Ultimate Principles for Hamstring Rehabilitation

Hamstring injuries are the most common type of muscle injury affecting both the weekend warrior and the competitive athlete. Data collected from professional athletes suggests hamstring injuries are the most prevalent muscle injuries in all of soccer, Australian football, American football, and track and field. Dishearteningly, the data also confirms hamstring re-injury occurs up to 30% of the time and that’s in professional athletes  who spend a considerable amount of time and energy rehabilitating.  One can assume for the novice the risk of re-injury will be even higher!

 

So what’s the best rehab strategy?

There are many qualified individuals such as coaches, trainers, therapists, etc. who have very good ideas and detailed plans to get your “hamys” back in shape. So my goal here is not to give you a comprehensive twelve week schedule, but rather introduce you to guiding principles that when adhered to create an optimal environment for healing.

Eccentric Training

As the schematic illustrates eccentric muscle activation occurs when muscle attempts to contract while it is elongating.  Much research indicates that eccentric muscle activation causes a very powerful growth signal that stimulates new muscle growth. Additionally, eccentric movements help organize and align scar in such a manner as to improve scar’s mechanical properties, so it acts more like muscle and less like scar.  Recall, lingering scar in hamstring predisposes hamstring to re-injury. The term mechanical properties refers to scar’s strength and “stretchiness”. Scar is inherently weaker and stiffer than normal muscle. Thus, scar is at high risk of tearing. This tearing can initiate a chain reaction that results in hamstring re-injury. Eccentric strengthening helps boost new muscle growth and make scar stronger and more elastic; thereby reducing its risk of tearing and in turn reducing your risk of hamstring re injury.

https://youtu.be/7n-TMfCfb7I

Proprioception Training

Proprioception is a complex concept, but you can think of it as measure of how good nerves (peripheral nerves, spinal cord, brain) and muscle communicate with one another to coordinate their actions. For example, someone who has good proprioception usually has good balance. Proprioception plays a key role in hamstring injury and re-injury because excellent proprioception helps reduce the likelihood of two common modes of hamstring damage: overstretching and overuse.

Hamstring overstretching causes hamstring muscle fibers to fail in tension and tear. Over stretching is often a consequence of a communication breakdown between the hamstrings, nerves, and other muscle groups of the thigh.  In the setting of optimal muscle/nerve communication muscle contraction and relaxation are coordinated to confine hamstring lengthening within a safe zone were injury is very unlikely.

Hamstring overuse leads to muscle fatigue that overwhelms muscle cellular machinery causing breakdown and injury. Even the most simple movement is a complex interaction between associated muscle groups, under the command and control of nerves. Each muscle group plays a distinct and critical role in a well executed movement.  For many potential reasons some muscles fail to contribute their far share leading to certain muscles being overused and other muscles being underused during motion. If the hamstrings are required to contribute too much to movement their internal machinery fails leading to muscle tearing.

Proprioception combats both overstretching and overuse by training the hamstrings, associated muscle groups, and nerves to move in sync, minimizing the miscommunication and asymmetric muscle contribution that leads to hamstring injury.

https://youtu.be/Uyn0Y4d6NSA

 

Functional Foods & Supplement Use

Functional foods and supplements help boost hamstring regeneration by either promoting muscle growth or minimizing inflammation.

Muscle growth

Pro growth supplements and functional foods help magnify the stimulatory signal that catalyzes hamstring growth. When you exercise, especially during resistance training, your muscle cells are induced to grow. Certain pro growth supplements and functional foods help amplify this signal. Additionally, many functional foods and pro growth supplements provide the necessary building blocks for new muscle fibers, such as amino acids.

Examples:

  • Protein - Adequate protein intake is paramount to building new hamstring muscle mass. Protein both amplify’s growth signals and provides amino acid building blocks. For adults consider 1.8 g to 2.5 g per kg/weight per day.
  • Branched chain amino acids - The three BCAAs are leucine, isoleucine, and valine. BCAAs are versatile substances that can act as a fuel source for muscle during activity, can stimulate protein production, and can help prevent muscle breakdown. 
  • HMB(Beta-hydroxy Beta Methylbutyrate)- HMB is derived from the essential amino acid leucine. A substantial body of evidence suggests that HMB when combined with proper training increases strength, decreases body fat, decreases muscle breakdown, stimulates protein synthesis, and decreases soreness.
  • Creatine - Optimal creatine levels maintain robust cellular energy levels during both intense and normal activity allowing for a greater stimulatory signal for growth and repair. Additionally, creatine’s antioxidant and anti-inflammatory attributes protect against excessive cellular damage by oxygen based free radicals that are generated during activity.

 

Anti-inflammatory

To be sure healthy inflammation is absolutely necessary to enhance healing of hamstrings and support new growth. However, inflammation is only optimal in the early stages (first 3 weeks) of the hamstring repair process. As you enter the later stages of hamstring repair (6 weeks and beyond) excessive inflammation can cause collateral damage to healthy muscle, expanding unhealthy scar formation. Natural anti-inflammatory nutrients should be consider if you are experiencing excessive pain, stiffness, and weakness 6 weeks or more after your initial injury.

Examples

  • Green tea - Green tea is rich in polyphenols. By some estimates, green tea contains up to 40%  polyphenols by dry weight. Polyphenols, due to their chemical structure, are potent antioxidants. Some scientific data suggests one of the main polyphenols in tea, epigallocatechin-3-gallate (EGCG), possesses 25 to 100 times more antioxidant capacity when compared to Vitamin C and Vitamin E. 
  • Turmeric - Many healthful phytonutrients are found in turmeric, but most investigators believe curcumin is primarily responsible for turmeric’s health promoting properties. Curcumin has demonstrated potent anti-inflammatory, anti-oxidant, and anti-fat properties.
  • Bromelain - Bromelain is the Nom de Guerre for a mixture of health promoting compounds that can be extracted from Ananas cosmosus, the pineapple plant. Bromelain has been associated with re-balancing the immune system’s response to injury to help boost healthy muscle.
  • Rosemary - Rosemary is home to a diverse amalgamation of health promoting substances that can grouped in three categories: essential oils, polyphenols, and polyphenolic diterpenes. Combined these nutrients exhibit powerful anti-inflammatory and antioxidant attribute.