Getting over hamstring injuries (tear, pull, strain, weakness)

[Kit_L]

I have posted parts of my own story in various places, and have talked about in both the @Emmet Louis and Propane Fitness podcasts, so thought to write a concise account here.

For the TL;DR crowd, here's the 'Cliff Notes' version:

Rest will not repair an injury, despite rest being the most common recommendation by practitioners

Fascia, the stuff we injure when we "pull" a muscle, has a half-life in the body of six months, according to Robert Schleip (pers. comm.); figures around the net span 300–500 days. If Robert* is right (he runs the fascial research lab at Ulm University), then we effectively live in a new fascial body roughly every 18 months to two years. If you rest (so do not stress the injured area) then the new chemistry simply reproduces the problem and the state/organisation of the old tissues, and the brain has no reason to change its perspective—it will not trust the part, and the propensity for re-injury remains.

Strengthening the injured part is one of the most efficient ways of straightening the undifferentiated fascia that characterises a newly healing injury site; our approach to using C–R (the "C" of C–R means "contraction") is a highly efficient way and completely scalable way to strengthen any muscle in its lengthened state. In my own situation, single-leg Romanian deadlifts (RDLs) and weighted Bulgarian deadlifts (BDLs) were key.

Mobility work of a range of movement (ROM) that does not tax the injury is essential.

Occasional replication of the activity that caused the original problem to assess progress is essential; when the day comes where the activity that caused the injury is experienced only as a stretch or a benign sensation, the brain (somatosensory cortex) immediately remaps the attribution of significance and fear that an injury always carries with it.

Once "fixed", the body needs to experience a greater stress than that which caused the injury for the experience of "completely fixed". 

That's the point I'm at today; if you head over to the Pancake thread I started a week or so ago, you will see that I had the best front splits ever yesterday, and in form that is significantly better than the old, pre-injury, days. I am also stronger in that ROM than I have ever been before too, and stretching that "underbutt" part of the hamstring (short head of biceps femoris) is simply a stretch. 

*Robert works out, as do many of his research subject groups—his figure of a half-life of six months probably reflects a faster turnover through greater activity. My own "complete" fix took about two years, and I never stopped working out.

Other relevant threads:

https://kitlaughlin.com/forums/index.php?/topic/931-stretching-hamstring-scar-tissue/

If members can send me other links, I will add here, so all is in one place.

[Nathan]

Excellent, Kit! Isn't the body(/mind) amazing? This thread deserves to be pinned, I feel. Both this very issue, and other closely related issues, come up quite often around the forums. Edit: I just noticed that it is already pinned! 

The mentioned podcasts can always be found on the Stretch Therapy site, but, for convenience, here are some direct links:

Emmet Louis Discussing Injuries with Kit Laughlin

PropanePodcast 57: Interview with Kit Laughlin Part 1

PropanePodcast 58: Interview with Kit Laughlin Part 2

The return of Kit Laughlin – PropanePodcast 107

I highly recommend listening to all of the PropaneFitness podcasts above, too. Yusef does a great job of playing host!

[arbo]

Absolutely genius. I logged on today after a morning meeting with an orthopedic surgeon, just to share my experiences in my other thread, and lo and behold, this excellent write up is here! Thank you Kit for sharing your own story and for the pioneering work you do

[Otávio Souza]

Hey Kit!
You mentioned that both RDL's and BDL's were key in your recovery. Can you dive a little bit deeper into how many reps you did, how many times a week and such?

Thank you

[Kit_L]

@Otávio Souza: Welcome to the forums!

On 4/23/2018 at 8:09 AM, Kit_L said:

In my own situation, single-leg Romanian deadlifts (RDLs) and weighted Bulgarian deadlifts (BDLs) were key.

Otávio quotes from my original post above. The single-leg Romanian deadlifts exposed the problem area; here's a tutorial:

https://www.youtube.com/watch?v=Nenu2LI9_dw

I do not take the back leg up; I leave it folded and unweighted under me and only move trunk and head together, pivoting around the support leg's hip. If you modify the exercise this way, the required balance component is increased, and very light weights will be experienced as serious resistance (because the weight is not being counter-balanced by the leg being lifted). I used no weight in the beginning, but used a greater ROM than the guy demoing (keeping my back straight, support leg bent, I went down until my ribs touched my thigh, so well below horizontal).

In the beginning, just two or three sets, no weight, and twice a week. Then weights, slowly, over time (ending with 16Kg KB).

Re. Bulgarian/Romanian DLs:

https://www.youtube.com/watch?v=JCXUYuzwNrM

The key form point is to stick your butt out, and keep it there—too often the lumbar extension is lost (so the back muscles do more work); with the butt stuck out, you will feel the effects high under the glute, and that's where you want to feel it. If you're not flexible to keep that form and touch the plates to the floor, do not lower as far. To make this work as a rehab. exercise, you need to be ruthless with form. I worked up to 100Kg, for sets of five–eight. This took months. By best-ever BDL was 8 x 140Kg, year ago.

More than sets and reps, though, is how it felt on the day. Sometimes you need to rest more; if that problem hammie is DOMS–sore, rest longer. No less than once a week though. I have found to be a good minimum.

[Nathan]

48 minutes ago, Kit_L said:

I do not take the back leg up; I leave it folded and unweighted under me and only move trunk and head together, pivoting around the support leg's hip.

Interesting! I never even thought to try keeping the leg folded to reduce the lever. Not using this for rehab, personally, but will play with this next session to see how it feels.

51 minutes ago, Kit_L said:

Re. Bulgarian DLs:

https://www.youtube.com/watch?v=JCXUYuzwNrM

This link will not open for me now, which is strange because it opened the first time I tried it. When I did, it was a Scott Herman Fitness video about Romanian deadlifts, though. Bulgarian deadlifts seem to have the rear leg elevated on a prop. Which one are you referring to?

[Kit_L]

Added "Romanian" (and thanks for that catch).

I've heard of both descriptions used to describe what otherwise we would call "bent-leg deadlifts". Romanian or Bulgarian DLs just sounds so much tougher!

[Otávio Souza]

Thank you Kit!

Do you think that alternating the days of stretch and strengthening is enough or should it be alternating weeks (such as one week stretching and one strengthening?)

 

[Kit_L]

If it were my hamstring, I'd be gently stretching it in an exploratory kind of way after every strength session that potentially affects it. The key focus here should be on trying as many different hamstring stretches you can, to find out what it needs. Sets and reps, or schedules, are not how the body works and everyone's body literally is unique. Please try this and report back; this helps everyone.

[Xams2387]

This is great news. 

I get hamstring pain for a couple days after resistance-stretching (but not during the stretching). Not as much aggravation from passive stretching. Any idea why?

Used to get it for about 10 days when the injury started 6-8 months ago.  

Even RDLs aggravate it. Rack Pulls, Leg Curls etc don’t. It seems like the Eccentric stuff is what angers it. I really don’t know why. 

Do you think just going in and warming up and doing Rack Pulls (too inflexible for deadlifts off the floor) will allow me to gain flexibility by maybe 1/4 - 1/2 inch each session? I can try to gradually lower my starting position during the Pulls.

Would passive stretching or anything help if done before or after the workout?

 

Really need a way out if I’m to get over my pelvic floor dysfunction, because my ticked pelvis and incredibly tight hamstrings, and thus weak and impositioned glutes are causing it. 

For reference the 45 LB plates on the Barbell are about 11 inches away from floor. 

[Nathan]

Hi Xams,

On 8/24/2018 at 12:08 AM, Xams2387 said:

Any idea why?

There are lots of posts on the boards that will tell you about others' experiences, but all of these are specific to the individual, just like your experience is/will be. They may provide hints, but you need to explore and discover your own solution. Kit's summary of what worked for him has already been posted above, so you can choose to try something similar if you like. But neither him nor anyone else here on these forums will be able to give a diagnosis.

It sounds like you've learned a lot about your own issue, which is good. You already know what aggravates the problem. I suggest you avoid aggravating it. Strengthen and mobilize the problematic area as much as possible without aggravating it. Work near aggravation, but not into aggravation. Over time that boundary will shift, until one day it will most likely simply disappear. Since you say you aggravate it with "resistance-stretching" but not passive stretching, my guess is that you are pushing too hard, and likely lack the strength necessary to stretch in such a fashion. Have you tried using the same movements while drastically reducing the weights (to zero, if need be) and moving slowly and mindfully?

On 8/24/2018 at 12:08 AM, Xams2387 said:

Really need a way out

I could be mistaken, but this sounds like you are in a hurry. That's okay - we all feel that way sometimes (most of the time for many of us)! Just be aware that these things can take time. It could be several years before the issue is completely resolved. But it is an opportunity to mindfully explore the body that you have right now (which is all there is!) and learn a lot about yourself in the process. Ask yourself if focusing on where you think you need to be will actually serve you in any way. I suggest focusing instead on where you are right now (explore what you can do rather than worrying about what you can't do), work within those limits (while still challenging them), and enjoy watching them change with each day.

[Matt Chung]

On 4/22/2018 at 11:09 PM, Kit_L said:

Occasional replication of the activity that caused the original problem to assess progress is essential; when the day comes where the activity that caused the injury is experienced only as a stretch or a benign sensation, the brain (somatosensory cortex) immediately remaps the attribution of significance and fear that an injury always carries with it.

Over the past 2 months, I can recall two memorable experiences of remapping. First was my shoulder rotator cuff. Second was my IT band. In the former, I almost always hesitate to throw the ball for my dogs with the "Chuck-It" tool because historically, my right rotator cuff would act up and a sharp twinge of pain would concentrate deep in (one of) shoulder muscles. Then about 2 weeks ago, I was just "fully present in the moment" with my dogs and happened to launch the ball high into the air and then after, I immediately remember thinking to myself "What the hell, how come that didn't hurt? Amazing." With the IT band pain, I often avoid doing "floor work" when it comes to dancing. More specifically, I avoid the deeply squatting. However, similar to the rotator cuff instance, I found myself pleasantly surprised and experiencing joy when I crouched down during a dance workshop and low and behold, a very minor amount of discomfort. Yes — still uncomfortable. But much much more tolerable than before. I'll take these little wins.

[Kit_L]

The little wins are 1) big wins, and 2) all you need!