Hamstring Rehabilitation

Hamstring Rehabilitation

Hamstring injuries are a common occurrence in most field sports. If you’re one of those people that can’t go through an entire season without hamstring, groin or related lower back pain then this is for you.

Now I know that the cause for hamstring injury can often differ, but I have a very straightforward system that will likely help everybody with hamstring issues.

The system is broken into 7 key areas:

  • Range of motion testing
  • Mobility
  • Activation
  • Body position
  • Strength exercises
  • Running posture drills
  • Conditioning

Range of motion testing (Straight Leg Raise)

To start with you need to know how much wiggle room you’re working with. The ideal straight leg raise has 90 degrees of range at the hip. So lay down on your back and raise one of your legs as far as you can, Keep your leg straight!! Take note of where it finished up. Now to show how important our 4th point is (Body position) I’m going to get you to squeeze your butt and tuck your pelvis under and repeat the test. Where did you get to now? It was better wasn’t it. This was because you were in a better position. Which gives the impression that your hamstrings now have more length. Replicating this while standing, walking and most importantly running is an absolute must if you don’t want to repeat that injury.

Mobility

This is the key to building your very own injury free body. Everyone has his or her own aches and pains. But it’s your ability to manage these aches and pains that will keep you injury free. This is pretty easy when doing your mobility work. Simply put if it hurts, you’re doing it right and you need to do more. For all injuries you often need to not only look at the injury itself but also look up and downstream of the injury site to uncover the point in the chain that is causing your injury. For the Hamstring it’s very important you also manage the areas that are directly linked, often times you will find that by working on these areas your injury site will feel better. The areas you will address for the hamstrings are:

  • Thoracic spine: Lacrosse ball release, Weighted lying cross
  • Low back: Low back release
  • Hip: Hip capsule mobility, Couch stretch
  • HAMSTRING: Hamstring release
  • Groin: Adductor release
  • Knee: Flexion gapping 

Activation

Once you feel loosie goosie it’s time to turn on the muscles for correct body positions and movement patterns. The following exercises focus on actively lengthening the previously restricted areas (Quadruped rotations, Inch worms, Straight leg pull downs) and firing up the previous un-fired up prime movers (Glute bridges, Monster walks, stepping lunge). All exercise demonstrations are linked in the table below.

Body position

This is the entire goal of the last 2 points. First find where your current position is and if is sucks fix it, then turn on the appropriate muscles to move like a champion. Body position is a little tougher to fix than mobility because you can’t take a smash and crash approach, it requires a bit of body awareness. So honing in the following positions is key if you’d like to progress quickly and not get injured once you get back into competitions. You must develop these key body positions.

  • Glute squeeze/Pelvic tuck/ Flat back position: This is the key body position you must learn. Being able to set your pelvis underneath your trunk will not only decrease the tension in your hamstrings, lower back, hip flexors and superficial abdominals. But it puts you in a better position to be more powerful and the beauty of it is, its simple. All you need to do here is squeeze your butt and bring your pelvis underneath your torso. Super simple right.
  • The hard part is the next step: holding this position while standing, walking and running. The way we teach this is by practicing your forward lean running on a wall. Then literally all you have you do is take away the wall and continue to hold that position. Make a conscious effort to correct yourself as much as possible when first learning a new posture you’ll find yourself defaulting to your old position a lot so stay aware.

Strength

This is where we start to consolidate those mobility and movement improvements. Moving under load enforces movement patterns so ensure you’re moving as well as possible here. These are the best exercises for you to consolidate all of your previous hard work!

  • Good morning
  • Single leg deadlift
  • Step ups
  • Stepping lunge
  • Bulgarian split squat
  • Squat therapy 1min
  • Kb swing

Running drills

You can begin this in conjunction with your strength program but you must have mastered your body position before moving onto running drills. You’ll need to hold your body positions while running at all speeds. Your drills are aimed at enforcing the pelvis under trunk position; the key is mastering these running positions without defaulting and arching your back. Forward leaning wall running is the ideal tool, once you can hit that position for 2 minute efforts practice without the wall. Remember: Don’t over extend your lower back, don’t heel strike and maintain neutral spine position.

Conditioning

Once you’re a killer at the running drills you’re expected to carry them over into your conditioning drills. Use the first few weeks to practice these positions, as you’ll be walking and jogging laps at a slow speed, so you’ll be able to emphasise correct positions. Make sure that you are progressing pain free, if you’re getting increased soreness in your injured areas pull back the load until you’re confident to progress. A progression through your conditioning will look like this:

  • Start with walking: A great opportunity to work on pulling your pelvis underneath your hips while moving forwards.
  • Light jogging: Start with 1-2 laps of your oval, start slow and run within yourself. If it starts to get tighter slow to a walk and try again in a couple o days.
  • Long slow distance: This is where you have to try build your gas tank again. Depending on your sport you may be running upward of 3-4km in one effort.
  • Accel/Decel training: Begin Accel/ Decel training when you’re pain free during and the day after light jogging. Set up three 20m distances. Use the 1st 20m to accelerate up to a manageable pace (55-65%), then maintain pace for 20m and steadily decelerate over the final 20m and come to a complete stop before the final cone. Complete 6-8 repeats building pace as you go.
  • 100m+ run throughs: This is where you’ll begin to challenge yourself and your hamstring. So start slow and progressively build. Remember if it feel tight or painful the next day you’ll need to take a few steps back and do more mobility and positional work.
  • Change of direction running: Shuttle runs and figure 8’s are easy enough to set up and do.
  • Competition specific: Re-introduction back into training.

Extras

  • Do not stop the mobility and activation exercises even once you’ve returned to competition.
  • Sleeping with a pillow for support
    • If you sleep on your back place a pillow under your lower legs to help flatten your back during the night.
    • If you sleep on your side sleep with the pillow between your knees to keep your pelvis neutral.
  • Avoid sitting for extended periods
  • Avoid excessive lumbar extension
  • Ensure you’re hydrated, a simple way to test this is to get your thumb and press it into your shinbone for 5 seconds, if you remove your hand and there’s an indent after 15 seconds you need to drink more water.
  • Skill specific: Remember if you play a sport you’ll need to find time to practice your sporting skills where you can. You don’t want to get back into training with no touch for the last 1-2 months.
Mobility Activation Strength Conditioning – Progression
Lying crossover Quadruped rotations Good mornings Walking laps
T-spine release Straight leg pull downs Single leg deadlift Slow jog
Low Back release Inch worms Step ups Accel/ Decel training 20:20:20
Couch stretch Glute bridges Bulgarian split squat Long slow distance (1-2km)
Hip capsule mobility Monster walks Squat therapy 100m+ run throughs
Hamstring release Stepping lunges Kb swing Change of direction running
Adductor release Forward leaning wall run   Sport based running
Flexion knee gapping      

 

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