Hamstring strains are a very common and often stubborn injury, particularly with typical treatment methods. Hamstring injuries related to running often occur in the deceleration phase of the swing cycle, or simply stated, as the knee in front is straightening just before that leg hits the ground again. During this phase of the running cycle, the hamstrings are active, lengthening and absorbing energy from the decelerating leg in preparation for foot contact. As the muscle is contracting in this active lengthening phase, this type of contraction is called an eccentric muscle contraction. In weightlifting, it is often called the negative phase of a lift. During recovery from injury, the hamstrings must be properly rehabilitated to handle high eccentric loading upon return to running.

Often, people with hamstring injuries aggressively stretch and ice the injured area, but never rehabilitate the strength deficits that reside after the injury, particularly the eccentric strength deficits. Many times, these eccentric strength deficits were present from the beginning and may have led to the initial injury. Unfortunately, these deficits are only worsened with the injury, and consequently, often leads to re-injury.

Thus, progressive eccentric loading at varying speeds after the acute phase is necessary for full and proper treatment of a hamstring injury and will assist to a return to running. The other key component of a rehabilitative program is pelvic and trunk stabilization exercises. Many studies have found that core and gluteal strength were also related to risk of re-injury, finding those with better core strength were re-injured less frequently. Neural tension, or tension resulting from an aggravated nerve (from either your low back or buttocks in this case), could also hinder one’s progress with healing and should be examined and addressed if present. Finally, poor ankle or knee mechanics can lead to increased stress on the hamstrings when running, so it is important to address any deficits in this area also.

Returning to running after a hamstring strain can be very complicated and involves treatment anywhere from the spine to the ankle. If you are looking to fully recover or return to athletics following a hamstring injury, it is best to see a sports medicine doctor for a comprehensive examination and to guide you to the proper treatment so you can properly recover.

The author of this article is Ryan Perry, PT, DPT, OCS, CSCS, MTC, FAAOMPT from NovaCare at Fitness Formula Club- North Ave.