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1067 Views 3 Replies Latest reply: Aug 25, 2012 4:32 PM by JamesJohnsonLMT RSS
hayes55987 Amateur 9 posts since
Feb 28, 2012
Currently Being Moderated

Aug 22, 2012 8:05 PM

Finishing up Hamstring Pull Recovery?

I have been running for about 2 years now total and am stil trying to recover from a hamstring tear (I believe).

How it happened: Overtrained for a half marathon and on a long descending run, I felt kind of a pulling in the back of my leg behind my knee and slowed down. I kept running the rest of my long run and by the end it was a little tingly and could not put pressure on it. Very tight feeling. Went back to apartment, iced a little bit, but didn't think much of it.

As with all inexperienced runners, I kept trying to run on it and made a mess of things

 

Eventually I could not run on it any further and tried to get it diagnosed. The pain seemed to change/morph. I started out thinking it was runners knee with the patella and eventually the pain started shifting to the back of the knee and along the medial side. I went to two PT's and both diagnosed me as having ITB which I kept explaining to them was not the problem.

 

I believe I've eventually pinpointed this down to being a hamstring pull of some sort and I have been trying to recover from it since May now. It's "healed" and I can run on it but only when I have the leg wrapped in a compression form or with athletic tape. This has me worried since I did not hear any pops when I was injured, no bruising, etc which pointed to a level 1 strain which most say recovers in 1-2 weeks. I spoke to one sports therapist in a large city who thought the strain may have come from my pronation on my left leg. I have normal arches but they do collapse. She thought the collapsing of my arch when running was pulling my hamstrings and over-lengthening them which could in-turn result in my hamstring pulls and irritation. I have tried running with orthotics and it does help but I still have my leg wrapped and hamstring compressed.

 

Should I just keep nursing this along and running 2-3 miles every 3 days or so? Should I start isolating this muscle and trying to build strength? very lost and confused runner who has been reading to much. I have seen a few doctors around here and PT's and all are diagnosing it as..on it's way to being healed, ITB syndrome, hamstring inflexibility, etc.

 

Thanks for your time! I appreciate it,

  • velocityJ Amateur 9 posts since
    Jun 7, 2012
    Currently Being Moderated
    1. Aug 23, 2012 3:04 PM (in response to hayes55987)
    Finishing up Hamstring Pull Recovery?

    If it is a hamstring injury then those can take awhile to heal completely. It sounds like you're getting a lot of different opinions about what the root problem is. Here is an article that was published in the Journal of Orthopaedic and Sports Physical therapy that talks about the treatment of hamstring injuries:

     

    Hamstring Strains: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention

     

    It's geared more toward clinicians but worth reading to maybe gain some insight as to what could be going on. I think you're best bet is to find the doctor or PT who you trust the most and stick with their recommendations until the injury is completely healed.

  • JamesJohnsonLMT Legend 1,150 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Aug 25, 2012 4:32 PM (in response to hayes55987)
    Re: Finishing up Hamstring Pull Recovery?

    Medicine tends to focus too closely on the immediate problem, and all too often thinks past the big picture that highlights the etiology. Kudos to the Large City Sports Therapist and your sister for pointing out a possible connection to pronation. I want to add to that scenario by noting that a long descending grade on a long run might hammer your quads to the point of increasing resistance for your hamstrings when completing the gait cycle.

     

    Meanwhile, pronation often involves the external rotation of the femur which would lengthen the inner hamstring during this time, and cause it to be the first to take up the slack, if there is any (which I suppose is what they were talking about). The Hammies anchor on the base of the pelvis at a point we call the "sit bone," where you tend to feel the most on a bike seat. Rotate the femur the other way (internally), and the stress would be on the outer hamstring, which is why isolated stretches feature internal/external rotation of the femur/knee/foot. I suppose I could have said "leg," lol.

     

    The word on orthotics is that in general, they are a bit of a crutch, and extended use can lead to other problems, even when it seems to solve others. The best approach is to find the anatomical explanation for the pronation, which often involves foot structure or hip mechanics. Some of these traits can be trained out, and some require a much more specific and sophisticated type of orthotic approach, to compensate for anatomical shortcomings in the bones of the foot. You pronate for a reason. Find it.

     

    Is your arch flat? Are the bones of your foot hypermobile, or in the Morton's configuration? Is there sufficient tone/function in your Tibialis Posterior? Is your Plantar Fascia stretched out? Most people have a comparative leg-length discrepancy. Answers to these questions can go a long way toward developing a fix or a treatment plan.

     

    Sounds like you have learned a lot that may or may not be relevant or possibly confusing, and have consulted the wisdom of several professionals who have learned from their individually unique experiences and patients. You will hit pay dirt when you find someone who has solved this exact problem for a person with your exact anatomy, or can extrapolate from something similar. Then again, you should keep learning more, because this problem can be solved best by someone who follows every lead to the bitter end. If that's not you, then you can help save someone else some time with quality sleuthing.

     

    Meanwhile, make sure to relax or roll out those Quads, perform light ROM stretches in various degrees of femur rotation to look for limitations, relax or roll out the Hammies, and keep up the neuromuscular re-education in your down time. Injuries are a gift to get stronger and prepare for the recovery ahead.

     

    Don't forget the Adductor muscles in the medial thigh, which serve as auxiliary hip flexors and rotators. If you've done Yoga, be aware that the Sartorius muscle, which wraps from the outer hip to the inner knee, can be strained in Lotus position. When injured, it hurts. A lot. Forget about stretching it though, since that is pretty much impossible to do. Its pain tends to manifest on the inner knee but can produce outer-thigh burning that might mimic ITBS. This occurs when the tight muscle compresses the nerves. If you feel better sitting than standing, and worse when extending the leg back in a stretch, suspect this muscle.

     

    Chances are very good this is a composite problem, and not just one to lay at the feet of a single anatomical part. The key is whatever excess motion may have led to the breakdown of tissue and/or inflammation and/or hypertonicity of a muscle or subsection of a muscle. Occasionally tendinous attachments, ligaments, and bursa are involved. If you were involved in cross-training or other exercises while piling on the miles, this problem could be a symptom of such overload.

     

    A lot of times advice comes out of sequence. People train, get a problem, learn what they could have done to prevent the problem, and start doing it, too late for anything but to make things worse. Take this rest time to relax, restore muscular balance, and gradually prepare and build up to your eventual goal of the Half. I've had to skip races I overtrained for, or risk hurting myself for false glory. There will be plenty more races to run.

     

    An interactive aid to studying anatomy and function... http://www.getbodysmart.com/ap/muscularsystem/legmuscles/sartorius/tutorial.htmlhttp://

    What can you do? What can't you do? Find out the anatomical connections here.

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