Chronic Hamstring Injury
Hey Folks,
New Member J.T. here and unfortunately my first post is medical.
Currently dealing with a Chronic Hamstring injury that started last year and has been off and on since. Was fine this spring and early summer, then came back with a vengence a couple of weeks after I did Eagleman 70.3. Have gone thru the medical forum and read all the posts on hamstrings, but thought I'd see if anyone has additional thoughts.
Have been in Physical Therapy for three weeks, doing various stretching and strenghening exercises. Have also been getting ART treatments from a chiropractor who was part of the Olympic Medical team in Athens. Also doing strengthening and stretching at home. Over the year have also had adductor and hip soreness on the same leg/side...believe it's all related but have gotten varying Dr. opinions.
Progress has been slow. Doesn't bother me swimming, is ok during slow runs, but on the bike, starts to ache after about 15-30 minutes. Now per PT, just totaly resting, but have a charity bike ride next weekend (have thousands of dollars committed by people, so need to ride some) followed by Chicago Tri the week after. Plan is to take it easy for both and then probably finish the season.
If anyone has any ideas or references to information, I'll take it. Like I'm sure with most EN athletes, this injury is testing my patience.
Thanks....J.T.
Comments
Hamstrings can be tough as contact is difficult is the adhesions can be very deep and hard to contact.
Does it hurt in the morning at all? How long does it last?
Vince
Some thoughts- 1) when was the last bike fit? 2) did it involve setting up your shoes/cleats/inserts?? 3) what's your home program look like as far stretching/rolling etc?? you can dig the hammies out till the end of time, but if your calves are tight, it will still overwork them and then move into the hip as the body tries to compensate. 4) you say slow running is okay. what happens with fast? 5) how did it start last year? big volume or intensity? was there an injury or more gradual?
sorry to hear about it... I'm with ya... off and on for a few years now. ugh! It's worse for me when I run (particularly hills)... not sure if you've checked out the athletestreatingathletes.com website... some videos there of how you can work out all sorts of different issues... a part of my problem is my glutes not firing properly... so I try to be sure to dig those out, too... and to warm them up before a run/ride... good luck!
The pain is in the middle of the hamstring and not near the glutes. I don't think it's bike seat related, as it bothers me even on my road bike, which I've had the same seat for a number of years. On bike fit, was fit just last year with a new tri bike. On onset of the problem happened last year trianing - did a 60 mile ride on the tri bike and then it hit me on an 8 mile run the next day, so it was a more an injury. I'd say it was a combination of volume and intensity that caused it. Has been on and off since then. Does not hurt in particular in the morning.
Stretching regularly at home and also using a Triggerpoint foam roller. Have also been stretching the calves. I've also been doing hip flexor stretching, which has caused some soreness in the hip, but physical therapist noted that I have very tight hips as well.
I will definitely check the recommended website - never heard of that one before.
Open to any additional ideas/thoughts/questions......just want to get off the couch!
Ok, mid hammy. So, can rule out saddle wing issue. Capacity and load. Your training load exceeded the tissue capacity and hammies are very tough. Does it hurt then 'warms up' after a mile or two?
If not, you likely have an adhesion that is being missed, a tear, tight quad/antagonist causing the hammies to overwork, weak glute or gastroc firing causing compensation.....lots if options and I've seen all of the above. There is an answer for you.
Recently I have a cop that runs marys at a rather pedestrian rate with hamstring complaints. Very similar to yours. It was a combination of L4 disc and sacrotuberous ligament adhesion. I worked her over 3 x last week and she ran: 3, 5.5 and 7 miles Thurs, Sat and Sun.
Thanks for the comments. So the hamstring generally doesn't bother me much at the start, but after about 15-30 minutes, it just starts to ache. No piercing pain to start, just a low grade ache that increases with time. Finally got to the point where I could ride easy, but then trying to do a brick run was not good.
Agree that it's probably a capacity and load issue. I've had tight hamstrings for years, and have worked on increasing the flexibility. Interesting that you mention the disk issue, as I did fracture my C7 three years ago skiing, and still have some residual numbness in my shoulder and weak tricep - but not sure that it's related.
I'll keep working on the PT and ART and will report back in time with an update. Thanks again for your time...J.T.
It doesn't sound like a tendonosis issue based upon your sequellae, which is a good thing.
Question, if you've always had tight hamstrings have you worked diligently on stretching them? If so, are they more flexible? If not, the you might have a neural issue at the spine, sciatic nerve gliding issue (adhesions), tight dorsal sacral or sacrotuberous ligs....
Keep us in the loop.
Acute injuries are easier to manage IMO as chronic issues are normally layered heavily and peeling back the onion is challenging via the Internet.
Vince
Yes - agree don't think it's tendonosis, and you are correct that I've had tight hamstrings and have been trying to stretch them out some for a number of years...Guess it come from years of cycling. Had a PT session today and seeing a little gradual improvement, but it will be slow. Doing the Chicago Tri in 11 days, so it looks like I won't be racing much of it, just cruising and pulling out if it goes bad.
Will advise how this goes and thanks again for your time....
Vince
@Vince - You are in the Roseville area, correct? I think it might be time for me to set up an appointment and getting out there for a diagnosis. Or if you know a rock-star here in the San Jose/Sunnyvale area that you can refer me to (which of course would be a little easier for followups!). Heck, my ham is sore enough that driving out there would be hard (thank you to whoever invented cruise control!).
Mike
Thanks Leigh!
Mike
So been taking time off from training and gone thru a physical therapy session. Didn't see much improvement and did more research and found the following info:
Muscle Tears
The most common injury which I see in middle and long distance runners is the chronic muscle tear. These injuries are almost always localized to a large muscle group, either the buttock, groin, hamstring, or calf. I term chronic muscle tears insidious or menacing because they present in such a way that the athlete can continue to run daily, but when fast running is attempted, especially track workouts or racing, the chronic muscle tear interferes to the extent that either the speed work is painful or impossible.
In contrast to acute (sudden) muscle tears and bone and tendon injuries which improve with sufficient rest, chronic muscle tears never improve unless the correct treatment is prescribed.
The athlete can rest for months or even years without any improvement. This type of injury is usually reasonably easy to recognize. The characteristic feature is a gradual onset of pain, in contrast to the acute muscle tear's sudden onset of pain. At first the pain of the chronic muscle tear comes on after exercise. It develops to where the pain starts during exercise, with the athlete being able to run through the pain. Pain finally becomes a limiting factor, getting progressively worse, interfering with training to the point that speed work in particular becomes impossible.
The athletes describing their injury confirm a chronic muscle tear in their own simple way.
Eamonn Coghlan was aware of injuring his hamstring two years ago but it never became a serious injury until he upped his training last September in his quest toward masters greatness. He describes his injury as 'a drag in the leg and a pain in the butt'; "I cannot get full extension when running fast. There's a constant ache deep in there." Running slow didn't bother him but faster work became painful. Marty Liquori, the legendary US miler, had retired years ago from running due to a calf injury and on every attempt to resume running the calf acted up; his description of it "I get to about 3 or 4 days back running and the pain starts and I have to walk home; I can't get up on my toes". After working with Marty this winter he resumed running and recently ran a 4:46 mile.
Chronic muscle tears occur in muscle at sites that are exposed to high loading. This loading is especially high during faster running. Because the loading is so concentrated over a small section of the muscle, an initial small tear develops at that site. The tear is initially too small to cause discomfort. The athlete may be aware of a tightness or low grade soreness similar to delayed muscle fatigue in the muscle involved. However, once the initial tear has occurred, a cycle of repair and retear develops that leads ultimately to a large tender knot developing in the muscle, which comprises muscle fibres surrounded by scar tissue. I like to use the analogy of scar tissue as being like chewing gum stuck and hardened to a wool carpet.
In the muscle the scar tissue is inflexible so when the muscle either contracts forcibly (shortens and broadens) or stretches (lengthens and narrows) the scar tissue re-tears and the cycle of repair and re-tear develops with increased irritation and a matrix of more scar tissue is laid down. Excessive Scar Tissue Formation at the site of tear inhibits normal contractibility and extensibility of muscle.
TREATMENT
To confirm that the injury is indeed a chronic muscle tear, a physiotherapist needs only to press firmly with a thumb or two fingers into the affected muscle. If it is possible to find a very tender hard "knot" in the muscle then the injury is definitely a chronic muscle tear. When palpated with digital pressure, the knot in question can be excruciatingly painful. Tim Noakes MD in the Lore of Running states, regarding chronic muscle tears: "Conventional treatment, including drugs and cortisone injections, is a waste of time in this injury; the only treatment that works is a physiotherapeutic maneuver known as cross fibre frictions. A better term would be 'crucifixions' because nothing, not even the runner's toughest ever race is as painful as cross fibre frictions applied to a chronic muscle tear. Therein lies the key to the treatment of these injuries.
A chronic muscle tear will only get better if (a) the cross fibre frictions are applied to the injury site, in this case the tender knot in the muscle, and (b) they are applied sufficiently vigorously. If the cross fibre friction treatment does not reduce the athlete to tears, either the diagnosis is wrong or the physiotherapist is being too kind. "This is the one treatment for which you must have a physiotherapist who has big hands, the forearms or a gorilla, and unbridled sadism."
I have been named everything from Hitler, to 'thunder thumbs, magic fingers, Saddam Hussein and worse,' but the painful treatment is well appreciated by the athlete as chronic muscle tears respond rapidly to six or eight sessions of therapy. Physiotherapists who specialize in sports injuries usually have expertise in administering cross-fibre friction and because of the invasiveness of the therapy, which I term "bloodless surgery," it is important to go to a therapist with experience in the physiotherapeutic maneuver.
PREVENTION
To avoid chronic muscle tears the athlete should be fastidious about stretching, especially the main locomotive muscles which cross two joints, ie, the hamstrings, gastronemius, quadriceps and adductors. Muscle strength imbalances between opposing muscle groups should be corrected. The strength balance between hamstring and quadriceps is very important and serious athletes should have their strength ratios tested on a Cybex or similar strength testing machine. At all times, but especially when doing speed work, it is imperative to be adequately warmed up. Prevention is better than cure, but for the runner who has the symptoms of a developing chronic muscle tear a little treatment early on saves time out and a great deal of agony later on.
The hamstring symptoms really fit my situation, so I've started working with my ART doc on this. First session, found that marble of scare tissue deep on the hamstring and have been going after it aggressively, so I'm optimistic this will come around and I can start training for next years IMCDA.
Would welcome any additional thoughts.....
Thanks....J.T.
if it were me?? get the thing dug out once and for all by a pro. look for ART or someone who is graston certified (www.grastontechnique.com) or both. it's been a while. Going to take some quality work to get rid of it. the work on your end is to maintain the new mobility as you get it loosened up, so you have to be super dilligent about stretching and strengthening.
What I'm unsure about is the best way to gradually get back into training....Should I go thru a period of time where I just strengthen and stretch or get into some slow training work while doing strengthening and stretching at the same time. I'm speculating that it may depend on how it feels. Just don't want to screw this up again since it's been driving me nuts for a while...
Thanks....J.T.
Hi folks,
I've recently learned a hamstring stretch that ACTUALLY WORKS for me...and it's been years since I've started searching. After this thread started I brought up my ham and glute pain to my local chiropractor, and he showed me a stretch he does:
1. stand with feet shoulder width apart.
2. lean forward as if you're going to touch your toes (though I can usually only get 10" away from my toes at the beginning).
3. hang for 2-3 seconds (just hang)
4. stand up straight, pause briefly, and repeat
5. each time down I typically get 1/2 to 1" lower for the first 5 or 10 reps
After about 10 reps, I intentionally lock out my knees and do the sequence again - this lengthens out a different set of muscles.
I don't push to make it hurt, I just hang.
If I get dizzy, I do shorter pauses.
I've had good luck doing this after a run, or even cold (I think that since it's 'gentle', it isn't hitting cold muscles hard).
Mike
@ JT- if you are currently undergoing treatment honor the process and sit tight on the training front. this is a great time to hit the pool for deep water running and easy biking (very non-OS type workout!). ideally you want to keep moving to maintain mobility but not overly tax the area either. stretching is key and most effective following your treatments. Hit the A-T-A website and the injury box on the right to look at stretches in either the Runners Knee/ITB treatment posts. You can also go to the EN wiki for a lower body strengthening routine. The deadlift exercise and ham curls with the stability ball will be good for you.
07 Nov 2010 07:56 PM Edit Quote Reply Alert
CRAP
R hammy went from playing the role of 'Sore' to an official 'Injured'.
Don't think it'll require much more than a few PT visits. It usually doesn't bother intense cycling sets, just shows up when I run out of my comfort zone. I expect that Tues and Thurs bikes will be unaffected. Wed run might be a teaser. Should be able to get to PT on Friday.
2 x .5mi (3') at z4/TP (ie 7:04) then 1 x 1mi at same pace...the half mile intervals were sore but not so bad as to slow down. Then on the 1 mile interval, I felt it lock up pretty good at about 3/4 mile. Walked it off. May have pulled up just in time. We'll see.
Autopsy:
Reviewing my watch showed that I was going too hard. I wasn't necessarily trying to. It was dark and I was checking pace intermittently. Looks like I was running 6:35- 6:50 for most of the work sessions. (that's about :30 faster than goal pace) That being the case, it doesn't surprise me that my leg acted up.
I'm not interested in asking for a gimp version of the OS plan. I plan on doing the sets as prescribed, as much as possible, and just get back in the habit of babying my leg through PT and stretching. Seems that the OS requires plenty of time to recover between runs. i wouldn't be surprised if I'm running Wednesday.
Just send some good mojo this way, will ya?!
That was yesterday. Today, its tender. Tight if I squat. But not so bad to make me think I have to take time off. Tomorrow's Brick Run calls for an ez run with a few strides. That seems like it'll be a decent test, predictor for Wednesday's more aggressive run.
any feedback would be appreciated.,
Chris
@Leigh - Thanks again for your comments. Very reassuring to hear from another expert in this field. I'm in full agreement on taking it easy for now - haven't been doing much for a couple months. Will start stretching after the graston sessions and slowly start exercising again before getting into full blown training.
@Chris - take it from someone who's been dealing with a hammy issue for over a year - take care of now so you don't end up where I am....
Thanks again everyone......J.T.
Thx
I 'pulled' my hamstring at b'ball practice, about 19 yrs ago. And now, when I run too hard (relative, and fitness dependent), I have this ol'friend visit me for a few weeks.
Thanks, Leigh, for your info and expertise. I found this thread a couple of weeks ago when my hamstring began to hurt whenever I attempted the L4 efforts on the half and one mile intervals. I backed off, found a graston certified PT, and I am back on the road with no pain at all. Paying a lot more attention to my stretching now, and warming up more methodically. So, I appreciate your sharing this, it saved me a whole lot of recovery time to know what to do as soon as it started. I get to do my first race of the season (Sprint Tri) this Saturday. I couldn't have been ready without this thread.