Stretching Hamstring Scar Tissue?

[Kratos183]

So in practicing the horse stance, the part of sticking my butt out (anterior pelvic tilt) I've noticed is causing me some pain in my upper right hamstring, which I am pretty sure is due to scar tissue from a hamstring pull I had about fifteen or so years ago. What I am wondering is if there is any way I can reduce the scar tissue? Or stretch it out? I can deal with the pain as it is minor, the problem is I don't want to re-injure it.

 

Thanks

[Jim Pickles]

The only cure as far as I can tell is rest - ie not stretching the area. Scar tissue disappears over many months to a year. The trouble is that we dont like waiting that long between stretches. But scar tissue is less extensible than the neigbouring uninjured tissue. So if we stretch - even within the range that is normally OK for us - the scar tissue doesnt stretch as much, so the nearby uninjured tissues take up extra stretch and get overstretched - and therefore get injured in their turn. In this way, hamstring injuries can keep themselves going for years.

 

As far as I can tell, the only thing to do is to avoid any stretches of the area that lead to even small discomfort. As time goes by, you can build up the stretches a bit (you can tell if things are getting better or worse) but never into the range of pain. You might also consider taking anti-inflammatory medication (NSAIDS - eg ibuprofen) before any activity that might lead to accidental stretching of the area.

 

If anyone knows a better method, I'd like to hear it.

 

Jim.

[Kratos183]

How does rest make the scar tissue disappear though? I have heard of things like using a foam roller or something to break it up to a degree, but I would think rest would just leave the scar tissue as is, right?

[Kit_L]

Personally, on day 71 of the 90-day challenge, I can tell you something about hamstring pain. I have never pulled my outer hamstring (but have pulled my calves) but my R outer hammie is "injured" by most people standards. When I load it in particular lines, pain is the response. What I can also add is that even though stretching it every day has been painful, it is getting looser and stronger—so this tells me it is fixing itself. I have been using ballistic, pulsing, and C–R techniques, severally and together sometimes.

I have been using a hockey ball (plastic, incredibly hard) on both the distal side of all hamstring attachments to the ischial tuberosities, and all painful places around the external rotators, using our RollStretch protocols. In addition, I have been strengthening the area too with weighted or resistance exercises of various kinds too, so varying the stress.

Although I have been stretching this area daily, I do vary the intensity according to how it feels, and am being sensitive to this aspect. Nonetheless, I have not missed a day. Has it been painful? Very, on occasions, but it is loosening; this is all I care about.

So, in my opinion, scar tissue will not resolve itself. It needs passive and active work, and it will benefit from a good soft tissue therapist, too. If you go too hard in any of your exercise strategies, the original injury will re-manifest, and that will allow you to calibrate the intensity of subsequent loading.

Sounds brutal, but this is what I have found. I agree with Jim's point about surrounding tissues becoming injured IF you go too hard, but in my experience, pain will stop you before this happens if you are paying attention. What Jim talks about is what happens when sprinters or footballers take to the field before they are ready—and re-injure while trying to compete. I recommend strongly against this approach, because in the game or competitive environment, you cannot be listening closely to what's happening in your body and, potentially, there are massive forces in play. 

What I am talking about is learning precisely exactly how far you personally can push that envelope on a day-to day, moment-to-moment basis. One thing is for sure: if you re-load an injured area without doing all the things I mention, re-injury is certain.

[Frederik]

A slightly different take on the subject:

 

At this point there widely an acceptance in sports medicine that the best measure for prevention of hamstring tears is to directly strengthen the area. This prevention can be either primary ie. before injury or secondary ie. after injury not to sustain further injury.

The go to exercise is Nordic Hamstring Curls.  The injury is very common, and tend to recur, however it needs not be this way!

 

Studies has been done, mostly on footballers, and the results are fairly unambiguous. The people who do Nordic Hamstring Curl do not get hamstring tears, it is that easy, really. Since it is a few years since I read this research I cannot recall whether the study population was injury naive or mixed with both injury naive and athletes that previously had a hamstring tear.

 

The take away for me is that by stressing (applying force to) the tissues incrementally, under control and then allowing it to adapt we give it a chance heal. Most people do no such thing. They simply rest and wait until the problem is "gone", at this stage they are likely at lower level of fitness than before the exercise, and nothing has been done to solve the underlying problem. 

 

If I had the above problem I would definitely stretch it, and by all means be gentle when you begin, and then increase the intensity over time, and as Kit has alluded to above, if you pay attention you will not hurt yourself. The only time I would not do either exercise nor stretching is immediately post-injury and even then I would mobilize as quickly as possible.

- and - I would add exercises to specifically strengthen the area, think Nordic Hamstring Curls, Stiff-legged deadlifts and good mornings.

 

regards,

[SDowd]

To my logic...the only way scar tissue is going to "disapear" is via massage / tissue work.

 

2 ways of doing it on yourself:

• Softball on a box
• set a barbell up in a rack and sit on it right near the ischial tuberosity and grind away!)

 

 

Also having a skilled manual therapist glide distal to proximal with enough depth of pressure to really get in there can be magically terrible! I've felt like I was almost tearing a hamstring variously over the years of working on my front splits / middle splits and every time I felt that sensation in my body, when I went to go do tissue work on that area - there was junky tissue there. When softened up the scar tissue / dense tissue - it felt like a normal muscular stretch again!

 

Good luck!

[Jim Pickles]

"How does rest make the scar tissue disappear though?" Many tissues of the body replace themselves over time (called turnover). In some cases, the old cells disappear and are replaced by new cells. In other cases the cells remain but the molecules are replaced. You are a different person from who you were a year ago, even though your friends think you are the same. You can look up the turnover time of different organs of the body.

 

Connective tissues, which include scar tissue, turn over in about 9 months, with a lot of variability. However it is possible that massage may speed up the turn over, so it could help. I must admit that I dont normally use massage on my injuries, but maybe I should. Also, we expect that stretching may increase the turnover of the connective tissue (if it can be done without further damaging the tissue), with the result that the damaged tissue may be replaced by new fresh tissue faster than otherwise. Possibly..

 

In relation to Kits point "I agree with Jim's point about surrounding tissues becoming injured IF you go too hard, but in my experience, pain will stop you before this happens if you are paying attention."

 

In me, even fairly mild pain (which can come from a carelessly large - but not very large - movement) means that I will get set back in further stretching. So I work so as to avoid even that.

 

In relation to Frederik's point about hamstring tears - we may ask - why do footballers and runners among others get hamstring tears? My understanding is that it is not because they have been stretching their muscles too much (runners dont usually try to do the splits, and when they pull their muscles, it is usually when running hard, not when stretching hard). Rather it is because the muscle has contracted at an inappropriate time - when it should have been relaxing. So it is usually a failure of programming or proprioception. It is possible that the Nordic hamstring curls help with this - the slow progressive loading and contraction or extension would be ideal for reprogramming the nervous system. My son (who is a basic athletic skills trainer for the Netherlands Olympic team) says they use slow repetitive squats to retrain proprioception as a preventative for hamstring injuries in their athletes.

[Kit_L]

Jim, in your thoughtful reply, and your quote from my post, the key to understanding what I am getting at is in your next point; you wrote:

"In me, even fairly mild pain (which can come from a carelessly large - but not very large - movement) means that I will get set back in further stretching."

It's the carelessly bit that I am pointing to, explicitly: if you are paying close enough attention (and thus by definition not being careless) then you cannot hurt yourself in that moment and subsequent moments. There will be a clear, accurate awareness of pain, and you will not go further. The magnitude of the force is far less significant for the very reason you mention: even small forces can damage in some circumstances.

Regarding turnover: in my experience, if you do not actively work to change scar tissue along the lines I am recommending, then the new fascia will resemble the old very closely. The cells will be new if the research is accurate, but the arrangement of them, and the brain's attribution of significance to that area will not have changed, necessarily.

I have worked with people who were carrying injuries they felt were caused 20 years earlier, and the many-times-replaced scar tissue (and the brain's distrust of the area, with the attendant increased anxiety about further injury and the increased tension that results in a greater disposition to re-injury) had not changed. 18 months later, though, with the kind of new stress I mention, that scar tissue can be replaced by new, well organised, fascia; there will be experience of many repetitions of stressors that resemble the original stressor, and in time, the brain learns to trust the part again, and the injury can be just a memory.

[Frederik]

"How does rest make the scar tissue disappear though?" Many tissues of the body replace themselves over time (called turnover). In some cases, the old cells disappear and are replaced by new cells. In other cases the cells remain but the molecules are replaced. You are a different person from who you were a year ago, even though your friends think you are the same. You can look up the turnover time of different organs of the body.

 

Connective tissues, which include scar tissue, turn over in about 9 months, with a lot of variability. However it is possible that massage may speed up the turn over, so it could help. I must admit that I dont normally use massage on my injuries, but maybe I should. Also, we expect that stretching may increase the turnover of the connective tissue (if it can be done without further damaging the tissue), with the result that the damaged tissue may be replaced by new fresh tissue faster than otherwise. Possibly..

 

In relation to Kits point "I agree with Jim's point about surrounding tissues becoming injured IF you go too hard, but in my experience, pain will stop you before this happens if you are paying attention."

 

In me, even fairly mild pain (which can come from a carelessly large - but not very large - movement) means that I will get set back in further stretching. So I work so as to avoid even that.

 

In relation to Frederik's point about hamstring tears - we may ask - why do footballers and runners among others get hamstring tears? My understanding is that it is not because they have been stretching their muscles too much (footballers dont usually try to do the splits), but because the muscle has contracted at an inappropriate time - when it should have been relaxing. So it is usually a failure of programming or proprioception. It is possible that the Nordic hamstring curls help with this - the slow progressive loading and contraction or extension would be ideal for reprogramming the nervous system. My son (who is a basic athletic skills trainer for the Netherlands Olympic team) says they use slow repetitive squats to retrain proprioception as a preventative for hamstring injuries in their athletes.

 

I agree sincerely that the ability to relax when it is appropriate is immensely important, for all sorts of reasons. But I feel this point has already been made sufficiently in this context.

 

The hamstring tears most often happen at a later stage in the game when soccer player is fatigued. It also important to realize that contrary to a stretching session, on the soccer field there are many factors which you CANNOT control. As Steve Maxwell likes to say "People will put you into a position whether you like them to or not(!)" Other players are acting upon you, your awareness is anywhere but on the level of relaxedness in the hamstrings. 

The Nordic Hamstring Curl builds strength in the hamstrings, probably both muscular and fascial? This gives a reserve capacity to draw on. This is the reason why the concept of "proper" alignment is so deeply wrong when it comes to real life conditions.

 

Of course other factors such as aerobic capacity and technique surely play a role.

 

To make the statement a little more blunt, in my mind it is obvious that this type of remedial strength work is much more important from an injury prevention standpoint than any other single factor.

 

EDIT: and I would guess that the most effective protocol to remodel scar tissue would involve such remedial strength work, coupled with various types of stretching and soft-tissue therapy.

[Jim Pickles]

A few points in reply to Kit and Frederik:

 

1. Kit - careless movement - yes, usually when I reinjure a pulled muscle it is due to a careless movement - a thoughless fast movement which I regret as soon as I've made it (more like, as soon as I feel the pain). So I try to always go into and out of stretches slowly and deliberately, but sometimes take short-cuts. Unfortunately.

 

2. Kit - well, though I preach rest, I have never fully rested after an injury - usually I restretch as soon and as quickly as I can, but always try to stay out of the range of pain (sometimes with the help of ibuprofen). But next time I will try deep massage too. I can see that someone with a longstanding injury who has never got to trust that area again, might never re-stretch it, and so never develop the flexibility which is possible. Even if scar tissue does disappear over time, if the muscle stays contracted, it might well be that the new connective tissue will re-form at the new shortened length. We remember that the connective tissue matrix around all cells (including muscle cells) - which includes fascia - is continually being degraded and replaced, presumably with a configuration that matches the geometry of the site at the time it is being deposited.*

 

(*Scientific aside. This occurs under the influence of the relaxin group of hormones. We usually think of relaxin as being involved in relaxing the ligaments in pregnancy; in fact, relaxin hormones are continually active. There are 7 hormones in the relaxin family. Relaxin receptors (I quote Wikipedia here) are found in the heart, smooth muscle, connective tissue, and nervous system. If the receptors are knocked out in experimental mice, they develop progressive fibrosis in these tissues, suggesting that normally relaxin keeps the growth of fibroblasts - which make collagen - in balance.)

 

3. Frederik: I guess it depends on the type of activity. Runners also pull hamstrings, but are not subject to the unpredictable forces found in a football game. The method I mentioned earlier is used with swimmers and rowers, who I also would expect to have generally predictable patterns of movement. I remember once when I pulled a groin muscle, getting out of a pool - jumping on the bottom and then lifting myself further with my hands - my adductor muscle contracted when it should have been relaxing. There was nothing unpredictable there - it was probably the unexpected excitation in the spinal cord that led to inappropriate activation of the antagonist muscle. Not suggesting that strength is not a preventative; but maybe other things can contribute as well.

 

Jim.

[Tones]

Movement alone will work it out the patch up job after the body's healed. Fascia models itself by the directions it gets pulled. So you just may need to keep at it and be patient.

I've broken up scar tissue in my hammies before and it felt like I strained something (also took a few weeks to feel 100%). It's kinda weird because all the normal functions are there minus the ability to continuously bound extreme explosiveness.

In terms of where you're talking about, I get pain there when my abductors need a little bit of loving.

[Xams2387]

Has there been any new discoveries or atleast anecdotal evidence of how to recover from a hamstring strain?

Mine happened 4 months ago and haven’t been able to make flexibility gains since. 

Its still sorer/slightly painful than it should be in the middle/upper area when flexed. 

Ive tried several weeks of rest, passive stretching, isometric stretching, and a tad bit of high rep-low weight strengthening (25 reps or so). 

None of these hurt during, but the soreness and slight pain later that evening and the following 4-5 days seems excessive, along with not making any flexibility gains in only this body part. 

 

Im stumped. 

 

Edit: I’ve made fantastic gains with eccentric resisted stretching for about 8 reps, followed by 2 minutes of end range isometric stretching, for what it’s worth. 

I went from a beginner quad stretch on the floor with my legs under me and getting to about a 45 angle to getting my butt to my feet and finally I’m just about getting my butt to my feet in the Couch Stretch with this method. 

If you have any questions about that, feel free to ask what I mean about how I stretch!

Edited April 16, 2018 by Xams2387

[MarkusO]

9 hours ago, Xams2387 said:

Has there been any new discoveries or atleast anecdotal evidence of how to recover from a hamstring strain?

Have you watched this?

[Xams2387]

On 4/17/2018 at 4:22 AM, MarkusO said:

Have you watched this?

That was a good video, thanks. 

[Stunningwill]

Hello,

This conversation is of interest to me. I am 20 months in from an ACL reconstruction using my hamstring. I had a slower recovery than most. After about month 11, my hamstring started to become tight to the point that it pulls when I walk. It pulls noticeably just behind the knee on the calf muscle. A very annoying and uncomfortable feeling. I've been stretching and doing strengthening exercises for past 6 month with no improvement. I've now over the past month started to stretch it every day and using a hard roller to help massage it. No issue with running as in I don’t feel the tight sensation as much as walking. The hamstring is very easy for me to twitch the movement. Even when sitting, I can trigger it to contract very easy.

Maybe I was not doing much stretching doing recovery; I was doing exercises, just not much stretching.

I've gone back to the surgeon last week who said he has never seen such a tight hamstring in his entire life from thousands of operations. The only cure is to learn to cope with it. I suggested the idea of cutting it and letting it re generate. He said, it could work but he has never done it before. His not sure what could happen.

I will continue to stretch and massage it daily with roller. I have a referral and will see another person for second and even third opinion. I will also get an MRI done for peace of mind. Maybe there is something there that is causing the tightness.

I understand this is the result of maybe too scar tissue. It's the semimembranosus hamstring that is the issue here.

Doing too much exercise can also result in sore hamstring the next day; not serve sore but noticeable.

Why on earth did I not go for the tissue bank.

Keen to hear your thoughts and recommend anyone I can see. I am happy to travel to see the top experts. I am based in Sydney.

Thanks.