Hamstring Injuries: Stretch or Strengthen
Straining your hamstring can be one of the most frustrating injuries for runners and team athletes alike. They are known to linger for months — and when you finally get rid of it, you’re out for another run or game and reinjure it. It’s not uncommon for someone to come see me with a history of multiple hamstring strains over and over again.
The first and most important reason why these injuries tend to linger for ages—and return so often—is because, in my opinion, they are treated very wrong most of the time. To understand why, it’s important to understand what is actually happening during a hamstring strain.
Typically you injure your hamstring when running fast. It’s really rare to mess up your hamstring if you’re slow. It will generally happen on intense speed or hill days, or when you’re full-out sprinting. What happens is that you drastically and rapidly overstride and extend your knee too fast. Your hamstring, which is supposed to decelerate that knee extension, can’t handle that rapid overstretch and ends up tearing to some degree.
A hamstring strain is just a relatively mild tear. You may hear a pop or a tear sound, which is typically worse, and it may swell and bruise within the next few days (again, those are on the more severe end).
Where most people go wrong with their rehab is that they strain their hamstring, and the immediate plan of attack is to stretch it. You just injured it by stretching it too much. Stretching it more isn’t the answer.
When you do static (longer duration) stretching to a recently strained area, your body lays down scar tissue to sort of fill that void. Scar tissue, while dense and firm, isn’t a great filler. It’s not stretchy or elastic like muscle is, so when you’re going for another fast run and overstretch it, it just rips open again like a scab. It might feel good to do those stretches in the moment—and maybe even immediately after—but you’re not letting it recover as well as it can and are definitely risking a reinjury.
So what does work?
You can try to foam roll your hamstrings, though I find that it’s hard to get a lot of body weight onto the hamstrings. And by no means would I recommend that you roll directly onto the area at first anyway.
What you can start foam rolling and stretching is your quads and hip flexors. Let’s pretend you have a history of right hamstring strains. It would be common for you to have really tight quads and hip flexors on the opposite (left) side. The reason for this is pretty simple when you think about it. If you’re tight on the left side in the front of your hips, you won’t be able to extend back into your stride. In order to maintain a good, “healthy” stride length, you’ll compensate by reaching out extra far on the right side. The faster you’re going, the more that hamstring needs to work.
Once most of the pain starts to calm down, do a trigger point technique to your hamstrings by sitting on a firm chair and place a lacrosse ball under your thigh. Find a tender spot and then extend and relax your knee a few times. At first, don’t do this directly on the injury but around it. As it calms down more, you can get closer and closer to the area.
At this point, you can also add in some gentle dynamic stretching (emphasis on dynamic!). I stretch the hamstring by standing and placing one foot on a stool, coffee table, couch, etc. Keep a slight bend in the knee that you’re stretching. Then bring your chest towards your knee 10 times. Again, your muscles are three-dimensional, especially your hamstring, so also make sure to bend down and off to either side several times.
You can also add in some running-specific functional strengthening exercises. Here are a few I’d recommend:
Squats with various foot positions
Multi-Directional Lunges with hamstring and glute emphasis
Step Ups/Downs
Bulgarian Split Squats
Single Leg Deadlifts
Start with the easier strengthening exercises (squats) and only do a couple of sets of 10 or so. Then build up to doing more sets. After that, add in some walking and side lunges. You can also do some rotational/diagonal lunges. Eventually add in the more difficult exercises like high step ups/downs, towel slides, Bulgarian split squats and single leg deadlifts. Slow and steady is the best way to recover from hamstring strains so the most important thing is to avoid rushing back. At Pinnacle Chiropractic, we will assist you in the recovery from beginning to end with stretching, cold laser therapy, graston, kinesiotaping and eventually strengthening the musculature to avoid lingering issues.
