Hamstring Injury and Recovery

As you know, I injured my hamstring during the 2014 Boston Marathon.  The good news is that it was caused by overuse and was not torn.  The best description of my injury according to my physical therapist/masseuse was a pulled hamstring.  It is more commonly referred to as a hamstring strain.  Simply put, it is a tear of the hamstring muscle fibers.  My hamstring strain is rated as somewhere between a Grade 1 and a Grade 2 strain.  The injury has definitely limited my ability to run at all and walk comfortably.  I wanted to discuss with you what a hamstring strain is and how I am rehabbing it so that I can resume my normal running routine.

Let me start by describing what the hamstring is.  The hamstrings are the tendons that attach the large muscles at the back of the thigh to bone. The hamstring muscles are the large muscles that pull on these tendons.  These muscles help us bend our knees, extend our legs, drive us up hills, and power finish-line kicks.  It is important to have strong hamstring muscles. They also attach up onto your pelvis which is why a hamstring strain can cause some pain in the hip and gluteus maximus area.  As a runner, you need to make sure that your quadriceps are not stronger than your hamstring muscles.  If you don't maintain a balance it can lead to hamstring injuries.

Hamstring issues usually arise because your hamstring muscles are weak.  It is believed that very flexible people are prone to hamstring problems because their overly stretched-out muscles are more vulnerable to damage.  I have been really diligent in my stretching over the years and now wonder if it was a partial cause of my injury.  I am not suggesting that you should skip stretching altogether because it is also known that people who can barely touch their toes or who sit for long periods of time (like me at work) are also at risk for this type of injury. As most of you know when you have tight or shortened muscles you are placing them under greater tension during exercise.  And as I alluded to above, runners' with strong quadriceps can overpower their hamstrings, which sets them up for injury.

What I have discovered in speaking with my physical therapist and reading up on the injury is that treatment of a pulled hamstring is dependent on the severity of the injury. But all of the data I have collected says that the best treatment is to simply rest. As a general rule, if you have a hamstring strain, you can do activities that do not aggravate your recent injury. What I needed to do was rest until I was pain free giving time for the injured hamstring muscles to heal.   Allowing time for the muscle to rest is the first step in treatment of most hamstring injuries. Rest allows the swelling to subside and inflammation to settle down.  If I resisted this treatment, I was sure to prolong my recovery time. 

Secondly, I was going to have  to stretch.  Stretching can begin soon after an injury.  But you cannot, aggressively stretch the area or you will exacerbate the injury. Stretching should be gentle and not painful. What my physical therapist told me was to use the normal stretches that I have been using for this portion of my legs.  She told me to stretch to the point of discomfort but not pain.  This is a very fine line.  You should never have pain while you are stretching -- even healthy muscles.  If you are experiencing pain you need to back off the stretch before you cause an injury.

If you are a runner like me, you should be seeing a masseuse regularly. I also recommend that you find one who is also trained in physical therapy.  This person can help guide you with appropriate treatments for any number of running maladies.  For this injury my physical therapist has been using ultrasound, electrical stimulation, and therapeutic massage.   After 3 session with her, I have been able to resume my running although at a much slower and less impactful pace.  I intersperse some street running with elliptical machines.  Running a slow, easy pace is usually less bothersome than attempting intervals, speed work or hill repeats. She also recommended that I could bicycle, pool run, or swim as good alternative activities. The good news is that I am feeling much less pain now when I exercise. 

What I am now starting to do is strengthening my hamstrings with one-legged hamstring curls (raise the bar with both legs, then slowly lower it one leg at a time) and one-legged dead lifts. I am also including bridges.  This is where you lie on your back with your feet on a chair or exercise ball. Raise your hips, then lift one leg into the air. Slowly lower your hips back down to the floor, using the supporting leg. Return that leg to the ball. Repeat with the other leg.  I am not very coordinated at these yet.  And I have purchased a  foam roller to alleviate tightness before and after my runs. In addition, I will be seeing my physical therapist at least monthly to have her use active release technique (ART) and deep-tissue massage  to keep me on the roads.

It has been over a month since the marathon.  I am happy to be nearly recovered from the injury.  I will need to be a little careful over the next several weeks to make sure that I don't reinjure the hamstring muscles.  Running has become such a huge part of my life and I don't want to lose the ability to run.  I also have to recognize that I am getting older.  Slowing down is a natural part of this sport as you age.  I am just not ready to give in.

May 5 – 5.20 miles (45:44, 8:49 pace)

May 6 – 6.00 miles (1:00:00, 10:00 pace)

May 8 – 5.70 miles (1:00:00, 10:32 pace)

May 9 – 5.20 miles (45:57, 8:49 pace)

May 10 – 7.10 miles (1:05:33, 9:14 pace)

May 11 – 6.10 miles (1:03:00, 10:20 pace)

May 12 – 5.20 miles (48:11, 9:14 pace)

May 13 – 5.30 miles (1:00:00, 11:20 pace)

May 14 – 6.20 miles (54:02, 8:43 pace)

May 15 – 5.10 miles (58:20, 11:26 pace)

May 16 – 6.10 miles (55:57, 9:10 pace)

May 22 – 5.20 miles (47:55, 9:14 pace)

May 23 – 5.20 miles (49:05, 9:23 pace)

May 24 – 5.50 miles (1:00:00, 10:55 pace)

May 25 – 7.10 miles (1:05:48, 9:14 pace)

Total Miles:  86.2 miles

2014 Total Miles:  895.6 miles