric wall hold squat is a great transition to full range of motion squats in a few days or weeks. Step-ups are also a useful substitution here. Lunges can cause pain, so load conservatively with assisted body-weight volume first, then adding resistance after full pain-free (or very low pain) range of motion is achieved.

Grade 1 & 2 Hamstring Strains – Movements without Restrictions

Good ol’ push and pull. Pushing and pulling should not cause too many restrictions, so this is an opportunity to improve push/pull strength. Core work can also be a focus during this time, especially glute recruitment combined with activation of the abdominals. This combination may help stabilize the pelvis without causing hamstring pain and may allow faster hamstring recovery.

Grade 1 & 2 Hamstring Strains – Proceed with Caution in these Movements

Sprinting and multidirectional demands. If you are recovering towards more dynamic training challenge like sprinting or field sports, running should start as soon as possible pending pain. Running, power, and agility tasks are the same prescription to the 2/10 pain guideline for lower body training. Once jogging is achieved, adding pain-free or very low pain increases in running speed is imperative. Power and agility training here are also ideal and should start with pain-free variations, progressing as quickly as recovery allows towards faster velocity movements and increased resistances. This time period can also serve as an opportunity to return to the basics of all movements, placing down a new thick layer of physical knowledge, strength, and stability.

Conclusion

There are many right and wrong answers to facilitating hamstring recovery for yourself and others. Listen to YOUR/THEIR bodies. Find smarter people than yourself to bounce training and recovery ideas off. Cautiously try things out and note what works and what does not. Sleep. Reduce your life stress. Eat for recovery. Keep moving!