The rehab clinic: quit your gimping and get back in the game. This month: how to deal with hamstring pain

Men's Fitness, Oct, 2005 by Bill Hartman

PROBLEM A stabbing pain in the back of your thigh, starting below your glutes and running down to the back of your knee. It may or may not have been preceded by a "popping" sensation.

TRIGGER Most often, pain in this region is the result of straight-ahead running, especially if you were attempting to accelerate to your top speed. But it could also be the result of single-leg exercises, such as lunges.

DIAGNOSIS Hamstring strain. The hamstring is made up of three muscles that originate at the ischial tuberosity (the bone you sit on) and run down the back of your thigh to attach at the middle and outside portions of your knee. The hamstrings work in two ways, helping extend the hips (as in a deadlift) and bend the knees (as in a leg curl). When you run, the hamstrings perform both actions.

WHAT YOU SHOULD DO NOW The severity of strains can vary, but in general, you should look for swelling, pain, and discoloration. For the first two days after you notice the pain, ice the area for 15-20 minutes every few hours to soothe it and prevent the injury from getting worse. (Note: Not icing it will make it worse.) If you notice an area that looks like a large bruise, see your doctor--it could mean you've torn the muscle and may need surgery.

WHAT YOU SHOULD DO LATER If the pain subsides after 48 hours, stretch your hamstrings--but don't do static stretching. Research shows that athletes who use standard sit-and-reach--style stretches to rehab hamstring injuries often take longer to recover end have a greater incidence of reinjury. The alternative: dynamic stretching, which increases flexibility by gently moving muscles through their natural range of motion. Start with simple side-stepping, backward walking, crossover stepping (side-stepping with one foot crossing over the other), exaggerated-length (giant) steps, and exercises like the golfer's bend--in which you stand on one leg and bend forward like you're retrieving your golf ball from the cup. When you're comfortable with these, you can gradually begin to lengthen your step, increase the speed at which you perform the steps, and throw in some stepups and squats.

If the pain persists after 48 hours, see your doctor or physical therapist.

HAMSTRING OK FOR NOW? Figure out why you strained it in the first place. If your injuries were the result of high-speed activities like sprints, your leg muscles may not be conditioned to handle the high forces that fast runs impose, and you may need to adjust your training program. More often, however, injuries are the result of tightness in other muscles, which causes an overload in the hamstring--hence the "pop." For example, tight hip flexors (the muscles that raise your legs out in front of you) tend to inhibit your glutes from extending your hips. The lack of help from the glutes then forces the hamstrings to work harder to extend the hips, setting you up for an overload injury when you sprint, stepup, squat, or lunge. To avoid the problem, change your training routine so that it includes Romanian deadlifts, hyperextensions, good mornings, and high stepups--all of which will strengthen the hip-extension component of the hamstrings.

Indianapolis-based Bill Hartman is an expert in the rehabilitation of sports injuries.