Home Posts tagged "Hamstrings Strain"

Not-So-Simple Sports Medicine Solutions

Last year, in her series on common injuries in professional baseball, MLB.com writer Lindsay Berra covered the topic of hamstrings strains, and even interviewed Cressey Sports Performance - Florida co-founder Shane Rye for the piece. You can give it a read here.

This article goes into some detail on why these injuries have been so prevalent and challenging in MLB over the years:

a) the nature of baseball (stand around for a while, then have to sprint full-bore without a re-warm-up)

b) poor strength and conditioning practices (e.g., lifting too much to the exclusion of actual sprinting and mobility work)

c) muscular imbalances (e.g., poor glute recruitment, quad/hamstrings imbalances, etc)

I'd also add previous injuries as a big risk factor. Many times, it's one player who is reinjuring the same old hamstrings injury to "inflate" league-wide numbers. 

For a while, the solution was to get the hamstrings stronger relative to the quads. Then the answer was to bring an underactive synergist (gluteus maximus) up to par. And, lately everyone has jumped on board the Nordic hamstrings curl bandwagon; they apparently not only help prevent hamstrings strains, but cure cancer, acne, and hemorrhoids - and will even make girls like you. I joke, but it's actually a perfect lead-in to the next point: sports medicine doesn't have a perfect answer to the hamstrings problem in baseball.

Luckily, as with everything in life, the internet has all the solutions. Monday Morning Quarterbacks abound, and all these doctors, rehabilitation specialists, and strength and conditioning professionals really could have just gotten the billion-dollar solution they needed on Twitter.

As an example, when I linked to the aforementioned article on Twitter, one reply was particularly entertaining: 

"Simple fix already seen especially in female soccer training. With the 'best' sports med docs in pro sports crazy it hasn't been corrected."

This response couldn't be further from the truth.

First, comparing males and females is an issue in itself. Females have far more joint laxity, so they're significantly less likely to have "tight" hamstrings (for a variety of reasons) that could potentially be injured. Moreover, male athletes are stronger and more powerful than females, so there are gender-specific differences in the actual forces experienced. The faster you are, the more likely you are to pull a hammy. This is also why we see far more hamstrings strains in baseball than we do in softball even if they're both equally "far behind" in prevention strategies.

Second, soccer and baseball couldn't be more different. Soccer is continuous play for 90 minutes, and as I recall, the average midfielder covers approximately seven miles per game. Baseball games might last four hours, and a player might not cover seven miles in an entire month - and all of it is done at a high percentage of maximum speed. They stand or sit around, and then are expected to sprint full-tilt without much warning. Improving work capacity in soccer players can definitely reduce the risk of injury late in matches, but won't do much in the baseball world because they never really get fatigued; rather, they stiffen up from doing nothing.

Third, the competitive calendar is different. If you look at the Major League Soccer schedule, most clubs play 6-7 matches in June. Major League Baseball teams play this many games each week - and do so with a much more challenging travel schedule. That crazy schedule pushes out a lot of training time, and makes optimizing recovery incredibly difficult.

Fourth - and this is a very subjective, anecdotal observation - baseball players are less likely to take good care of themselves off the field. Major leaguers are far more likely to go out and crush eight beers after a game than the 16-year-old female soccer player that's been positioned atop a pedestal of sports medicine excellence. They also don't test for recreational drugs in 40-man roster players in MLB. Don't you think the guy who went on a bender the night before a doubleheader is more likely to strain his hamstrings than Susie Soccer who still lives with her parents?

I could go on and on about the differences, but I don't think that the point needs to be illustrated any further. Every sport has different physiological, biomechanical, social, and psychological factors that need to be taken into account in the injury prevention battle. Most people on social media can't possibly even come close to fathoming all these different contributing factors.

Now, I'm all for borrowing training ideas from different facets of the sports medicine industry. I've learned a ton from coaches in everything from sprinting, to tennis, to track & field, to powerlifting. Nobody has the perfect solution for your sport-specific problem, though (even though social media might tell you otherwise). Still look to to learn from these other professionals, but critically evaluating everything you come across. 

Above all else, make sure that you're still working hard to get educated in your specific sporting discipline. As an example, it's one reason why I highly recommend the American Sports Medicine Institute (ASMI) Injuries in Baseball course. This resource brings together some of the most renowned surgeons, rehabilitation specialists, and strength and conditioning professionals in the baseball world each year. And, it's on sale for $150 off (50% off) this week only. If you work with overhead athletes in any capacity, I'd encourage you to look into it. You can check it out HERE.

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Strength and Conditioning Stuff You Should Read: 6/19/17

I hope you all had a great Father's Day! It was my third one as a Dad, and I was fortunate to get in some reading and viewing during nap time so that I had material for this week's recommended resources! Check them out:

ASMI Injuries in Baseball Course - Mike Reinold just made this great course available online, and it's an absolute steal compared to what you would have to pay to travel and attend it. There's some excellent information from some of the top baseball sports medicine professionals in the world, so I'd call it "must watch" for anyone who trains or treats baseball players. It's on sale for $100 off through this weekend.  

Why are there so many MLB hamstrings injuries? - Lindsay Berra of MLB.com tackled this big injury topic with some help from Cressey Sports Performance - Florida's co-founder, Shane Rye.

4 Ways to Build Confidence for Powerlifting - I loved this article from Tony Bonvechio, who works with the women's powerlifting team at CSP. So few people pay attention to the mental side of lifting success, but this article delves into it nicely. I'll add another recommendation to go with it: Rookie Reminders is an interview withs several successful powerlifters on all the things to remember before your first meet. Picking the brains of those who've competed before you is one more way to build confidence in this regard. 

Top Tweet of the Week (three-parter) -

Top Instagram Post of the Week -

 

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The Best of 2012: Strength and Conditioning Articles

With 2012 winding down, I’ll be dedicating this week to the best content of the year, based on traffic volume at EricCressey.com. I’ll kick it off today with my most popular articles from the past year.

1. 5 Reasons You Have Tight Hamstrings - This article received about 24,000 more views than the next most popular post of the year.  I guess a lot of people have tight hamstrings!

2. Are Pull-ups THAT Essential? - People love controversy, and when you call into question the risk/reward of one of the most sacred strength training exercises of all time, that's exactly what you get! 

3. The Superset Survival Guide - This article, which featured my "Top 10 Supersets," got a ton of Facebook shares and Retweets.

4. Everything You Need to Know About the Front Squat - This article was published less than a month ago, but already shot up to the top five, which isn't easy to do!

5. 6 Tips for Adjusting to Exercise in the Morning - Early morning exercise might not be your cup of tea, but with some of these tips, it very well could be in 2013!

This wraps up my top 5 posts of 2012, but I’ll be back soon with more “Best of” highlights from 2012. Next up, I’ll list my top videos of the year.

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5 Reasons You Have Tight Hamstrings

There might not be a more obnoxious and stubborn athletic injury than the hamstrings strain.  When it is really bad, it can bother you when you're simply walking or sitting on it.  Then, when a hamstrings strain finally feels like it's getting better, you build up to near your top speed with sprinting - and it starts barking at you again.  In other words, a pulled hamstrings is like a crazy, unpredictable mother-in-law; just when you think you've finally won her over, she brings you back down to Earth and reminds you how much more she liked your wife's old boyfriend.

However, not all hamstrings pain cases are true strains; more commonly, they present as a feeling of "tight hamstrings."  If one is going to effective prevent this discomfort, rehabilitate it, or train around it, it's important to realize what is causing the hamstrings tightness in the first place.  Here are five reasons:

1. Protective Tension of the Hamstrings

This is readily apparent in someone who has a crazy anterior pelvic tilt, which puts a big stretch on the hamstrings, which posteriorly tilt the pelvis.  When someone is extremely anteriorly tilted, the hamstrings are constantly "on" to prevent someone from ending up with extension-based back pain, such as spondylolysis (vertebral fractures), spondylolisthesis (vertebral "slippage"), and lumbar erector tightness/strains.  This is a problem most commonly seen in females (greater anterior pelvic tilt than men) and athletes:

APT-250x300

Doing a lot of longer duration static stretching for the hamstrings in this population usually isn't a great idea, as you run the risk of making someone more unstable - particularly in the case of females, who have less rigid ligamentous restraints (more congenital laxity) to protect them.  To that end, our approach with these folks is to use the warm-ups to foam roll the area, then do some hamstrings mobilizations to transiently reduce stiffness in the hamstrings.

After this reduction in stiffness, we work to build stability in synergists to the hamstrings in posterior pelvic tilt.  In other words, there's a heavy emphasis on glute activation and anterior core recruitment both with a strength training program and postural reeducation for the other 23 hours of the day.

At the end of the training session, with the male athletes, we may do some shorter duration hamstrings stretching just to "dissipate" a little eccentric stress.  I like ten seconds in each of these three positions:


 

 

 

 

 

The thing to remember is that while you can do everything right with these athletes in training, what they do with their posture during the rest of their lives is of paramount importance.  If they continue to stand around in anterior tilt and don't help the new stiffness they've developed "stick," they'll continue to over-rely on their already tight hamstrings.

2. Neural Tension

Just because you feel hamstrings tightness doesn't mean that the hamstrings are actually the source of the problem.  In fact, it's not uncommon at all for those with lumbar disc issues to present with radicular pain, tightness, or numbness/tingling into the legs - especially the hamstrings.  The symptoms may also come from nerve entrapment (most commonly the sciatic nerve) on soft tissue structures further down the chain.  Just aggressively stretching the hamstrings can actually make these symptoms worse, so it's important to see a medical professional to rule out causes further up with the appropriate clinical exams, such as the slump test.

3. Truly Tight Hamstrings

In order for hamstrings to really be short, one would have to spend a lot of time with the knee flexed and hip extended - so just imagine the position you're in at the top of a standing leg curl.  That's a hard pose to hold for an extended period of time, much less do so on a regular basis.

That said, some folks do get somewhat close to that on a daily basis in the sitting position, and are therefore the most likely to really have "tight hamstrings." They have to be in posterior pelvic tilt and knee flexion for a considerable chunk of the day - and even then, it's still pretty tough to be truly short, as they are still in hip flexion.

These folks usually can't distinguish hip flexion from lumbar flexion, so if you do a standing hip flexion assessment, rather than maintain the neutral spine we see in this photo, they'll go into lumbar flexion (butt will "tuck under").

The same trend will usually be noticeable with any kind of squat unless they have a tremendous amount of core stiffness to overcome the posterior hip stiffness that's present.  If you test these folks on an straight leg raise, it isn't pretty, as the pelvis is already posteriorly tilted.  In a pelvis that starts in "neutral" on a straight leg raise, roughly the first 1/3 of movement that you see comes from posterior tilt of the pelvis before the femur ever starts to flex on the acetabulum of the pelvis.  These folks are usually already posteriorly tilt, so that 1/3 is already used up; you're really only measuring hip flexion and not hip flexion PLUS posterior pelvic tilt.  And, as you can imagine, if someone is truly short in the hamstrings, that straight leg raise isn't going to be pretty. Obviously, these folks usually have a terrible toe touch pattern as well.

This should also educate you on why you can't treat all hamstrings strains the same.  In the protective tension example earlier, we needed to work to regain stability to hold a position of a bit more posterior pelvic tilt.  We'd cue glute activation, and use exercises that draw folks back into posterior tilt (e.g., reverse crunches).  If you have someone has a pulled hamstrings because they are truly short from already being in posterior pelvic tilt, though, some of these cues and exercises would be contraindicated. You'd be feeding the dysfunction.

While manual therapy and stretching for the posterior hip is valuable, again, it must be followed by stabilization work at adjacent joints with the pelvis in a neutral position.  These folks can benefit from training hip flexion above 90 degrees as well, as it educates them on how to flex the hip without rounding the lumbar spine.  This is one reason why I think a lot of the chop and lift exercises we've learned from Gray Cook are so fantastic; they teach us anti-rotation and anti-extension stability in various positions of hip flexion while the pelvis is in neutral.  They make changes "stick" better.

4. Previous Hamstrings Strain

Not to be overlooked in this discussion is the simple fact that the single-best predictor of hamstrings strains is a previous hamstrings injury.  One you have an injury, that area may never be the same from a tissue density standpoint - whether it's the surrounding fascia or the muscle or tendon itself.  A previous injury can leave athletes feeling "tight" in the region, so regular manual therapy can certainly help in this regard.

Anecdotally, the athletes with the long-term problems seem to be the ones with the pulls up on the gluteal fold, right where the hamstrings tendons attach to the ischial tuberosity.  The area gets "gunked up"in a lot of athletes as it is because of all the tissues coming together and exerting force in a small area, but it's especially problematic in those who have a previous injury in the region.  Perhaps more problematic, though, is the fact that we sit on our proximal hamstrings attachments - and that isn't exactly good for blood flow and tissue regeneration.

Semimembranosus_muscle-2 

I haven't seen any research on it, but I have a feeling that if you looked at this region in a lot athletes with ultrasound (similar to this study with patellar tendons), you'd find a ton of people walking around with substantial degenerative changes that could be diagnosed as tendinosis even though they haven't actually hit a symptomatic threshold.  My guess is that it's even worse in the posterior hip region because a) we sit on it, b) the ischial tuberosity is a more "congested" area than the anterior knee), and c) the study I noted above used 14-18 year-old athletes, and degenerative problems will get worse as one gets older (meaning this study likely undercut the true prevalence across the entire population).

Very simply, an athlete with a previous hamstrings strain needs to stay on top of quality manual therapy on the area, and be cognizant of maintaining mobility and stability in the right places.  They have less wiggle room with which to work.

5. Acute Hamstrings Strain or Tendinosis

Of course, the fifth reason you hamstrings might be tight is because you might actually have a hamstrings injury!  It could be an actual hamstrings strain, or just a tendinosis (overuse issue where tissue loading exceeds tissue tolerance for loading).  There is no one perfect recommendation in this regard, as a tendinosis or grade 1 hamstrings strain is going to be much more tolerable than a grade 3 hamstrings strain where you have bruising all along the back of your thigh.  

In terms of maintaining a training effect with the less serious ones, here are a few suggestions:

a. When you are ready to deadlift, use trap bar deadlifts instead of conventional or sumo deadlift variations.  I explain a bit more about how the positioning of the center of gravity makes this more hamstrings friendly HERE.

b. Shorten up your stride on single-leg exercises.  This makes the movement slightly more quad dominant, but allows you to still get the benefits of controlling the frontal and transverse planes with appropriate glute and adductor recruitment at the hip.

c. Go with step-up and reverse sled dragging variations.  Eliminating the eccentric component can take a considerably amount of stress off the hamstrings, and both these exercises get the job done well.

d. If you're going to squat, start with front squats at the beginning, and reintegrate back squat and box squat variations later on, as they will be more hamstrings intensive.

e. Understand anatomy.  If you are in hip flexion and knee extension, you're going to really be stretching the hamstrings and likely irritating them in the process.  Select exercises that don't hit these painful end-ranges, and then gradually reintroduce more dramatic ranges of motion as the issues subside.

f. Do hill sprints before you do regular sprints.  Your stride is going to be a bit shorter with hill sprints, and that'll take a considerable amount of stress off the hamstrings at heel strike (pretty good research on uphill vs. downhill sprinting HERE, for those who are interested).  Just don't go out and run as hard as you can the first time out; propulsive forces are still quite high.

Of course, this just speaks to how to train around a pulled hamstrings; there is really a lot more to look at if you want to really understand why they occur and how to prevent or address them.  In my eyes, this post was necessarily "geeky," as it is important that we don't dumb down complex injuries to "just stretch it out."  This recommendation is analogous to a doctor just telling someone to take some NSAIDs for regular headaches; it doesn't get to the root of the problem, and it may actually make things worse.

For more information, I'd encourage you to check out the Functional Stability Training series. The entire package - and the individual components - are on sale for 20% off through tomorrow (Sunday) at midnight. The discount is automatically applied at checkout at www.FunctionalStability.com.

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