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today. Hello everyone and welcome to
the Docs Spring Podcast where we, a group of doctors to
physical therapy discuss the art and science of running and the
stuff that we put on our feet. Today at the round table we have
myself, Nathan, I'll be hosting and we have Doctor David Salas
who is joining me. We have a really fun episode
today, but if this episode goes from having both of us here to
becoming a David Solo episode. The reason why is because I got
up at 4:00 AM while 340 or whatever to catch the US Today
is the day where they played in the round of 16, the US women's
soccer. So I am totally spent.
I'm just so tired from getting up that early.
So if this becomes a David Solo episode, you know I just fell
asleep at the wheel here. But outside of that, we have a
really actually a fun episode today.
We are dipping into the mailbag and we wanted to hear what your
questions were surrounding hamstrings and hamstring
injuries. So that is going to be the topic
of today And that kind of leads us into our subjective, we
really got a lot of questions. We won't be able to probably hit
all the questions we got. So our next subjective is what
is the next condition or tissue or whatever that you want to
hear us talk about. So we've talked about some in
the past like planner fascia and Achilles.
We can always hit those again. But what do you want to hear
from us? That's our subjective for the
day. All right.
Are you ready to just jump right in, David, or do you have any
updates? No, I think we can jump right
in. Great, let's do it.
Actually, let's not. I was gonna also say this is a
great, this is actually a pretty crazy summer for our team family
wise. So as you all know like David
got married a couple weeks ago now and Matt as we as we record
tonight like at any moment his wife could go into labor to have
their first baby. So hang with us as we go through
a lot of crazy transitions. As a team, we are working hard
to make sure that we help or continue to crank out material
for you. All that is useful and
beneficial and hopefully at least a little entertaining as
well. But now with that said, let's
jump into the episode. So again, we dipped in the
mailbag, we got all your questions about hamstrings,
hamstring injuries, hamstring injury prevention,
rehabilitation and let's just start with this one because I
think it will kind of give us an opportunity to just talk about
what the hamstrings are. So this is from Sealy Sealy, Ft
Run. You got a better guess on that?
I'm so sorry, but it says no matter what I do or who I see to
try and fix it, it's always nagging.
Why? So I feel like we obviously
can't answer this question. But David, what are some things
about the hamstring that that make it what it is, make it a
common running injury? Let's use this as a platform to
talk about what's going on with the hamstring.
Yeah, so the hamstring is so dynamic of a muscle.
I mean, we're talking about a multi joint muscle.
They basically it runs from the issued tuberosity, meaning right
at the sit bone there right on the bottom of that pelvis.
It goes straight down your leg. And it's actually a group of
muscles. We refer to it as one all the
time, but it's actually three different muscles.
And when you look at the well, let's just go to anatomy first
actually. So biceps femoris goes down from
that tuberosity down the lateral side, meaning the outside of
your leg attaches to the head of the fibula.
And then the semimembranosis and semi tendinosis go from that
issue of tuberosity down immediately and then attach to
the inside of that knee or just distal to that.
One of them goes to a group called the peasant serene.
The other one kind of blends in as well.
What its job is to do in isolation is to bend the knee.
Essentially it's knee flexion, but it does so much more than
that dynamically and because it has that high attachment
basically up in your butt there. When anytime you extend your leg
out in front of you, whether it's walking, running, it's one
of the main mechanisms that helps control your leg speed
going forward so that you can prep your next step so that you
can snap down onto the ground and push off.
That's a very functional translation of it.
However, it also does help with that initial lift and like the
kicking up of the leg as well. So this is something that's on
all of the time and there's a couple of different mechanisms
as well. To help with that as well, your
adductors on the inside of your groin can help out the
hamstrings a little bit. And it's also, it's working
together with everything. I mean everything from your core
and back muscles to your hip flexors on the front side,
everything kind of has to work alongside with each other in
order to get the job done. And so it one of the reasons why
hamstring injuries or niggles like like things going up and
down over the course of time, it's not surprising because of
how much it does and. That's not just running, that's
living life as well. And so it's it's very, very
tough to answer that question because it can do so many things
and it's on all of the time. I mean, I can't tell you how
many times I've had someone where maybe they had a proximal
hamstring injury and their complaints shift away from,
well, I can't run to like I'm having a hard time going
upstairs. Like every time I sit down or I
drive, I extend my leg out like. Certain like daily things start
to get lost. And so when we look at
hamstrings, I think the biggest thing initially is to look at
irritability. How sensitive is this thing
right now and what can we do with it outside of a pain
sphere? And see if we could just make
that bubble just a little tighter, a little tighter, a
little tighter, Make it more functional, make it stronger,
make it all the above, you know, coordination, propriception, all
that stuff and and just create a better.
Platform better lever. In the most literal terms, it's
a very long stringy tendon, hence the name string, so that
it can work for you. And not to say that it's working
against you, sometimes it's just working hard.
Yeah, totally. And just to kind of reiterate or
hit on a couple of other things, just so that as we say terms,
they hopefully will come back and kind of make a little bit
more sense. So as you said, as David had
said, so this is a muscle that spans 2 joints.
So it crosses the hip joint and it crosses the knee joint.
So if you were to contract your, your hamstring muscles, the
whole group, you would extend your hip and you would flex your
knee. If you wanted to quote, UN
quote, stretch your hamstrings or put it on tension, you would
need to flex your hip or like bring your knee towards your
chest and then straighten your knee out.
Those those combinations of motions are what put the
hamstring on slack or stretch And then as David said, it's a
very involved muscle with running the highest, the highest
activation of the hamstrings is as David said in that what we
call terminal swing phase. So your leg that's in the air as
it's swinging forward, the highest activation of those
hamstrings is at that end part of the swing phase.
Because if you didn't, your leg would just keep swinging until
you did like a punter's kick, quite literally, because those
muscles are what slow it down and then they spike even a
little bit more once you land. So because they help with that
absorption of the shock. So you're slowing the limb, it
helps absorb the shock. That's its highest activation
point, and then it recycles over and over and over and over
again. The other thing that you'll
we'll know about the hamstrings is we'll go into this later
more, but speed does change how involved the hamstring is with
the stride. So faster, more hamstring,
slower, less hamstring. If you've ever raised a one mile
and you haven't raised a mile in a while, or you raised to 5K and
you haven't raised to 5K in a while, you probably like darn.
My hamstrings are sore today, the next day or the day after
because hamstring utilizations utilization at those higher
speeds is higher. So I think the other piece that
I wanted to bring up is nothing exists in isolation.
The hamstrings within them and underneath them flow the sciatic
nerve and a lot of other anatomical structures.
So when you have pain in that region, there can be a lot of
different causes for these things, which is why if you
don't get the right thing treated, it can lead to
prolonged issues. And as is most things, our
understanding of what causes the pain and why pain exists or what
is the actual like cellular changes, that's all under
investigation. Still nothing is completely set
in stone. We're learning a lot about our
perception of pain and where that comes from and what's the
actual, you know, source in the just because something
anatomically looks weird at the cellular level doesn't mean that
that's causing the pain. So I would just to premise this
whole thing, This is not going to be obviously a lecture, like
a doctoral level lecture around this stuff.
We're trying to give tangible things, but it's also not
everything's figured out. So we will obviously won't have
all the answers. Nobody can really have all the
answers. But we do want to try to address
some of these questions and maybe hopefully help people with
some some of their issues and pitfalls.
But this is all just educational, not specific
medical advice. The last thing I will add is we
always talk about make sure that there is an involvement from the
back when it comes to lower extremity injuries.
The hamstring is a muscle that's innervated by levels L5, S 1, S
2 and so that's a pretty common area for what we call lumbar
radiculopathy. So a lot of times if people are
having low back pain associated with leg pain, you might find
that there's weakness associated and all these other things.
So the back is also an important thing to be screening when you
have pain in the back of the leg whether especially if you're a
clinician, you should be checking that out with with your
runners. All right.
I think to DJ maybe giving a quick list of kind of just
general types of locations of pain or types of injuries that
we see in in hamstrings. Do you want to lay a couple out
for everybody? Yeah, so there's a couple
different things that can happen at the hamstring and.
We talked about it a little bit with the nuances.
Anatomically, there's just a lot going on and this is a really
long muscle. I mean, it's going from like
you're bumped all the way down to the like, distal part of your
knee, top of the shin there on the backside.
And so usually when we refer to hamstring injuries, they're
they're almost always either proximal or distal.
Proximal meaning closer up to like this centerpiece of your
spine there, so that would be essentially high up in the butt
there. Usually you feel it when your
leg reaches out in front of you or tries to decelerate your leg,
like we were talking about earlier.
But you can't have it distally as well and distally meaning
further away from you. That can be on the inside of the
knee. That can be on the outside of
the knee, probably more outside. Is more common than the inside,
just because of stability and other things going on.
You have internal rotation of your femur when you land.
It's part of the shock absorbing mechanism.
Sometimes it just gets a little bit irritated of rubbing on the
outside of the knee or someone's really quad dominant and they
have other things going on for the IT band and whatnot, but
usually that'd be proximal, distal.
Sometimes you can get muscle belly, you know genuine pain as
well, whether it's weightlifting isom like.
Isolated exercises, a bunch of knee flexion exercises or even
just straight like bridges with rollouts or things like that
where you're trying to isolate and really work those hamstrings
and they get sore. Sometimes you'll get proximal
that becomes belly where it kind of starts up high and then as it
gets a little bit more irritated, they'll feel it down
the leg. And then like you mentioned
earlier, this could not be a hamstring thing at all.
This could be something spinal where maybe there's a disc bulge
or some stenotic changes happening or some kind of
neurological involvement that's decreasing strength or
increasing, you know, just neurologic tension where like
everything around, it's just kind of gripping around that
hamstring a little bit more. So it feels tighter because it's
holding on to it more, you know where it's not maybe it's not
truly quote UN quote tight, but. It's guarded, so there's a lot
of different things that can go into hamstrings.
And I mean, we said it before, but it's so dynamic of a muscle
and it's so long of a muscle. There's just so many things that
can go into it. Yeah, I I like to categorize
them and basically is an issue with the tendon, is it an issue
with the muscle belly or is it an issue with the muscular
tendon as junction where the muscle kind of transitioned into
being a tendon and then the tendon attaches to the bone?
And the tendon issues can either, as you said, be proximal
up by your sit bone or distill down by your knee.
And then the everything in between is kind of from the
muscle belly. The muscle belly stuff is
typically like an acute injury from like.
Something sprinting, yeah. Yeah, so like that.
That's we often on this podcast end up talking a little bit more
about distance running pretty much anything 800 and up.
But you know, that is a reality where the muscle belly stuff is
probably gonna. To sit more in that sprinting,
which could happen in a kick for an 800 too.
So I mean, I've. Pulled up a little bit, Kick in
before. Yeah, you're 15105 K It's
happened. That's good.
That's a good thing.
That's. Great.
It's a great thing. You're so fast.
Shouldn't be pulling up in the last fifty of the race, but.
Hamstring, hamstring tears are great because it means you're
running fast enough, right? All right.
So let's move on to our next question.
So we had multiple questions on one of these topics that you
just kind of laid out there, David, and that's proximal
hamstring tendinopathy. So here's kind of the questions
Ebgb's asks. What can be done for rehab and
management of proximal hamstring tendonitis and then Fox in socks
in box with no asks? What do you recommend for
insertional hamstring tendinopathy?
And we're assuming that insertional means inserting into
the bone proximately up by the sit bone.
So I've been doing a little bit of work on this.
I have a couple athletes who've been dealing with proximal
hamstring tendinopathy. So there's a really great
article by a guy named Tom Gum. He's actually running physio if
you want to like, look him up, but he's an awesome
physiotherapist, has a lot of continued education for runners
if you are a PT and you want to do a core.
Course, he has what's called the running Repairs course.
It's an online CEU that you can do.
I think it's really good stuff and he's got a really great
clinical commentary that came out a bit ago about runners with
proximal hamstring tendinopathy. And I think the big thing about
proximal hamstring tendinopathy, just remember it's at that point
where it's inserting into your sit bone, you're often going to
get kind of like what feels like deep buttock pain.
Sometimes it feels like it radiates up into the buttock a
little bit more, sometimes it radiates down the leg a little
bit. And oftentimes the people feel
pain at that point where there's the highest hamstring
activation, which is right either as or right after that
foot is hitting the ground. Remember, your hamstring is
contracting to slow your limb down and then it helps a little
bit with. That shock absorption.
And that's the point where people who have proximal
hamstring tendinopathy tend to feel their symptoms and it's
actually a real bugger to treat. And part of that is because the
issue is not only the activation of the hamstring, but it's also
the compression of that tendon. So if you can, picture yourself
bringing your knee to your chest.
And you have, you know, the tendon sticking into a bone.
That tendon gets stretched but also compressed and like bent
over that sit bone. And so one of the issues with
this is that you not only need to.
Moderate the amount of of loading that goes to the tendon
from a force production perspective, you have to limit
the amount of compression and the way that you can do that
from a rehab perspective is limiting the amount of hip
flexion or bringing your knee towards your chest when you're
doing different activities. So if you're for example, for
some people, skipping a step might be painful, but a single
step as you're going upstairs might not, and that's because
you're going into less less hip flexion.
If you're running faster as you're bringing your leg forward
and if your knee is coming higher, that's more hip flexion,
you might get more compression of the tendon during that
deceleration phase. So there's a lot of things that
can lead to increased irritation that are very minute changes.
So running at 8 versus A7 versus a 6 minute per mile might be the
thing that flares it back up as you're trying to get in on your
rehab. There's kind of, you know the
the name of the game is Load management.
You have to do the right up type of loading, but you can't do no
loading at all if you just rest. This is one of those things that
isn't going to get better on a cellular level.
It has to do with real. Ultimately there's changes in
like what's called ground substance.
But it comes to changes in what's called collagen and it
means that you have to give it the right load to train it to go
back to the proper orientation, which we know in the Achilles
tendon can take about nine months.
So we don't know exactly what that looks like in the
hamstring. It's a little bit more
squirrelly in terms of our ability to see it when we're
doing research when it comes to like diagnostic ultrasound.
But a lot of those principles probably still apply where this
is a long term process. You can't hope for changes in
two weeks. You can't hope for changes in
six weeks. You can't hope for changes in
eight weeks. You got to think like 3-6, nine
months of a rehab process, which on the front end, if you have
that in your head, that can be really helpful.
That also means you just have to be super patient when it comes
to running because like I said, if you try to go too fast too
soon, it might be the one thing that just flares it back up and
just sets you back a little bit. That does not mean that it's the
end, you don't have to start completely over, but it's just
one of those Rd. bumps where you just have to be OK being patient
and then being smart with the types of exercises that you're
doing. So when it I I I can't go into
like all the details, but I will give a couple more kind of
tidbits on like progressing yourself through if you're
having pain, just like sitting on a chair if you're having pain
just with walking or just with stairs, I would say you're
probably in a more high irritability state.
Which means that your loading exercises should be ones that
aren't putting compression through the tendon.
And that means, as I just said, like keeping your hip fully
extended or straight. You don't want your hip bent.
So the only way to do exercises without kind of moving into
flexion are isometrics. So isometric bridges, if you
have like a row, I think it's called a Roman chair, that's
what I call them, where you can kind of like put your heels in
and kind of bend forward. You can just hold your body at
like a, you know, at an incline and just do single leg holds.
We actually have. We actually have some exercises
posted on our Instagram about proximal hamstring tenopathy
going through or through three or four phases of rehab.
But you got to start really easy with these long isometric holds.
That helps with pain modulation, that helps with starting to that
process. And once your pain comes down
enough, that's where you start to add in hip flexion.
That's where you start to put your feet on the ground.
That's where you start to add in mini squats, maybe some lunges,
There's a there's all these different kinds.
There's no magic exercise. It's all about the right
exercise at the right time. But you can't just push through
pain with this either. Pain is a bit of a sign for you
as you progress and it's recommended right now not to go
more than about a two out of 10 on kind of a zero to 10 pain
scale, which I I usually say is like a dull ache.
If it comes to that, like noticeable ache or starting to
be on like if you would actually define it as pain versus just
like achiness, that's too much. It's got to stay a little bit
low and it's got to stay low during the exercise and 24 hours
after the exercise. One really nice way to know is
if the exercise that you're doing are too much is you can
pick a movement like a single leg bridge and you can do one in
the morning and you rate it on a scale of zero to 10, How painful
is it to do that thing? Then you do your activities for
that day. The next morning you do the same
bridge in the same position at the same time.
And then you say, was it a zero out of 10, two out of 10, four
out of 10, whatever it is? And you watch your trends.
If your trends are getting worse, you know your activity is
too much. They're staying the same.
You're in a pretty good spot depending on how high that that
level is. If they're coming down,
obviously you're heading the right direction.
So I just word vomited for way too long.
David, what do you want to talk about with proximal hamstring
tendinopathy? No, I think you hit it great.
I mean, there is a couple things that go through my head
immediately. One of them was irritability and
then one is pain modulation and you kind of covered that pretty
well. And looking into the range of
motion like okay, what are we comfortable doing, you know, And
it's like if we can't hip, like we can't flex the hip and extend
her leg, well then why would we do those exercises if it's just
going to piss it off, to be frank.
And so I think it's great. You know, working in a straight
leg position, you can still work a lot of coordinated things and
get a lot of great work done. Without doing you know these
drop lunges or Rdl's or well actually an RDL depending on the
person, again right, looking at the individual.
But it's it's just using the information you have in front of
you and creating a plan that works for the individual and and
feels productive. And it's like if you're able to
get work done and your nervous system's okay with it, that
helps tremendously with pain. Like the brain starts to trust
it again and that nervous system starts to calm down.
You'd be surprised like how many times something's been like just
a little guarded. And then the 2nd that the brain
feels like it's OK, everything lets go and all of a sudden
there's like the limitations fall off and it's that's not the
case for everybody. But sometimes someone kind of
needs that permission from themself to like go into that
next area of activity. And sometimes it does take
taking a step or two back initially.
To realize that and be like, oh wait, I am okay, okay and then
it's fine. That's not the case with all
things, right? I mean, when we talk about
tendinopathy is usually these things have been around for a
while. So we talked about it earlier.
But having these kind of more longer vision approaches and
knowing that there might be some ebbs and flows depending on the
type of work that you're putting in, mileage, speed, whatever.
But I think. Also being comfortable with the
ebbs and flows and having a psychological readiness for that
can be so helpful, 100%, yeah. Because then it, I think, as you
just talked about the influence of how we approach the reality
of discomfort can really influence how we experience that
over time. And it's both a warning sign to
us in terms of what our body can tolerate, but also a normal part
of the adaptation process. If you're going to go through
loading. The important part about
exercise in my mind too, is if you have a proximal hamstring
issue and you either limit your running run differently or don't
run at all, you don't want to lose the overall capacity of
that muscle. So you want to do as much, you
know, loading and strengthening as you can without aggravating
that tendon so that you maintain all of the strength and power
that was there before. And I think that's what's missed
a lot too in in rehab programs. If you do end up working with
the PT is you get to a really good functional spot with pretty
much everything even like easy running.
But your rehab protocol either because insurance runs this out
or you you can't keep going to PT from a time standpoint.
We miss out on the power training and hamstrings are very
powerful muscles, like they're made-up of a lot of type 2
fibers. They are quick, fast twitch and
so they fire when we go fast and if we don't train that during a
rehab process that could re aggravate once you really go
back. So that that's just another
consideration for why strengthening is so important.
All right, so we have another question here.
It's from Genie Runner and they're asking how do zero drop
shoes play a role in hamstring recruitment?
Also, how would a carbon fiber plated shoe impact hamstring
recruitment or roll? So David, why don't you take
this one away? We're talking about kind of two
parts of the spectrum. Well, zero drop can still, I
mean kind of a carbon inflated shoe in a rocker.
Yeah, you can. But yeah.
But yeah, why don't you talk about that?
There's a lot there. Yeah, I think a lot of it comes
down to the design of the shoe. Not all zero drop shoes are made
exactly the same. I think when we look at what a
zero drop shoe used to be, it'd be similar to the Company 0,
ironically. You know, these very low to the
ground, highly flexible shoes, kind of wide tow bar.
Well, they don't always have wide tow box, but that's kind of
like the natural like oh, this is what your foot's supposed to
do type philosophy. With that in mind, I think of it
very similar as well to the very low profile bracing flats,
things like that, where there's a lot of flexibility up front
usually. Your legs going to be flying a
little bit more. So if you're trying to run fast
and push. So I would probably say on that
ecentric component when that legs advancing, you're probably
going to notice it a little bit more and then on the landing and
the pushing off, you're going to notice it a lot more in your
calves. So that could be potentially
more like middle muscle belly to distal hamstring because of the
kind of like landing stabilizing and having to like lift early.
But what you can also say the same thing about these high
stack rocker shoes as well. But I would say I'd probably go
more on the proximal hamstring side of things, especially since
a lot of these shoes are taken load away from the calves and so
everything's shifting up. Your rocker is kind of shifting
you and pitching you forward a little quicker, your heels
raising a little bit quicker, so.
I noticed myself, at least anecdotally between the two, I
probably would notice a flatter geometry more distally and a
highly rockered high stack shoe more proximately just on load
management and what's a little bit sore following certain
efforts. Yeah, I'd.
I would agree with you on those. There's obviously no like
randomized controlled trials on this exactly.
Yeah. But you know, so it's kind of
anybody's, it's anybody's guess. But from a biomechanical
perspective, those high stacked rockered carbon plated shoes
shift load away from the ankle, up towards the hamstring, up
towards the hip specifically. Which is why I think as you were
saying more proximately with some of those.
Whereas with the zero drop shoe, if it's more of that kind of
traditional flexible, zero traditional is the wrong word.
But the minimalist type shoe that would say hey, we're still
using a lot of our calf which means a lot of like load
sharing. So if it was going to be
involved with the hamstring, it may be, you know, more mid
belly, more distal, could be proximal.
I feel like that's a little more like dependent on the runner
than it is the shoe. Whereas I think we know enough
about these kind of like rocker shoes that it does shift load
away from the ankle. And we know that whereas this
other one's kind of like could be for me, nothing could be for
you the worst thing in the world for your hamstring.
That's an exaggeration, but that's kind of the point is it
could be anywhere on the spectrum and I guess in my
opinion, just because we don't have anything out there to show
exactly what's going on there. Right, Good.
And this question was actually from somebody who was recently
on our podcast. It was an episode that Andrea
did and interviewed her on the topic of back pain and scoliosis
as it relates to runners. This is Doctor Jeannie Halloran.
So check out that episode. Really interesting stuff there
that can be applied beyond just scoliosis and just understanding
kind of the role of our pelvis and her spine and running when
it comes to pelvis in running. That really actually is an
influence with hamstring stuff and we haven't touched on that
yet, right? So let's use this next question
and it'll flow right in perfectly with that.
So Warren's Ong is asking at what state stage of running with
the proximal or distal tendinopathy hurt the most.
So kind of asking at what point in that cycle might it hurt the
most? Do you have any thoughts on
that? Yeah.
I mean, we talked about it a little bit already.
But as that leg advances forward, you're probably going
to feel it a little bit more proximately.
As it lands, you're probably going to feel a little bit more
distally just from a shock absorption closest to the
ground, like everything's going to rotating and coming down with
you as you're landing. In relation to the pelvis or
just just in general, there just in general did I didn't say
pelvis, but. OK.
Because I think the the most likely spot for either the
proximal or distal to be felt is that terminal swing early stance
phase. It just depends on for you what
was the weak link and why. But I do think when we think
about the pelvis, when you if you tuck your tailbone
underneath you, OK, that's going to like posterior tilt of your
pelvis, that shortens your hamstring.
If you anteriorly tilt your pelvis, that lengthens the
hamstring. So if you're a runner who has a
very anterior tilt in your lumbar spine, that will bring
your pelvis into again that anterior tilt Lord on a curve of
your spine. All these can be OK things.
But that will put more stretch on your hamstring as your limb
advances. So if you're an over strider and
you are extending your knee all the way and you're in this
anterior tilt that because your other leg is in terminal stance
phase, which is where your hips are going to go into that
anterior tilt anyway, you have to recognize that that could be
leading to a lot of strain through that hamstring.
So anterior tilt of your palace put excess stress and if you're
overstriding with an extended knee, that's that's kind of a
recipe for high, high strain through the hamstrings.
And that could be again a reason why if somebody has that they
might feel a little bit more proximately than they do
distally just because that will lead to increased compression at
that sit bone joint. The other part is when it comes
to mechanics, when I'm doing running analysis with people,
one of the things that we look at is landing position.
I care a lot about, care a lot depending on the person, care a
lot about where the foot is landing and what it does the
limb look like. I care less if they're landing
on their toe or their 4 foot, their heel, their rear foot,
whatever. But if they land with a
completely extended knee, that tells me a lot more about the
demand on the hamstring than if they land with about 20 degrees
of knee flexion. Very different loading profile
shows also a different amount of like potentially neuromuscular
control, because if their limb is just moving to a straight
extension of their knee, fully straight, that means they're not
slowly slowing down the limb of of their their tibia, they're
not slowing that down. So that could be a part of the
training is how do you learn how to advance your limb without
letting your your foot just swing straight into full
extension. And for folks who are having
some distal stuff, I often see a fully extended knee as they're
as they're landing just because there's less control around the
knee joint and and that could be a factor for them as well.
So this next question is from Shipwreck Trent and they're
asking does overstretching contribute to hamstring injury?
So the way I conceptualize this question was like not stretching
during running, but just like stretching as a warm up or as a
cool down and doing kind of like a tripod pose or whatever it is
for a stretch. So do you have any thoughts on
that, David? Yeah, I think inherently, just
looking at the question, I'll tell people, mobility isn't
necessarily the enemy. If you're really flexible and
you have this crazy range of motion and can put your feet
over your head, there's nothing wrong with that.
The question is whether or not we can control it through the
range of motion you want to control it through.
Now, if you're a very dynamic gymnast and need that range of
motion, well, you better be able to control that leg through that
range or you're going to hurt yourself.
And the same applies to running and things like that.
Now, if we're looking at it from a force output standpoint and
you're doing a lot of stretching statically before before
exercising intensely, there is research out there that does
show that that does decrease your force output when you are
trying to do something with a high amount of load on the other
end of it. And so that's why they usually
don't recommend, you know, these long static stretching sessions
before a heavyweight lifting or a speed workout or things like
that. And then it's like almost the
opposite with dynamic stretching, you know, getting a
warm up in, getting the pliability of the muscle, the
tendon, get it used to kind of extending out a little bit and
get it primed at both in the neuromuscular stand.
Well, yeah. Nervous system and muscular
neuromuscular. From that neuromuscular
standpoint so that it knows that it's about to do something and
it's ready to go do it. So stretching is so wide of a
field. But if I'm hearing if I'm like
reading it, at least the way I feel like I'm interpreting this,
it sounds static based on the question and if it's before a
high intensity effort then it probably would be detrimental
from a force output standpoint. But.
If you're doing it just throughout the day for your own
Wellness, even afterwards, I haven't really seen anything
detrimental there. And if you feel good and it
helps get some blood flow to the area and you have nice mobility,
then that's great. Yeah, when they look at
hamstring injuries, it's not like stretching is a risk factor
for hamstring injury. But that I think that if the
question is about a healthy person just doing a lot of
stretching, doing yoga, doing things for mobility, is that
going to predispose you to a hand?
Does that contribute to injury? Not necessarily.
I think is what you were just saying.
And I would agree with that, where I think it flips a little
bit as if you're somebody with a more acute hamstring strain of
some kind and then you stretch that, that would contribute to
preventing healing. And the reason that this is
important is because when you strain a muscle, hip flexors are
a great example. Calves are an awesome example.
Hamstrings are another amazing example.
When you strain them, they feel tight, like that's what they'll
feel like. So it'll be like the natural
thing that you want to do is stretch.
That stretching can prolong the healing process.
So for an acute hamstring strain, they usually we
recommend not stretching for at least three weeks, if not four
to six depending depending on how severe your you know your
injury is. You want to avoid that
stretching because you think about it, if you had a rope and
you were to fray that rope, it wouldn't get stronger by pulling
on it more. You would have to give it time
to, you know, readhere to itself, and then you can stretch
it to get the length if you have a length deficit.
So in that sense, yes, overstretching can contribute to
hamstring issues, but that's only if you've had one in the
first place that you're trying to rehabilitate.
Otherwise, I think it's as you said, timing of your stretching
isn't maybe important and it may not contribute necessarily, but
it's also, you know, maybe not the most needed thing if you're
trying to like pair out, what what do I need to do to stay
healthy? Running hamstring stretching
regularly probably doesn't top the list.
And we're talking mainly here when we say acute strain, most
likely sprinting it pulled us, might have a partial micro tear
in there like you need to let that thing mend and you don't
want to be yanking on it a bunch, not necessarily like I've
been feeling this six months. Yes.
And things are pulling on a little bit.
And yeah, yes, exactly. I think the other group I would
add in there are like the group where I just ran my first 5K and
forever and my hamstrings feel so tight.
Now that's not a really a time to stretch either.
You've probably have a grade one.
This is what happens when you do a hard effort.
You you tear muscles, that's what you do, You break them
down. And that's why recovery is so
important because you get weaker during the workout and then
stronger during the rest. So if you went and raced
something and you're noticing your hamstrings feel quote UN
quote tight, you probably don't want to stretch them for that
week. Let them, let them feel tight
and loosen them up by doing as you said, dynamic warmups.
Go walk. Go do some like very light
movement related exercise. Body weight stuff, skips.
Yeah, skip, You know, high knees.
But get it. Moving do.
Something. Do some bridges whatever it is.
Like their butt kicks. I mean, like, yeah, yeah, great.
I know Casper the Friendly Ghost is feeling it a little bit right
now. Yeah, yeah, our audio, for those
who don't know, Casper, our audio engineer, He just had a
5K. I feel like I'm using the
example because it's him. Yeah, but he just raised his
first 5K and he just did bridges now.
He put it in the chat. It's amazing.
He just ran a 5K, did a great job, did better than what his
goal time was, and he's feeling it today.
So we're actually just talking to him this whole time.
All right, let's move on. We've we've hit a lot of these
other questions because Nanny Coleman was talking about
mechanical differences between the upper and and lower
hamstring tendinopathy. We talked about that.
We talked about where this proximal hamstring tendinopathy
tends to be up in the the glutes.
This is Eric Korup and they were asking is this kind of deep
glute bum pain, insertional hamstring tendinopathy.
They sometimes barely notice it. Maybe because it could be so
many things. It could be that proximal
hamstring issue. It could be something with, you
know, the low back referring there.
It could be one of the gluteal deep gluteal muscles.
There's a lot of anatomy but that is where the pain comes in.
So I think the the last big question that I want to ask you
David and we've we've gotten this from a few people.
It's for those who haven't had a hamstring issues and want to
maintain healthy hamstrings. What recommendations do you have
for for that group where they're like I haven't had an issue
before, Are the things I should do I I always fret to use the
word prevent these injuries, but what are your thoughts on that?
Yeah, I mean, when we take a look at late stage rehab for
hamstring strains, it's a lot of that stuff.
Yes, keep your strength good, keep your pliability good.
I mean whether it's plyometrics, dynamic stretching, I mean
you'll never see me before a track workout and not doing any
kind of drills like I will always be doing some skips.
I'll like. I mean it might be a little bit
different on the day depending on what I'm feeling internally,
but I will always be doing something and making sure that
things are mobile, you know I. Try to be good about the
strength training and other side of things as well, and just
making sure that your body is a good machine that you can use.
And if you keep it, you know, if you take care of it, it should
take care of you. And that's not to say that
people doing all the right things don't get hurt.
It does happen. I'm sorry for the situation.
It's happened to myself, you know, And you sometimes there's
things outside of your control there and you just have to take
things in your hands and do the best you can and get back out
there. But if you're doing things well
and things are going well, keep try to keep them going well.
Like, yes, I wouldn't necessarily, unless you're doing
absolutely nothing and just thinking about it, I probably
wouldn't change too much. And even then, if you're not
doing anything and you want to start doing something, ease into
it. Because if you go and you
overload your body in a different way on top of other
things you're already doing, that's also asking for an
injury. So just don't overextend
yourself and gradually increase the load of whatever it is
you're trying to do, whether it's get faster, it gets
stronger, or just, you know, do things around the house.
Yeah, I totally agree. I think that one of the best
things we can do for just the global idea of trying to stay
healthy when we run is to pre plan.
So if you are not a 5K runner or one mile or whatever, and you
want to go and do something faster, but you've just been
running. Casually and recreationally and
maybe some long distance stuff. Prepare your body for that
before you start that training cycle.
So like, if you want to train for if you know like, oh this
summer, I think I want to do a 5K and I really, really want to
run it hard. That that's winter and spring.
You should be doing that late stage rehab, so you should do
heavy strengthening. You should load those tendons a
lot through ecentrics or heavy concentrics, either one, and
then be hitting plyometric stuff so that you're getting that
power and fast response to it. Because our muscles and tendons
don't adapt to loads, we don't give them to give to them.
So if we don't train plyometrics in that high speed velocity
stuff, it won't really be ready for it when the time comes.
So take your. Time when you're not in a heavy
training cycle and do exercises that are specific to the demands
that running will put on it later.
Because running and doesn't really get us stronger.
We have to get stronger to like do the running that we wanna do.
So that'd be my biggest recommendation is pre plan and
get a plan in place to do it I think when it comes to like.
Gait retraining, I think you'd have to have something pretty
pronounced on on kind of your running analysis.
So I even though I have a 3D system like in our clinic and I
use it all the time, I'm not changing somebody's running for
something minor, you know, because even the evidence on
injury prevention through GAIT retraining.
It's getting there. There is some stuff there now,
which is nice, but it would be if you were the person who has a
lot of extension through your knee and you're really landing
over striding. That would just be part of
global injury prevention, not specifically hamstring.
So I think that there is a space for assessing your running and
kind of looking at it, but you'd have to have somebody who knows
what they're talking about and not just make changes for the
heck of it. All right.
Final question of the night. David, this is for you.
Is it Hammy Hamm i.e. Or Hammy HAMMY.
Interesting, I wonder. He sent that one.
That's a great question. It was.
Doc Sabrent, David. It was the first question we
got. You know, I'm from the i.e., the
Inland Empire. I gotta go with Hammy i.e.
What? No, no, this is an HAMMY
situation. Or I mean, I think if it's
similar actually to like the Tammy Tammy or the Sammy, Sammy,
like which one's right? They're both right.
I think you're wrong in this scenario.
Maybe that's our new subjective. Is it hammy with an i.e.
Or hammy with a Y, but then whammy is only with the Y I've
never seen whammy with an i.e. No whammies.
But then if you see that it's Ies right on all those.
Yeah, it's true. Have you seen that game show?
What's it called? No whammies.
No whammies.
That one. Why would I watch a show called
No Whammies, No Whammies, No Whammies?
No, no, no. It's called something else.
Gosh, what's it called? It's, but it's a game show and
that's like when they hit the spinner, they're like, no
whammies. Anyway, I can't think of it.
Also, somebody help us out and tell us what that game show is.
Anyway, thank you all for contributing questions about the
hamstring. We had a fun time talking about
this and again, we do have some resources of specific rehab
exercises on our Instagram. You'll kind of have to dig a
little bit. They are easy to find this.
I feel like we're plugging this so but on my.
The running lab that I kind of lead, it's called Pioneers
Running Lab. We'll link these in the pod as
well or in the in the description.
But you know on Pinery's running lab, our Instagram, if you hit
the exercises tab or highlight reels or whatever, it'll bring
up some reels of of these exercises.
And yes, Casper, our audio engineer in the clutch, it's
called press your luck, that's the game show.
Anyway, thank you all for joining us tonight.
We just went off the rails for the last three minutes, so sorry
for wasting your time and look forward to talking next time.
Have a great night, everybody.