Hamstring Injuries - A Practical Discussion [ARTICLE]
|Hamstring Injuries - A Practical Discussion|
|By: Jim Vahrenkamp
Originally Published in: Techniques Magazine
Provided by: USTFCCCA
Motor patterns are important to what we do. Consider the following movements:
Body weight squat
Over head backward
Between legs forward
Standing long jump
Each movement on this list builds both in intensity, range of movement or in complexity on the base motor pattern of the squat. Each skill requires increased demand or intensity of the movement. The by-product of this increase is often irritation of the soft tissue, ligament or tendon structures resulting in tendinopathies or syndromes which require cessation of activity to get symptoms to abate. As coaches and athletes, the abatement of symptoms does nothing to solve the root of the problem, and often we find ourselves again at square one, wondering when the symptoms of our dysfunction will present themselves again, inhibiting our potential and ultimately ending or hampering our season.
In sports, the muscle most often injured is the hamstring. As an athlete, I suffered injuries to my hamstrings repeatedly. Usually I was told it was a strength issue which made me resolve to develop enough strength where I would never injure my hamstring again. Even after improving my squat max significantly I still found myself a victim of another hamstring injury. Early in my career hamstring injuries plagued some of my athletes and yet not others. To me, it seemed there was no rhyme or reason to what I was observing. What was the problem? Was it weakness? A technical error? What was it?
The central tenant of the Central Governor Theory states that the brain serves as a primary entity that serves to protect us from ourselves. In distance races, it is the small voice in the back of our head encouraging us to save some for the finish. Timothy Noakes asserts that we are capable of much more than we can demonstrate because of the brains interest in self-preservation.
In sprinting the CGT is present in the length-tension relationship in the musculature of the posterior chain. Motor dysfunction in the psoas and glutes as a result of persistent seated position cause negative compensation patterns where the hamstrings pick up the load that the glutes typically perform. At submaximal velocities these compensation patterns don’t present an imminent threat, however as speeds approach maximal, the brain shortens the hamstring to protect the organism from itself and the potential damage present in the large amplitudes of movement and rates of movement. Stretching these tight muscles will do nothing to convince the brain that function has returned to the psoas and glutes. It will, however, deaden proprioceptors in the hamstring further compromising the integrity of the system as a whole.
During my second year at Augustana University in South Dakota, I had a talented Norwegian athlete named Henrik Holmberg. After several hamstring injuries, he went to see an athletic trainer named Brad Pfeifle who prescribed several general strength exercises. The following year Henrik blew up. He improved in every event and went from being a kid that could score at the conference championship to a national qualifier in several events.
Something about that experience still did not answer all of my questions. Of the muscles in the lower leg, why was the hamstring the only one getting injured? Rarely did I see issues in the glute, the adductor, the soleus or the psoas. If each of these muscles is in use during full velocity movement, why then is the hamstring the only muscle becoming injured? I researched the mechanics of running by reading and speaking with experts like Ralph Mann, Loren Seagrave, and Boo Schexnayder. What began to present itself was a different paradigm from what I had previously coached from.
A product of these conversations was a move to look at movement patterns. Within these movement-based coaching paradigms, the most important elements are posture, mechanics, and function. Humans develop coordination through the combination of sub-maximal and maximal rehearsal of movement patterns. Babies are a prime example. We have each observed a child as they develop the coordination and mastery of the movement patterns required to move from stumbling to walking to running and jumping. Most of these children develop these motor patterns as they explore their world barefoot. Young children also have the ability to move through complete ranges of motion such as a full depth squat without difficulty. It is common sense to understand that these abilities are achieved before developing maximal strength levels. Children accomplish all of these functional abilities through general strength work.
So where does a virus in a movement pattern originate? As humans, we each solve movement problems differently. There are general principals to how we run and jump, however, the nuanced details of how we accelerate or amortize impact have unique differences specific to our development of our movement skills. For example, Stuart McMillen, sprint coach at Altis suggests that facially driven athletes organize their motor patterns in a way where they tend to pull down the track while other athletes that display a propensity for excellence in the squat tend to push themselves down the track. These differences are displayed in the location of their COM at touchdown and the errors in sprint pattern that arise. As athletes, we lean toward our strengths and away from our weaknesses.
Another large part of the issue is injury history. Our primary engines of movement are the shoulders and the hips. The body seeks balance in the movement which means that the upper body mirrors the movement of the lower body and vice versa. That means that often injuries in the posterior chain of the upper body affect the movement patterns in the lower body as the body attempts to compensate for changes in ranges of motion resulting in an injury chain.
Three other pieces of our everyday life further complicate these issues. Our posture in day to day life involves a great deal of sitting which affects our posture in sport or activity. Because the body moves toward homeostasis, our movement patterns gravitate to a hunched compromised posture. Shoes also complicate things. While protection for the soles of our feet is a wonderful development, the way that our foot interacts with the ground has a lot to do with how we use or fire the muscles in our body in movement. Often when I have athletes that run heel-toe, merely removing shoes and having them run lightly on the track or grass reveals the proper motor pattern that was developed as a child. The shoe often reinforces a movement virus.
To identify movement issues in our athletes, we rely on movement screens. Often in the industry that means three or four tests that show us ranges of motions that the athlete is capable. In our program we rely on a warm-up that requires athletes to move in every plane of motion while challenging coordination. Additionally we look at posture in hurdle mobility to determine appropriate ranges of motion and proper movement coordination in the multiple joints associated with running. Lastly, we also look at the movement in the weight room. I am not interested in increasing horsepower blindly. Horsepower typically exacerbates problems rather than solving them.
Each of the following should be considered opportunities to screen athletes for the presence of compensation in normal movement patterns. Keep in mind that adjustments to any established motor patterns do not promise immediate improvements in performance. The organism is forced to reevaluate its solution to movement in an effort move in a pattern that minimizes injury risk.
Once we have identified a virus in a particular movement pattern, we use the following modalities to address the problem.
RE-EDUCATION OF MOVEMENT PATTERNS
Hurdle Mobility: Used to identify and coach correct firing patterns, ranges of motion in joints while maintaining posture. The dynamic nature of this activity challenges the athlete to improve and develop functional movement patterns that stave off injury.
General Strength: These movements are performed in static positions where athletes can be coached to fire the correct musculature associated with correct movement patterns. More often than not our general strength sessions will have a glute dominant theme to a session where athletes seek to ensure that the glutes are the primary driver in each of the movement required.
Multi Throws: Multi throws are a more dynamic opportunity where correct coordination can be developed prior to moving into the weight room to introduce greater loads to the system. They also allow the coach to continue the teaching process in a more dynamic situation where the athlete is able to make connections to other more dynamic activities.
Multi Jumps: The dynamic nature of this activity is more complex than multi throws because of the elastic nature of the movement. Correct posture can be emphasized while proper amortization of impact forces can be coached.
Sprint Drills: Sprint drills have very little transfer to the maximum velocity demands of coordination of sprinting. They do offer, however, an excellent opportunity to develop specific strength while developing coordination and maintaining posture during a complex and dynamic movement that does transfer to sprinting. Again proper movement patterns can be cued here and the actual drill can be used as a movement screen to detect and injury or compensation pattern before it threatens the organism further.
Tissue Mobilization: Foam rolling, Active Release Therapy, Rolling Sticks, Fascial Stretching, Deep Tissue Massage all have a role in ensuring that the muscle tis- sue is supple and ready for the dynamic demands of sport. A good coach will be familiar with what healthy supple muscle tissue feels like. This knowledge can be developed through conversations with massage therapists and other professionals. Kelly Staret has done an excellent job providing solutions to these issues in his book, The Supple Leopard.
Muscular Activation: Through the palpation of certain trigger points dysfunctional muscles can be activated for a period of time, however in my experience teaching the body to properly recruit the correct tissue for movement is the only solution with lasting effects.
In conclusion, there are many factors present which require a multifaceted approach to maintaining healthy movement patterns. The hamstring is an alarm bell for dysfunction in the posterior chain, indicating issues including but not limited to a hampered range of motion in the ankle, glute dysfunction, mechanical issues, etc. Boo Schexnayder suggest in a short paper on dealing with hamstring issues that the level of use of the hamstring eliminates the consideration of weakness in the muscle. This article should not be considered a definitive work on the matter but rather a starting point for further research. Additionally, there is no replacement for practice and experimentation. The suggestions here should be considered a loose guideline for the development of your own expertise.
Movement - Gray
Supple Leopard - Kelly Staret
Long Anatomy Trains
Jim Vahrenkamp is the Director of Cross Country and Track and Field at Queens University in Charlotte, North Carolina.