Getting Back to Running After a Hamstring Injury

By Konrad Barnes

In our previous article we spoke about my personal injury history. Specifically my hamstring injuries. In a nutshell, I suffered 4 separate hamstring related injuries in plus minus 7 years. Yes, it sounds terrible, but honestly it was my own fault. Because the truth is I didn’t know anything about preventative rehabilitation or about risk factors that essentially set you up to fail. It was only after my final hamstring tear that I did my due diligence. And that’s what this second article will all be about:

My journey of understanding the importance of the hamstring muscle group for runners.
My injury treatments and the same rehabilitation principles I followed to recover and remain injury free for the last 6 years.

How Important are Our Hamstrings?

In our previous article we covered the anatomy and the biomechanics of the hamstring muscles. We should note that, even though this muscle group plays a vital role in lower body mobility, they don’t work exclusively. They almost always work in unison with other major and minor muscle groups. Which I personally feel, reinforces their significance during movement.

Now as a runner, your hamstring has two basic functions:

1
Extend the hip during running, which simply means moving your thigh backwards.
2
Flex the knee, which means to bend the knee. This can be passively or actively.

And when you take these actions and group them together they describe the basics of gait.

Yes, this is oversimplified, because running requires much more than just flexion and extension. Concepts such as stability, balance and conditioning all come to my mind when you think about all the factors that contribute to gait. But that being said, at the core of running mechanics the hamstrings reign supreme. Because at the end of the day, without them we can’t run.

How to Treat a Hamstring Injury

During the acute phase of any soft tissue injury the RICE protocol remains a staple:

Resting is your body’s natural therapy. It’s quite simple: No rest, no recovery.
Icing the injury will significantly help reduce unwanted inflammation and improve circulation to the injured area.
Compression helps stabilize and protect the injured area to prevent further injury. As well as aid in reducing unwanted inflammation.
Elevation is used as a method to improve circulation to the injured area. This is of crucial importance especially when you’ve injured a part of your lower limb.

So whether it’s a hamstring strain or a tendinopathy RICE always plays a vital role in the recovery process.

However, the RICE protocol is only effective during the acute phase (initial 14 days). From week 2 onwards pain and inflammation can be managed through the use of NSAIDs (Non-steroidal anti-inflammatory drugs).

The final phase of treatment (before rehabilitation) is therapy or more specifically physical therapy. This is the part where you look up your local PT and just trust the process.

NOTE: TREATMENT PROTOCOLS MAY DIFFER FOR SURGICALLY TREATED HAMSTRING INJURIES. FOR THESE PLEASE CONSULT YOUR SPECIALIST PHYSICIAN FOR GUIDANCE ON YOUR PROGNOSIS.

Hamstring Rehabilitation

When it came down to my own journey my actual rehabilitation was the turning point in my recovery process. After suffering successive hamstring injuries and not really being disciplined in my rehabilitation I finally decided to make a commitment to becoming injury free.

That’s why the following information is the same steps I followed to fixing all my hamstring issues. Now I must say I personally haven’t suffered from a hamstring tendinopathy (I had different grades of hamstring tears), however I have had clients who I have successfully helped recover from proximal hamstring tendinopathies. But despite my lack of personal experience, the principles remain the same whether it be a hamstring strain or tendinopathy.

Let’s get to it shall we.

These are my 3 phase plan to get you injury free. These are 3 principles that will act as a sort of guideline for how you would design and implement your own specific program.

Phase 1

This phase will be implemented for the initial two weeks of your program
During this phase the majority of your rehabilitation will be based on the principle of ISOMETRIC training. In short, isometric training is muscular activation without any movement. Think of a plank? You're essentially staying in place yet you’re getting crazy activation and contraction in various muscles.
Isometrics serve as the initial phase because they allow activation and stretching of the injured tissue without the risk of reinjury.
No running is done during this phase.

Phase 2

The Eccentric phase, this probably the most important phase in your rehabilitation. Eccentric training is loading the muscle in its longest position. Think of a reverse bicep curl, the load is moved as the muscle belly lengthens.
Eccentric training has been scientifically proven to aid in muscle recovery and provide significant injury protection.
This phase can last up to 6 weeks and fitness is maintained with zero to low impact cardio exercises like cycling or swimming.

Phase 3

Concentric and RTP phase. RTP is short for return to play, and concentric training is the standard mode of exercise most people follow. Exercises like bicep curls, hamstring curls etc all fall under this category.
The aim of this phase is to strengthen the injured muscle and slowly return to your sport of choice.
So in your case you would be hitting the gym hard and slowly reintroducing running to your training plan.
This phase may last up to 6 weeks depending on the severity of your injury.

However, these phases won’t take place independent of each other. Overlap will definitely occur because all 3 forms of exercise training complement each other. So despite the fact that during phase 1 your primary focus remains isometrics, a certain percentage of your training will be eccentric in nature. This will apply to both the other phases as well.

Make sense?

How to Start Running After a Hamstring Injury?

This is a tricky one. But the number one thing you need after you’ve recovered from a hamstring injury is confidence. Confidence in your own abilities to run without any fear of re-injuring yourself. How do you achieve that?

Finish your rehab! Seriously, most runners get overly eager by week 6 of their rehab because they feel “great” and then boom! Injured again. Trust me I was that guy twice! Smh.
Practice. Slowly ease into your running routine. Remember you're essentially retraining your neuromuscular system to be able to successfully complete a race without any injuries. You might be tempted to shoot out of the blocks, but please don’t?

All it takes is a split second of bad judgement and your back to phase 1. Again, do as I say, not as I did haha!

All in all, my journey with hamstring injuries has been quite the roller-coaster. But today I can confidently say that I am injury free and performing at a higher level than I did before I got injured in the first place. So I hope my mistakes can help guide you on what not to do, because at the end of the day isn’t that basis for wisdom?

I’ll let you decide. Until next time, run forrest run!