Hamstring injuries can be a real pain in the butt (literally). Hamstring strain is a common injury in all sports that involve running, and in distance runners can be the cause of deep gluteal pain (White, 2011). This is the one running related injury that shows up in my life occasionally, and I can attest to how irritating it is. Perhaps more frustrating is the conflicting research showing how to "deal" with it. Interestingly, the cause of the injury is often forceful eccentric contraction, which occurs during the swing phase of running gait, when the hip is flexed and the knee extended. If the pelvis is in an anterior tilt, the hamstring is a lengthened position (see image below). As Panayi (2010) points out, both anterior pelvic tilt and/or pelvic asymmetry puts increased demand on the biceps femoris origin and increases functional demand of the hamstring group because the synergist muscles (glute max) are inhibited. I have had a number of clients suffer from hamstring strains, all have been female, and all have been prone to excessive anterior pelvic tilt. The literature shows the best way to treat hamstring strain is using an eccentric approach to improve flexibility and strengthen the musculotendinous junction (White, 2010). The rationale for this is that eccentric strength training might allow active tension to return to normal by restoring the musculotendon length (Heiderscheit, Sherry, Silder, Chumanov, & Thelen, 2010). However, by ignoring the lumbo-pelvo-hip complex, the issue of why the hamstring was injured in the first place is being ignored. Heiderschei et.al, cite a study by Sherry and Best that found a progressive agility and trunk stabilization program emphasizing neuromuscular control was more effective than a progressive stretching and strengthening program at reducing hamstring reinjury risk- after 1 year, 70% of the S&S group had been reinjured, while only 8% of the neuromuscular group had experienced reinjury. This is more closely related to my experience; eccentrically training my hamstrings when they have been injured doesn't feel good. I have always felt I needed a different approach to training my hamstrings, I just wasn't sure what it was.
Enter Eric Cressey's blog on hamstring strains and me learning some PRI techniques. I have already written about how DNS had a positive impact on changing my thoracic position. PRI takes it a step further and begins to address pelvic position, thoracic position, and thoracic and pelvic asymmetry. Some of the lower body PRI exercises are specifically designed to integrate hamstring and glute function using a slight posterior pelvic tilt and proper thoracic positioning. I was learning these when I read Eric's blog here: http://www.ericcressey.com/5-reasons-tight-hamstrings-strain. Even though he works with baseball players and probably doesn't spend a lot of time assessing runners, I finally felt like someone was giving me permission to avoid end-range movements while trying to improve my hamstring strength and stability. Up until this point, I was getting ART once every three or four months, which makes my hamstring feel fantastic, but (as is the case with most manual therapy work), wasn't "fixing" the problem. I was fully aware that my movement patterns were causing the hamstring to flare up again (although to a lesser extent and in a different spot, oddly enough). It's only been a month, but I can honestly say the hamstring feels like it's healing. It doesn't bother me after riding (which seemed to be the biggest culprit, although I am sure running wasn't helping), and yoga no longer seems to aggravate it. I am doing a lot of spinal mobility/breathing/PRI/DNS type work, and throwing in the occasional backwards stair walk. The strengthening movements I am doing in the gym, such as deadlifts, are performed after some glute/hamstring integration work and no longer feel like they might be doing more harm than good. The crazy thing is, training the hamstring in a shortened position with a posterior pelvic tilt feels really good- more how you expect something to feel when it is rehabbing an injured area. I am all for a little mobility, but as Eric states in his blog, you have to assess the individual. Not every rehab protocol will work for every person. And sometimes, the research focuses a little too much on the site of pain rather than the source of pain.
Yours in health and wellness,
White, K.E., (2011). High hamstring tendinopathy in 3 female long distance runners. Journal of Chiropractic Medicine, 10(2), pp. 93-99.
Panayi, S., (2010). The need for lumbar-pelvic assessment in the resolution of chronic hamstring strain. Journal of Bodywork and Movement Therapy, 14(3), pp. 294-298.
Heiderscheit, B.C., Sherry, M.A., Silder, A., Chumanov, E.S., Thelen, D.G., (2010). Hamstring strain injuries: recommendations for diagnosis, rehabilitation, and injury prevention.