Common Hamstring Injuries In Runners
We teamed up with Sports Rehabilitator Claire Taylor from Taylormade Rehab to outline the most common hamstring injuries in relation to running. Read more on this article as we take you through causes of injury and how to treat them effectively.
The hamstring is one of the most important muscle groups while running. It has a variety of roles throughout the gait cycle. These include forces to control the knee as it extends thorough the swing phase and creating the hip extension in the stance phase as the body passes over the planted foot. There is no wonder that this can be such a problematic region of the body when considering injuries that a runner might suffer.
With such a complex role, pain in this muscle group can be caused by various injuries along the hamstring. This article will explore some of these most commonly suffered by runners.
Hamstring Tear/Strain
What is it and what causes it?
Muscle strains are categorised into three grades. This system is true for Hamstring strains. Generally, a hamstring strain will occur in the muscle belly (in the middle of the posterior thigh) or at either end of the muscle belly in the musculotendinous junction (as the muscle blends into the tendon). The most significant of strains (grade II or grade III) are more commonly experienced in sprinters due to the explosive forces. These types of strains can also be suffered because of sudden change of direction or acceleration and deceleration. Trail or fell runners who leap, jump or frequently run hills may be more susceptible to these types of strains than the steady state road pounding miles of a distance runner.
The grade III rupture is a significant injury which will stop the runner in their tracks. It is often described as a pop or crack. The runner will feel like they have been shot in the back of the leg and is likely to leave them lying on the floor in severe pain. There will be immediate bruising and swelling as the blood rushes through the torn muscle. There will be a reluctance to put weight through this leg and the runner will be unlikely to walk. This would need immediate medical attention and, in most instances, result in surgical repair. A grade II strain will present similarly to a lesser extent. Although painful the runner would likely be able to walk, and subsequent bruising and swelling may be less severe or even non-existent.
The more commonly experienced hamstring strains for steady state distance runners are the low grade I strains. The principle of injury is the same. The muscle is overloaded to the point it becomes under stress enough to tear. The over loaded muscle could have been caused by fatigue with increased intensity or lack of recovery in training. The tight shortened muscle in this state can create increased tension through the fibres as the hamstring goes through the gait cycle. These forces can expose the fibres to tear. A grade I strain will cause the runner a degree of pain but perhaps something that they can continue to run through. This pain usually stops after a run leading the runner to believe there is not an injury present. There is also unlikely to be any visible bruising or swelling present.
How to treat it?
- All muscle strains irrespective of their classification benefit from following the R.I.C.E (Rest, ice, compress and elevate) protocol.
- NSAIDs (anti-inflammatory drugs) may help manage pain.
- The rest element should be relative to the category of the strain. A Grade III or severe grade II may require a period of immobilisation. Whereas a grade I would only require rest from strenuous activity such as running.
- Following this period of rest gentle mobility should be encouraged. This should focus on encouraging active range of movement and not strong passive stretches.
- Appropriate strengthening exercises to be progressed as pain allows.
- Alternative non-weightbearing/non-impact activities provide the opportunity to cross train without compromising the hamstring injury.
- A gradual return to running will depend on the grade of strain. This should be led by pain free daily living activities. If it is still too sore to walk, then running would not be wise. This return to running should be part of a progressive rehabilitation programme.
- It would be advisable for any suspected ruptured muscle to be examined by a health care practitioner.
- A carefully considered return to activity should be executed.
How to prevent it?
- Ensuring a suitable warm up and cool down helps the muscles to prepare and recover from activity.
- Introduce a gradual progression to the running programme, allowing for endurance to develop.
- A lack of flexibility in the hamstrings is often attributed to injury, along with over dominant hip flexor muscles. It is therefore considered important to introduce a stretching routine to the hamstrings, Quadriceps and Hip flexor muscles.
- The incorporation of a suitable conditioning programme can promote running technique, support posture and enhance resistance to fatigue, while addressing any muscle imbalances between the quadricep and hamstring ratio.
- Carryout regular soft tissue maintenance in the form of massage/myofascial release.
Tendinopathy
What is it and what causes it?
Proximal Hamstring tendinopathy is regarded as a commonly acquired injury in longer distance steady state runners. This is due to the gradual onset produced over time with a repetitive gait cycle. As previously discussed, the Hamstring muscle is under tension across two joints in the later stages of the swing phase (as the knee decelerates through extension and the hip drives into flexion). This position is thought to generate compression of the tendon at the top of the hamstring, causing irritation, inflammation, and pain.
Aggravating factors may be a sharp increase in volume or intensity of running, an increase in stride length, or swift introduction to interval/fartlek training or hill running.
Symptoms
- Gradual onset of deep, localised pain in the lower buttock and upper hamstring.
- Initially pain may only present briefly at the start of running, easing into a warmup and returning once the activity has stopped.
- As the injury progresses this pain could continue throughout a run and become present during daily living activities.
- Other activities that might generate the pain would be squatting, lunging, hill running and prolonged sitting.
How to treat it?
- Restrict pain eliciting activities. It is important to acknowledge that pain tolerance varies between injuries. Activity should be monitored and adapted accordingly.
- It maybe required to substitute running initially with an alternative cross training activity such as swimming or aqua running. Cycling can aggravate symptoms due to the additional pressure over the tendon and sit bones.
- Postural changes in sitting may ease compression over the proximal tendon.
- Alternate prolonged periods of sitting with standing. For example, if working at a desk consider the use of a heigh adjustable desk.
- Limit repetitive hip flexion activity in the early phases such as lifting and squatting.
- Avoid stretching the hamstrings in the early phases as this can encourage more compression over the tendon.
- Carry out gentle strengthening and trunk stability exercises.
How to prevent it?
- Ensure that increases in training load are gradual.
- Moderate repetitive up hill running.
- Consider limiting the stride length keeping the foot strike closer to the centre of gravity.
- Increase pace gradually ensuring adequate rest between training.
- Promote cross training to include a suitable conditioning and trunk stability programme.
- Carry out general mobility and flexibility programme without strong prolonged holds/stretches over the hamstring particularly in a deep hip flexed position. It may be better to consider some dynamic stretches or mobility instead.
The main problem between Hamstring injuries and runners is the tendency to try and continue running through symptoms. Unless it is a full-blown hamstring tear, runners are often guilty of either not resting at all or trying to return from a niggle too quickly. In the long run this leads to more disruption to the training routine. The advice would always be to limit the pain provoking activity and settle the symptoms. Its always helpful to get some professional advice from a health care practitioner to ensure that you are doing all you can to aid recovery rather than hinder your return.
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