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Hamstring Injuries

Hamstrung! When your hamstrings go, you're toast. Here's how to keep them healthy 

Hamstring injuries are among the most common and frustrating problems endured by runners. Not only can they take a long time to heal (sometimes months), they also can become chronic.

Ben Beach, 52, a veteran runner from the Washington, D.C., area has suffered nagging hamstring problems since 1986, when the pain first hit at mile 7 of a 20-K race. He recovered well enough to run a 5:40 pace a month later in the Cherry Blossom 10-Mile, but he has never felt the same since.

"Why am I more susceptible to hamstring problems than other runners?" Beach wonders. "I didn't always know that stretching was important, so during my first 10 years of running, my hamstrings got tight. Now I'm paying the price."

The Basics:
Your hamstrings are three muscles that run down the back of your leg. They bend your leg at the knee and also extend your leg at the hip joint. These muscles are critical for fast running, which is one reason why sprinting and speedwork often result in hamstring injury.

The underlying causes of hamstring problems, however, usually involve overtraining and fatigue, improper warmup, leg-length differences (your shorter leg can develop an overly tight hamstring), previous hamstring injury (making you vulnerable to re-injury), lack of flexibility, or muscle imbalance.
The latter is a chief culprit when it comes to hamstring woes. "Many runners have a combination of too little hamstring strength and too much quadriceps strength. It's a tug-of-war in which your hamstrings lose," says Janet Sobel, a Bethesda, Md., physical therapist.

Usually a strain tears your muscle fibers, and you feel a sudden pain that can range from a twinge to a searing sensation. You may even experience immediate bruising and swelling, or bruising may show up later and gradually move down your leg. A complete rupture occurs only rarely, but may require surgery.

Treatment:
If you suffer a hamstring injury, here's what to do:
RICE it. The standard, immediate treatment for a hamstring injury follows the RICE method: Rest, Ice, Compress, and Elevate. Ice your injury for 20 minutes, three to five times a day, as long as you have pain or swelling.
Don't run. "Take off as many days as it takes until you can walk briskly without pain," says Sheldon Laps, D.P.M., a Washington, D.C., podiatrist.
Take anti-inflammatories. Since inflammation often accompanies hamstring injuries, you should take a nonsteroidal anti-inflammatory medication. Ibuprofen and naproxen sodium are the best, but aspirin is okay, too. Follow the instructions on the bottle, and take these medications for 1 to 2 weeks. Always take them with food.

Stretch gently.As soon as your initial pain subsides, begin a gentle stretching program. Stretch only up to the point where you feel slight tension in the hamstring.

"You need to stretch because you don't want that muscle group to shorten up, or scar tissue to form," says John Bojchuk, M.S., a clinical assistant at Midwest Orthopedic Sports Medicine in Chicago. "But if you stretch beyond your limit, you could tear the muscle again."

Sometimes the previous four remedies are all you need to recover and start running again. If recovery takes longer, however, consider seeing a physical therapist or athletic trainer who might recommend ultrasound treatments or a more aggressive stretching/strengthening program to promote healing.
Sports-oriented massage therapy also can help. A massage therapist's deep-tissue work can break up muscle knots in areas you can't handle yourself.
"Resume speedwork only when you have no more pain, but just an aching awareness of your hamstrings," Sobel says. "Start speedwork very gradually, assess how your hamstrings react, and, of course, take off some days between workouts." It's okay if you feel some sensation in your hamstrings, as long as it doesn't worsen after you finish.

Keep in mind that sciatic pain, a herniated disk, and other conditions can sometimes resemble hamstring pain. Also, don't be surprised if you start to feel aches elsewhere, such as in your knee or ankle. This can occur when a hamstring pull alters your running mechanics (making leg lift difficult, for example), which can stress other parts of your body. If your injury doesn't improve within 10 days, consult a professional.

"The toughest hamstring strains can take as long as 3 or 4 months to recover," Bojchuk says. "The higher in your leg the strain, the longer it takes."

Prevention:
Do the following to keep your hams strong and healthy:
Warm up thoroughly. Before you run, especially in cold weather, walk or jog until you break a light sweat. "It's also a great idea to massage the injured area with Myoflex, Bengay, or a capsaicin cream for 3 minutes before you run," Sobel adds.

Modify your stride. Some experts believe it helps to shorten your stride, since longer strides (particularly going down hills) increase your risk of a hamstring injury. On the other hand, short bursts mean "you're contracting your muscles more violently, so that might predispose you to straining your hamstring," Bojchuk says.

Stretch and strengthen. The following stretching and strengthening exercises can help prevent hamstring injuries or re-injuries.

Lie on your back with your left leg bent and your knee to your chest. Clasp your hands around the back of your thigh and extend your left foot upward until your leg is straight. Keep your left foot flexed with your heel pressing toward the ceiling. Your right leg should remain flat against the floor. Stretch only to the point where you feel tension in the hamstring. Hold for 15 seconds, relax, and repeat. Then repeat the sequence with the other leg.

Do "mini squats." Stand with your lower back pressed against a wall, and your feet about 4 inches from the wall and about a foot apart. Slowly bend your knees until you've slid down the wall about 6 to 8 inches, then slowly return to your starting position. Do three sets of 15, all slow and controlled.

Try hamstring curls if you have access to a leg-extension machine. Concentrate on lowering your leg slowly. Don't just drop the weight.

Buy a set of ankle weights (start with light ones, such as 5 pounds) or a resistive sports cord. Strap on the weights, lie on your belly (on a bed or the floor), and bend your knee. Do three sets of 10 to 15 repetitions.



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