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hamstring injuries exercises, hamstring injuries prevention, hamstrings

Hamstring injuries exercises - how to keep your hamstrings in tune and singing sweetly.

Does this sound familiar? You trained well for an important marathon, got yourself into great shape, and cruised through the first half of the race without problems - and on course for a very fine PB. Then, you began to notice an annoying tightness in one of your hamstrings. At first, it was a mere blip on your radar screen, nothing more than a small mosquito bite, but the tightness got steadily worse, mile by mile, until your hamstring was a stiff, painful mass of tissue which cried out at every step. You slowed down, you stopped to stretch, you tried to relax, but nothing really helped. Realizing that you were not only not going to make your PB, but that your chances of actually reaching the finish line were approaching zero, you dropped out of the race, your hopes and expectations crashing down around you. After six months of careful, time-consuming preparations, some strips of muscle tissue in the back of your thigh had kept you from reaching your goal.

If that kind of disaster has never happened to you, perhaps you have been in the following situation: you bolt from the starting line of a 5K or 10K, feeling fit and ready to have a great race. As you sizzle through the first half-mile, you marvel at how fast you are running and how easy the pace feels to you. Suddenly, the runner behind you stabs you in your hamstrings, trying to slow you down. Agonizing pain shoots from your leg into your brain, and you are forced to hobble to a complete stop. You quickly realize that you haven't been stabbed; you have merely torn up your hamstrings so badly that you probably won't run at anything faster than an inchmeal jogging pace for at least six to eight weeks.

If either of these scenarios sounds familiar, you are not alone: Most runners (both competitive and recreational), as well as athletes in a wide variety of other sports, from cricket to soccer, have at one time or another suffered from some form of hamstring problem. Although novice athletes are at high risk of hamstring woes, accomplished competitors are far from immune. Witness the 1998 Rotterdam Marathon champion from Spain, Fabian Roncero, who, after being on pace to break the world-record time of 2:06:50, had to stop running completely to stretch his hamstrings for several moments - not once but twice during the final stages of the race. Roncero still managed to run one of the fastest races of all-time at 2:07:26, but the world record would have easily been his had he only been able to keep his hamstrings trouble-free.

The list of potential hamstring difficulties is annoyingly long, with hamstring strains, 'pulls', tendinitis, and tightness the most common maladies. So why are hamstring troubles so common? Most athletes have insufficient flexibility and mobility in their hamstring muscles, which can dramatically increase the risk of problems. In addition, many individuals possess imbalances in the strengths of the flexors and extensors of their hips and knees. Add hamstring fatigue to the mix, and these 'weak links' can tighten, cramp, strain, or even tear the hamstrings at the drop of a hat. As Steve Jones once said, 'Every great athlete is only a hamstring away from oblivion'.

Sometimes hamstring difficulties build up slowly but steadily over time. An athlete might initially notice a tiny bit of tightness, so slight that it would seem to be just one of the many small aches and pains associated with strenuous training. Often, however, the extent of hamstring tightness (and associated pain) increases inexorably over a period of several weeks, sometimes becoming so severe that fast or prolonged exercise becomes impossible - and even routine workouts are uncomfortable. Unfortunately, hamstring injuries are rather slow to heal, and athletes often spend several weeks resting or carrying out alternative activities before they are able to train without much pain. Like many muscular injuries, hamstring misery tends to return again and again, especially since athletes tend not to address the source of their difficulties. Too many athletes simply rest - or cross train - and hope for the best, without figuring out why their hamstrings went wrong in the first place.

However, one of the most curious things about hamstring problems is that they seem to show up in two seemingly disparate situations - toward the ends of prolonged efforts or very early in much faster-paced ones. Why is this so?

Hamstring troubles in the marathon

To illustrate what can occur, let's take a look at runners once again. In the case of marathon runners, what probably happens is this: as the race proceeds, muscular fatigue, including hamstring fatigue, increases. Remember that the hamstrings help to control the forward swing of the lower part of the leg (from the knee down) during running; one of their key jobs is to slow down the natural extension that occurs at the knee during the middle part of the swing phase of the gait cycle as the knee drives forward and upward prior to footstrike. This reduction in extension in effect reduces the length of the leg and makes it easier to propel the leg forward at decent speed (if the leg were straight, it would require considerable force to accelerate the foot forward, poised as it would be at the end of a very long lever).

However, as hamstring fatigue builds steadily as runners complete one mile after another, the hamstrings do a poorer job of controlling (slowing down) the extension that occurs at the knee during 'swing'. The leg is thus straighter as it swings forward, which puts more stretching (eccentric) force on the hamstrings (remember that the hamstrings are shortest when the knee is fully flexed and longest when the leg is straight; the longer the hamstrings are, the more difficult it is for them to withstand stretching without becoming stressed or injured). Of course, late in the race is precisely the worst time to place more force on the 'strings, since they are already fatigued and less able to handle the pulling, tearing stresses of swing. As fatigue mounts further and knee flexion continues to decrease, greater and greater stretching force is created, and the hamstrings become tight, irritated, and painful, which is exactly what happened to Mr. Roncero (and what has happened to thousands of other marathon runners). At this point, the possibility for a serious tearing injury to the hamstrings or their tendons is high.

Testing your own 'strings'

If you're not sure (or convinced) about how all this works, try this simple test:
(1) While standing only on your left foot, bend your right knee (to 90 degrees of flexion or greater), and repeatedly swing your right leg up until your thigh moves beyond (above) the point at which it is parallel to the ground (at this point, there will be greater than 90 degrees of flexion at the hip). Do this for eight to 10 repetitions, noting the degree of tension/stretch in your right hamstrings (with your knee bent).

(2) Now, keep your right leg straight and repeatedly swing it forward and backward for 8-10 repetitions, trying to attain the same elevation of your thigh that you managed with your knee flexed and noting the degree of tension/stretch in your right hamstrings.

It doesn't require a whole lot of flexion at the hip for a person with tight hamstrings to feel a dramatic pull during the second exercise. Granted, nobody runs with straight legs, but if knee flexion decreases during swing (due to hamstring fatigue), it will unquestionably place a greater load on the hamstrings. This is exactly what happens in the late stages of a marathon.

Blown 'strings'

When an athlete 'blows out' his/her hamstrings during a very intense effort, the mechanism which produces injury is somewhat different. Often, when this kind of hamstring trouble occurs in competitive runners, the athlete has reached an extremely high state of fitness and is ready to have an extraordinary race (although it can also happen when a runner simply starts a race at far too fast a pace). Whether the runner is very fit or merely overexcited, he/she charges away from the starting line at unprecedented speed, which usually means longer-than-usual stride lengths (rather than higher stride rates). This of course also means greater-than-usual hip flexion - and thus a big increase in the stretching force placed on the hamstrings. Unfortunately, the hamstrings are often somewhat tight, because most runners have trouble with hamstring inflexibility, and/or because the pre-race warm-up has done a poor job of optimizing hamstring mobility. As a result, the explosive strides tear the hamstrings or their associated tendons, and the athlete hobbles off the course after a half-mile (or less) of running.

The following exercises are designed to address both types of hamstring injuries - the ones which occur during prolonged exertions and those which are the result of explosive efforts. They will lengthen and strengthen those important cords of muscle in the backs of your legs - and help keep them trouble-free. The first exercises - the leg swings - will help you warm up your hamstrings dynamically in a manner that is similar to how they will be used when you are actually running. The second and third exercises - the specific swings and step-ups - will fortify your hamstrings for the rigours of the repeated flexion and extension of both the hip and knee which occur during running. The fourth exercise - the standing isometric hamstring stretch - will help you significantly increase the range of motion and flexibility of your hamstrings so that your legs move freely and easily without undue hamstring tension or overwork.

EXERCISE 1: WARM-UP LEG SWINGS

Include the following series of dynamic-mobility leg swings as part of your warm-up routine:

A. Forward-backward leg swings - knee flexed: stand with your weight fully supported on your left leg (you may place your right hand on a wall or other support to maintain balance). Begin by flexing your right hip and raising your right knee up to waist height (so that your right thigh is parallel to the ground), with your right knee flexed to approximately 90 degrees or more. Perform this action reasonably quickly so that your leg 'swings up' to this top position - rather than being slowly lifted. Continue the exercise by swinging your right leg downwards and backwards until your right leg is extended behind your body (as if following through on a running stride). Your right knee should be completely extended at the end of this backswing, ie, your right leg should be nearly straight at the back of the swing - just as it would be after take-off during a sprint stride.

Repeat this forward and backward action 10 to 20 times while gradually increasing the speed and range of motion of the movement. Then, carry out the same movements with your left leg.

B. Forward-backward leg swings - knee extended: stand with your weight fully supported on your left leg (you may place your right hand on a wall or other support to maintain balance). Begin the exercise by flexing your right hip and raising your right knee up to waist height (with right thigh parallel to the ground) and with your right knee near fully extended (straight-legged). Perform this action reasonably quickly so that your leg 'swings up' to this top position - rather than being slowly lifted. Continue the exercise by swinging your right leg downwards and backwards until right hip and leg are extended behind your body (as if following through on a running stride). Your right knee should remain nearly fully extended throughout the entire movement, ie, your leg remains straight at all times.

Repeat this back-and-forth action 10 to 20 times while gradually increasing the speed and range of motion of the movements. Then, repeat the same movements with your left leg.

As you become more comfortable with these exercises, use the principle of progression to increase their value. As the weeks go by, carry out the swings at faster speeds; faster movement is more difficult and requires a higher degree of coordination and power. In addition, increase the range of motion (ROM) of your swings. Greater ROM is tougher to perform, and it must always be done within reason. You should maintain an upright body position and rhythmic coordination; never sacrifice form (including good posture and coordination) to achieve more ROM or speed. The final part of the progression is to gradually increase your quantity of repetitions. Eventually, you should be able to complete nearly 40 to 50 reps with each leg at nearly full ROM with very high speed, but it will take time to develop this level of ability. It's a good idea to carry out both the knee-flexed and knee-extended swings before all of your workouts (but, of course,only after a good warm-up consisting of at least 10 minutes of jogging).

EXERCISE 2: SPECIFIC STRENGTH: BICYCLE LEG SWINGS

Perform the following exercises early during your workout when you are reasonably fresh and free from fatigue. These exercises should be performed twice a week by individuals who do not have a hamstring injury and at least three times a week by those who are suffering from hamstring troubles.

A. Bicycle leg swings without resistance: stand with your weight fully supported on your left leg (as with the warm-up swings, you may place your right hand on a wall or other support to maintain balance). Begin by flexing your right hip and raising your right knee up to waist height (your right thigh should be parallel with the ground); as you do this, your right knee should be flexed to 90 degrees or more. Once your thigh is parallel to the ground, begin to extend your right knee (swing the lower part of your right leg forward, unflexing the knee) until your knee is nearly fully extended (ie, your leg is nearly straight), with your right thigh still parallel to the ground. As your right knee nears full extension, allow your right thigh to drop downwards and backwards until the entire thigh and leg are extended behind your body (as if following through on a running stride). Your right knee should be near full extension (your leg should be straight) until it reaches the peak of the backswing. As your right hip nears full extension (ie, as you approach the end of the backswing), raise your right heel by bending your right knee; your heel should move closely towards your bum as you do this. As this happens, move your right knee forward until it returns to the appropriate position in front of your body, with your right thigh parallel to the ground. Repeat this entire sequence of actions in a smooth manner such that the hip and leg move though a continuous arc without stopping or pausing. Once you are able to coordinate the movement, strive to perform the swings at a cadence of at least 12 swings every ten seconds (slightly faster than one swing per second).

Begin with one to two sets of 15 to 30 repetitions with each leg. As you become more comfortable and skilled with this exercise over a period of several weeks, progress to one to two sets of 40 to 60 repetitions. To more closely mimic the specific actions of the running stride, it is important that you increase the speed and ballistic nature of the movement over time as well.

B. Bicycle leg swings with resistance: repeat the above exercise with a piece of rubber tubing attached to the ankle of your swing leg and anchored to a fixed point at knee level in front of you (start with beginner bands and work up to advanced models). The tubing should be stretched somewhat when you are standing in the starting position. In addition, the tension should be increased (by standing further from the fixed point or increasing the strength of the tubing) as you gain more strength and coordination with the exercise. Once you are able to coordinate the movement, strive to perform the swings at a cadence of at least 12 swings every ten seconds (faster than one swing per second).

Begin with one to two sets of 10 to 20 repetitions per leg. This can progress to one to two sets of 30 to 50 repetitions over a period of several weeks as your strength improves and you become more skilled with the exercise. It is important that you increase the speed and ballistic nature of the movement over time to more closely mimic the specific actions of the running stride.

EXERCISE 3: GENERAL STRENGTH: HIGH-BENCH STEP-UPS

Perform this exercise twice a week after you have warmed up thoroughly.

Begin from a standing position on top of a bench that is approximately knee high, with your body weight on your left foot and your weight shifted toward the left heel. The right foot should be free and held slightly behind your body. Lower your body in a controlled manner until the toes of the right foot touch the ground, but support all of your weight on your left foot. Return to the starting position by driving down with the left heel and straightening your left leg. Maintain an absolutely upright body posture with your trunk throughout the entire movement, with your hands held at your sides.

Perform this exercise for two sets of 10-15 repetitions with each leg. You can make the step-ups progressively more difficult by holding dumbbells in your hands as your perform the exercise (start with three to five pounds and gradually increase to 25 pounds) - and by gradually increasing the height of the step. Increase the height of the step by no more than two inches from workout to workout. Of course, you can eventually add on additional reps and sets as well - and increase your overall speed of movement.

If you are a devoted follower of Peak Performance, you may have noticed with some surprise that we called the bicycle swings a specific strength exercise for the hamstrings - and labelled the high-bench step-ups a general hamstring-strengthening activity. Since the high-bench step-ups force the hamstrings to exert force while they are in a weight-bearing mode, while the bicycle swings call for hamstring action when the hams aren't bearing any weight, shouldn't that be the other way around? The high-bench step-ups seem more specific to the act of running, which of course was a weight-bearing activity the last time we checked.

To understand why we have labelled the exercises this way, think about this question: do hamstring injuries occur more often when the leg to be injured is actually weight bearing, or when that leg is in the air (during the swing phase of the gait cycle). To put it another way, is a typical hamstring injury a 'closed-chain' or 'open-chain' event?

The full answer is probably both, but most hamstring injuries probably occur as a result of an open-chain (non-weight-bearing) problem. As we have mentioned, the key problem is that the thigh swings forward repetitively during running while the hamstrings are becoming more and more fatigued; the hamstrings in fact have to control this forward swinging, yet they become too fatigued to properly handle this forward-pulling, eccentric action (ie, the strain on the hamstrings during the swing phase of the gait cycle becomes greater than the strain the hams can withstand without getting hurt). As we mentioned, fatigue is not a necessary factor, but it certainly helps. If the hams are not fatigued, they may still be over-stressed early in workouts or races by explosive and expansive strides which also place too much strain on the hams during swing.

Thus, the 'swing' exercises described above are designed to strengthen the hamstrings during the swing phase of gait by manipulating and increasing the speed, range of motion, and resistance that the hamstrings must properly handle while the leg is off the ground. These exercises are specific to the action during which the hamstrings are most often injured. Meanwhile, the high-bench step-ups strengthen the hamstrings during weight-bearing movement, but since this is not the specific time when most hamstring injuries occur, we label the step-ups a general strengthening activity for the hams.

EXERCISE 4: POST-TRAINING EXERCISE: THE STANDING ISOMETRIC HAMSTRING STRETCH

Perform the following stretch at the end of your training session. You should not be overly fatigued when using this stretch, so incorporate it into workout sessions that are not overly difficult. The standing isometric hamstring stretch should be performed twice a week if you don't have a hamstring problem and three times a week if you are currently rehabilitating a hamstring injury.

Begin by standing with your weight fully supported on your left leg (you may place your right hand on a wall or other support to maintain your balance). Then, place your right heel on a chair, table, or other similar support in front of you. The height of this supporting structure should be somewhere between your knee and hip; the more flexible you are, the higher the support can be. Your right knee should be extended so that your right leg is straight. With your shoulders and chest facing straight ahead (towards your extended right leg), attempt to move your navel as close to your right knee as you can - until you feel a strong (but not painful) stretch in your right hamstrings.

At this point, you are ready to begin the isometric portion of the stretch. Starting gradually, attempt to push your right heel down towards the floor by contracting your right buttock, hip, and hamstring muscles for a count of six to eight seconds. This contraction should start gradually and build to close to maximal effort by the fourth second or so. Allow your muscles to relax completely for a few seconds after the contraction, and then again attempt to move your navel a little closer to your right knee. Repeat this sequence: isometric contraction - move closer to knee - isometric contraction - move closer to knee - at least three to five times before performing the entire sequence with the other leg. Rest for a short period, and then repeat with both legs. These isometric hamstring stretches will take you no more than five to six minutes to perform.

Pull bounding

Yet another way to improve the strength and dynamic mobility of the hamstrings is to perform some exaggerated pull bounding. To do this, warm up with at least 10 minutes of relaxed jogging, and then - on a gym floor or smooth grassy surface - bound quickly for about 30 to 40 metres, emphasizing longer-than-usual - but also very quick - strides. During these exaggerated pull bounds, you should focus on both increasing the forward swing of each leg (hip flexion) and also the backward pull (hip extension) of each leg once the foot has hit the ground. By doing so, you are increasing hip (and thus hamstring) range of motion, fostering the ability of the hamstrings to withstand injury-producing forward-swing forces, and also increasing hamstring strength. Progress your exaggerated pull bounding by increasing the number of reps (start with just three to four 30- to 40-metre reps), by expanding the length of the reps (to 100 metres or so), by upgrading your speed of movement, and by then moving the venue for the pull bounds from a flat, forgiving surface to a hill of moderate steepness.

Another progression, of course, would be to move from pull bounding to exaggerated pull hopping. This exercise proceeds exactly the same as pull bounding, except that you remain on one leg for the full duration of a repetition (staying on one leg will dramatically improve the fatigue-resistance of your hamstrings). Begin with 10-metre reps and gradually increase to 50 metres (the pull hops may also be performed on a hill).

Yet another way to increase the fatigue-resistance of your hamstrings, especially if you are planning to run a marathon, is to challenge your hamstrings when they are already in a somewhat fatigued state (obviously, this challenge must not be great enough to injure your precious hams in the process). As you get ready for the marathon, one way to vanquish hamstring fatigue (in addition to carrying out the exercises described above) is to change the nature of your long runs. Instead of merely ambling along for 20 to 22 miles at slower than goal marathon pace, run 15 miles moderately - and then click off five to six miles or so at your goal speed, the one you hope to sustain on your big day. Doing this several times during your pre-marathon build-up will increase the ability of your hamstrings to handle the late-race pressures and strains which can damage less adequately prepared 'strings. After you have completed several of these marathon-specific runs, your hamstrings will have enough fortitude to lower their risk of trouble in late stages of the race.

If you have had hamstring problems in the past, you are at significantly greater risk for hamstring troubles in the future, compared to athletes who have been free of hamstring trouble. If your hamstrings haven't given you too much distress, what's the best way to assess your risk of difficulty? There seem to be three important risk factors: (1) Poor hamstring flexibility and mobility, (2) Inadequate hamstring strength, and (3) Being generally out of shape. The first two factors place too much stress on the 'strings during the swing phase of the gait cycle, as we have mentioned. Being out of shape is also risky, because it increases hamstring fatigue during running. As we have already noted, tired strings do a poor job of controlling forward leg swing and are more likely to be overstrained during running.

Is a big calf a big risk factor?

And there may be yet another risk factor - the possession of large calf muscles and/or big feet. Although this may seem strange, it's clear that heftier calves or bulkier feet would place added stress on the strings. During forward leg swing, it would be harder to stop those big calves and feet once they got moving (ie, angular momentum would be greater). Since it's the job of the hamstrings to slow down that momentum, they would be considerably more stressed. To make matters worse, the hams would also be more fatigued, since each step would force them to slow down a heavier weight, compared to 'strings which were dealing with thin calves and tiny trotters.

A curious thing about athletic endeavours is that when an athlete establishes a goal of moving from point A to point B, with point A being a state of lower fitness and B representing higher fitness (or a new PB), the path from A to B is seldom trouble-free. However, the stretch of rough road or long detour which one encounters on the path is often not due to the inability to improve the physiological variables associated with fitness, all of which respond quite effectively to well-planned workouts. A temporarily 'washed-out road' is often the result of an anatomical/biomechanical weak link which leads to injury and stops training in its tracks. Frequently, this big bump is a hamstring problem, but if you carry out our stretches and exercises faithfully, you will keep your hamstrings in superb shape - and dramatically increase your chances of reaching your goal.

Text by Owen Anderson
Exercises by Walt Reynolds

hamstring injuries exercises, hamstring injuries prevention, hamstrings