Last summer, I worked with a college running back who was contemplating
quitting football because of chronic hamstring injuries. His injuries had
started in high school and had continued on through his first two years of
college. He actually had well-developed hamstrings and great hamstring
flexibility, and he was exceptionally strong. And he should be. He had been
working on hamstring strength and had been stretching religiously for three
years. This is what he was told to do over and over again by his high school
coach, college team physician, athletic trainer, and strength coach.
Muscle strains are not always the result of tight or weak muscles. Many
times, the injured muscle is functioning just fine right up until the causative
event. What we need to do first is look at the mechanisms of injury. During
sprinting or while kicking, the hamstring lengthens across the hip as it flexes
and across the knee as it extends. Eccentric hamstring strength plays a role at
this point by decelerating the lower leg at maximum length.
In the most recent NSCA Strength and Conditioning Journal, an
excellent article appeared on this exact topic (Brughelli and Cronin 2008). The
authors examined the length tension curve of the hamstring and the location of
an athlete’s peak tension. Injuries tend to happen during the descending portion
of the curve and what they found was that reduction in injury coincided with an
increase in the optimum length of the peak tension. In other words, athletes
produce greater eccentric hamstring tension at longer muscle lengths. The
authors presented several studies to back this up.
They also provided a variety of eccentric hamstring strengthening exercises.
(Read the article for more detail.) My personal favorite is the stability ball
bridge and curl. The hips must remain extended throughout the curl portion of
the lift. Hip extension is a secondary function of the hamstring group, which
brings me to my next point…
A second mechanism of injury occurs as the athlete’s lead foot makes contact
and then propels the athlete forward again. Track athletes are often taught to
“reach and pull” with the lead leg to increase stride. This is a bad idea. This
goes back to the length tension curve again. The hamstrings are maximally
lengthened and then have to perform a maximum contraction to pull the sprinter’s
body over that leg. It is a concentric contraction at this point, but the
hamstrings are passively insufficient. This means that they are lengthened too
much to generate the appropriate force.
No special exercises are needed here. Just train or rehabilitate your
athletes by teaching them to “push” rather than “pull.” This will allow the
glutes and quads to come into play to a much greater extent, taking the load off
of the hamstrings. The lead leg will now land appropriately under the athlete
allowing for proper hip extension, a greater stride, and additional speed.
A third mechanism has to do with synergistic dominance. Many muscles are
often responsible for a certain movement. In this case, we are referring to hip
extension. Synergistic dominance involves one muscle overpowering the others.
Hip extension is supposed to be the job of the glutes, but what often happens is
that the hamstrings become the dominant muscle group. This is not at all what
they were designed to do and leaves them greatly overworked. So the athlete with
the strong hamstrings and chronic strains can actually blame his weak glutes.
Here are a couple simple tests to determine hamstring dominance over the
glutes.
Prone hip extension (also known as “testing the firing system”):
Palpate the glutes and hamstrings and ask the athlete to perform a straight
leg raise. The glutes should fire first. If not, the athlete is hamstring
dominant. You may find that the athlete can’t even voluntarily fire the
glutes without kicking in the hamstrings.
Double leg bridge: Palpate the glutes and hamstrings again and
ask the athlete to lift the hips. As before, the glutes should initiate and
the hamstrings should only provide minimal assistance. We’ve probably all
had someone cramp up in the hamstrings when attempting a bridge. That’s a
problem. The athlete really should be able to contract the glutes and lift
the hips with little to no hamstring involvement at all.
Now that we have established whether or not the hamstrings have dominance,
how do we rewire the athlete? Here are a few things to try:
Double leg bridge with foam roller: The roller goes under the
thighs just above the knees. Have the athlete perform a glute set first and
then lift the hips. It’s almost impossible to contract the hamstrings in
this position. To see a demonstration of this movement, view the video.
Double leg bridge: Have the athlete press through the heels with
the toes up (this will actually increase the contribution of the quad but
reciprocally inhibits the hamstrings). Have the athlete tighten the glutes
and then lift the hips. Manually cue the athlete to keep the hamstrings
turned off.
Single leg bridge: Have the athlete press through the heel with
the toes up. Have the athlete tighten the glutes and then lift again
attempting to shut off the hamstrings.
I also have my athletes work in the prone position from time to time as well
as attempt to contract the glutes first and then perform a hip extension. This
can be done with the knees straight or bent. If the knees are bent, the
therapist or trainer must support the lower leg. If the athlete really struggles
with this, have the athlete press the leg into your hand to engage the quads and
inhibit the hamstrings. Then have the athlete tighten the glutes.
References
Brughelli M, Cronin J (2008) Preventing Hamstring Injuries in Sport. NSCA
Strength and Conditioning Journal 30:55–64.
Joe Heiler is a physical therapist specializing in sports medicine and
orthopedics in Traverse City, Michigan. He is a highly sought after strength and
conditioning coach who works with athletes at all levels in football, baseball,
hockey, track, and powerlifting. Joe is also the owner of
www.SportsRehabExpert.com. Feel free to contact him at
joe@sportsrehabexpert.com.
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