Problematic Hamstrings Runners? Here's how to avoid them!

Most runners will have experienced muscular injury at some point whether that be a sprain or the familiar feeling of Delayed Onset Muscle Soreness (DOMS) following an over exuberant training session. The hamstrings, a set of three muscles at the back of the thigh, which bend the knee and extend the hip during the push-off phase of running, rank as the most problematic of all the muscles in the body.

The three most common hamstring-associated injuries seen in runners are;

Acute muscular strain occurs through overstretch or an over-reach movement where the fibres of the muscle are damaged. This happens more frequently in cross-country runners slipping on uneven or wet surfaces.  Acute strain also occurs during eccentric tensioning of the muscle. This is common since most of the hamstring activity in running, particularly sprinting and up-hill is eccentric.

Delayed Onset Muscle Soreness (DOMS) is the result of micro-tearing in the muscle fibres through overload and over-training. It is characterised by that familiar muscle ache one to two days after a change in training schedule or following a race. Although seemingly innocuous, it is important to allow the hamstrings to recover properly following this type of fibre damage, since ignoring it can lead to further deterioration.

Sciatic Nerve Irritation is often confused with a hamstring problem since it imitates some hamstring symptoms. Broadly, the Sciatic nerve emerges from the spinal cord in the lower back, passes through the pelvis and under the Piriformis muscle in the buttock. It then travels along the line of the hamstrings, the back of the calf and into the heel. It can become irritable through stress at any of these points. Irritation is characterised by burning and/or a deep ache and is sometimes accompanied by pins and needles or numbness. It will often be painful with a hamstring stretch.
The following will help you to determine whether you may be prone to any (or all!) of these problems.

The following is a basic but hopefully useful Preventative Check-list- a type of risk assessment for your hamstrings! 

1) The modified sit and reach test
Sit with your legs outstretched in front of you. Reach forwards towards your toes and ask someone to take a picture of you. Then compare it to the following descriptions.

a) Movement occurs mostly from your back (upper or lower). This indicates that you have short hamstring muscles which are prone to acute strain. The back and sciatic nerve are also vulnerable.
b) Movement mostly from the hips with a poor reach distance. You have a stiff back which needs loosening by your physiotherapist and also short hamstring muscles.
c) Movement mostly from the hips with a good reach. The hamstring length is good but the back and sciatic nerve are prone to problems.
d) You use both your back and your hips and you have a good reach distance. You have passed this test!

2) The Slump test
Sit on a chair. Slouch and tuck your chin in. Pull your foot up towards you, slowly extend the leg to straighten the knee until you feel a pull in the lower back or the back of the leg or calf. Now, holding this position slowly lift the chin up. Does the tension ease? And does it reappear when you put the head back down again? If it does, this indicates that you have tension and/or irritation in your sciatic nerve.

3) Hamstring to Quad strength ratio.
It is well documented that discrepancy in strength between one muscle group and its’ opposing group is a precursor for injury. The normal H:Q ratio is considered to be 50% to 80% when averaged through the full range of knee motion. However, an ideal range is a 1:1 ratio of concentric strength in the quads on the front of the thigh and eccentric hamstring strength. A crude way of testing this is in the gym with the Quads bench and the Hamstring curl (for the curl test the lowering movement) to see if you can lift equal weight. However, I would not test this without supervision from a Strength and Conditioning Coach or experienced Personal Trainer, since overloading the muscle in trying to match the weight could lead to muscle tear. A much safer and more accurate way of measurement is through isokinetic testing which you can book at a sports injury clinic where they will also advise you on appropriate strengthening methods and be able to check your progress.

4) Previous injury to the hamstrings is a strong precursor to further injury particularly if you have not had adequate rehabilitation to restore strength, flexibility and endurance to the injured muscle.

Now, onto the important stage; how to prevent your hamstrings from becoming troublesome!

1) Flexibility and Stretching
In order to perform efficiently the hamstrings need to be both strong and long, particularly to maximise their eccentric ability. Hamstring shortening is exacerbated by long hours at desks and in cars; part of life for lots of us.

Two types of stretching are important for your prevention strategy.

The first is the warm-up phase which should take the form of dynamic (or short duration) stretching.  Warm-up with gentle jogging or perform step-ups on the stairs for five minutes. Follow this with leg kicks. Do not statically stretch prior to your session! There is growing research to show that static stretching, where the muscle is held in a lengthened position weakens the muscle strength by up to 25% thus making it more prone to injury.

Static stretching becomes important post-run or training session. I recommend that you follow each training session or competition with a 15-20 minute static stretching program. Focus on all of the lower limb muscle groups particularly the Calves and Piriformis since restrictions in these muscles are associated with hamstring and sciatic nerve problems. To specifically target tight hamstrings you need to stretch for 3x20 seconds 5 times a day in order for your muscles to become more tolerant to stretch.

Remember that the sciatic nerve can cause hamstring type symptoms if compromised. If you tested positive with the slump test you can use this test position as a treatment tool to help mobilise the restriction. Using the position described, first lift your head up and down 6 times as if turning the stretch on and off. Then, with the head down, alternately point then flex the foot 6 times. Be gentle when doing this, a strong or very painful stretch feeling is not necessary. Repeat twice a day. I would also strongly advise that you visit a sports physiotherapist to diagnose and treat the cause of this problem.

2) Biomechanical Assessment
Again, I’m going to be boring and suggest that a biomechanical assessment where a physiotherapist, osteopath or chiropractor specialising in sports will assess and correct your ability to perform efficiently is a core piece of advice.  Asymmetry, muscle weakness and muscular imbalance will put the body at risk of overload. Fatigue occurs much more quickly and will result in the muscle fibre damage that we see with DOMS, eccentric overload and risk of acute sprain through loss of control and slipping.

3) Gluteus Maximus Programme.
The hamstrings need to be supported in their role with adequate lower back and pelvic muscles, particularly the Gluteals (buttocks). Where these are inadequate, the hamstrings overcompensate to aid stability in the pelvis with the result that they are overworked, short and prone to DOMS or sprain. Are you a runner with particularly tight hamstrings that seem not to respond to stretching? Either your stretching programme is insufficient, or you may have poor Gluteus Maximus activity.

Lie on your tummy over a couple of pillows.
A) Without tensing the hamstring muscles, squeeze both buttocks. You may want to put your hands on the Gluts to check that you are tensing correctly.
B) Then try with only one buttock at a time.
C) Having achieved this, practice tensing one Glut by 50% then releasing slowly to 25% and holding for 10 seconds. Repeat 10 x each side 2x a day.
D) Once you can do this, first activate the Glut 25% on one side, and then lift the whole straight leg up a few inches, allowing the hamstring and Glut to contract. The back should not dip or roll. Hold for 10 seconds. Repeat until you can do this comfortably for 4 minutes.

This is an early stage programme and must be done with supervision if you are at all unsure. It is worth visiting your physio or asking a running or fitness coach how to progress forwards. Strengthening the Glutes could mean all the difference between injury prone hamstrings and great performance.

More top training tips to avoid Hamstring Injury
• Follow the 10% rule; increase your schedule by no more than 10% weekly to allow muscle and connective tissue to adapt to the increased work-load
• Do not Increase your training speed too quickly. The prerequisites for running fast are a good training base, no niggles and a thorough warm-up.
• Start an eccentric strength programme designed by your physiotherapist / strength and conditioning coach.
• Avoid changing more than one aspect of your training at a time otherwise you can never pinpoint the source of an injury should one occur.
• Do not be a slave to your training log! If your legs are sore from the previous day’s session or your body feels sluggish and heavy then rest or undertake ‘recovery training’ such as swimming or exercise bike.  Use the opportunity of a rest day to stretch.

Final Word
The best piece of advice I can give to prevent muscular injury is to listen to your body. Pay attention to niggles and tightness and do not over-train. Recovery is as important a part of your schedule as the running itself.

NOTES
Eccentric muscle action occurs when a muscle is in a contracted, tension-generating state yet is lengthening at the same time to allow joint moment.

The author accepts no responsibility for misinterpretation of the advice and exercise techniques in this article. If you are unsure, please contact us and we will be happy to give you further advice.

Happy Hamstrings!