Hamstring Injury Prevention

Hamstring injuryWe all know about the dreaded hamstring pull or strain. We fear that feeling of a sharp pain in the back of our thigh as we are running down the field or about to cross the finish line. The recovery can take months and the loss of playing or training time can be priceless. So what can we do about this? Can we actually prevent the invisible sniper from targeting our hamstrings? Good questions, but the answer is not so straightforward.

We know exactly what hamstring injuries are. We know how to treat them once they are torn or strained. But what we still, as a medical community, have yet to nail down is exactly why they occur and what we can do to stop them. We do however have some very good advice. So if you really want to decrease your odds, the best advice out there is a proper warm up!

What should I do for a warm-up?

Our bodies work best when the blood is flowing and the body has some clue on what you are going to require it to do. So before you do any physical activity I would suggest at minimum a five to ten minute warm up. This can include light jogging or riding a stationary bike prior to participating in a run or other light-to-medium activity level event. But if you are going to be participating in a competitive sport, an intense workout or other physically demanding event you need to be performing a dynamic warm up routine that includes several exercises and stretches prior to the actual activity. The Fédération Internationale de Football Association, or FIFA, has released a great guide called the “+11” that has been used by soccer clubs around the world for injury prevention and warm ups. You can their Injury Prevention Guide by clicking the link and it is free to download. And just because it was made for the sport of soccer does not mean it will not translate well into other sports or events! I also found this great website article: “Try This Full-Body Dynamic Warm-up to Prep for Any Workout”  that has pictures, descriptions, and videos to other dynamic exercises you can use to warm up.

Other than warming up, is there other things that may prevent a hamstring injury?

Yes, anything that places undue stress on your hamstrings will be putting them at risk for a tear or injury. This can come from un-obvious places like your core muscles, ankles, or the way your position your body when doing an activity. For example, if you have a weak core then your hamstrings may be placed under increased stress as they try to stabilize your hips when running. Or, if you have a stiff ankle that does not allow for one of your ankles to go through the full range when doing an activity, your hamstring maybe responding by tightening up. During sporting events or intense activities your body really needs all systems to work together. If one system is not working properly, than other systems will be placed under stress to compensate. This is when injuries occur.

How about stretching?

This can, and probably will, be another whole blog post in itself! To sum it up here, stretching is not all it was once thought to be in terms of a tool to enhance performance or prevent injuries. Recent literature and studies suggest that while stretching is good for improving flexibility it has not shown to reduce the rates of injuries. It was thought that injuries occur when you stress the muscle to the limits of your flexibility and then it tears. However, most injuries to the hamstrings occurs during the normal ranges, and not at the extremes. So should you stretch, yes! But your muscles should be warmed up and you may not want to rely solely on stretching to prevent hamstring injuries as we once did in the past.

So while there is nothing you can do to absolutely prevent hamstrings tears or pulls, there are things that you can do to reduce your odds. Not only will these tips and techniques help prevent hamstrings injuries, it can also reduce your odds of other injuries as well. So warm-up properly and don’t let that sniper take aim at your hamstrings!

- Synergy Manual Physical Therapy Team

North Office (map)

4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)

600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

Piriformis Syndrome: A real pain in the butt!

SciaticNerve It may be there when you first wake up, after a run, or it can even haunt you as you are sitting at your desk. And whether it is called sciatica or piriformis syndrome, it can literally be a pain in the butt. Piriformis syndrome is a condition in which a small muscle (piriformis) in your posterior hip irritates the long sciatic nerve that runs down your posterior leg. The sciatic nerve commonly runs under your piriformis, but if you’re one of the lucky few (approx 17% of the population) it can also run directly through it which has thought to increased your odds of developing this condition. It can cause a variety of symptoms ranging from a simple annoyance or pain in the butt or posterior hip, to pain, numbness, or tingling down the back of your leg.

What causes it?

There can be a variety of reasons that the piriformis muscle can decide to tighten up on you. Commonly in non-athletic populations it occurs as a direct injury to the lower back or tailbone, causing the piriformis to tighten up in response to the injury as it tries to brace and protect your back from further damage. In athletes or those that workout regularly it can be from weakness in their gluteus muscles of the posterior hip, or from faulty mechanics while lifting, running, or working out. Externally rotated hips for extended periods of time can also lead to piriformis syndrome and allow for a shortening of this muscle to occur. If you tend to walk or run with your toes turned outward, this can indicate a possible source of the problem. Misalignment of the bones of the pelvis may also be involved.

To properly diagnosis piriformis syndrome is not the difficult part, but finding out the cause behind it can be. And to treat it without knowing the cause is likely to assure that this pain in your butt is not going anywhere anytime soon. This is why it is important to see your physical therapist so we can evaluate you and find the culprit as soon as possible.

What to do about it?

Fixing piriformis syndrome on your own can be challenging if you do not know the exact cause. I can tell you how to “plug the leak” for now, but if you don’t know why the piriformis muscle is squeezing the life out of the sciatic nerve, then it will come back. The most basic way to decrease the tension of a tight muscle is to stretch it. You can do this piriformisstretchby laying on your back with your feet flat on the ground, place one ankle on the opposite knee, and pull the thigh with the foot still on the floor to your chest (see picture). A deep pressure to the muscle can also help to release the tension in it. We sometimes will do this manually, almost like a deep tissue massage directly to the piriformis, or we advise our patients to sit on a tennis ball to perform a self massage. However, to do this effectively you will need some guidance on exactly where the piriformis is, or you could actually inflame it. Our clinics also use trigger point dry needling to help decrease the tension on the piriformis and other muscles that may be contributing to your symptoms. But when you come to Synergy Manual Physical Therapy we will likely find the cause and address the specific issues that are causing this in the first place. Sometimes it can be as simple as doing some simple stretching and exercises to improve glute activation which will decrease the need for the piriformis to fire during your runs or workouts.

As you read, there can be a ton of reasons for this pain in your butt and even more ways of how to correct it. This is why a little guidance from a musculoskeletal expert such as a physical therapist can help you get to the cause quickly and set you on the right track to making a full recovery without all the guess work you may be doing on your own. If you have any questions or want to know more, stop by one of our 2 physical therapy clinics in the Colorado Springs area today!

– Synergy Physical Therapy Team

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112

 

Runner’s Knee: What it is and how to treat it

What is Runner’s Knee?

If you have been running for a long enough time you are bound to hear the term “runner’s knee.” Hopefully it is another runner complaining they have it rather than hearing it from your doctor’s mouth, but either way you should know what it is and what to do about it. Runner’s knee is medically known as Patellofemoral Pain Syndrome, or PFPS. It is a condition where the undersurface of your patella (knee cap) rubs against your femur causing irritation. The pain can either be a sharp occasional twinge of pain or a constant dull ache that typically progresses the more your run, but has also been known to come and go as you run.

What is the cause of runner’s knee?

As you walk or run your patella glides up and down in a groove in your femur as your thigh muscles contract and relax. Where the problem lies is when it does not track correctly in the middle of this groove. This can occur due to several reasons which needs to be found and addressed to eliminate the symptoms and prevent further wearing. Some of the most common reasons are:

  1. Weakness in your quadriceps muscle, specifically your VMO (vastus medialis oblique). This muscle helps to balance your knee in the center of the groove in your femur. If weak, it can allow the opposing muscle to pull the kneecap towards the outside of the knee which can cause increased wear on the cartilage of the kneecap.
  2. Weakness in your gluteus medius. This is a muscle in your buttocks that controls the stability of the hip and knee. It is located more on the back and side of your hip and is a common weak muscle in runners and cyclists due to commonly only training in one direction, forwards. It activates each time you are weight bearing through your only one of your legs to keep you upright. Without it your hips will drop each time you raise your knee and you will compensate at the ankle and knee joints. This can become weak during long runs and cause subtle changes you may not be aware of that can eventually lead to a breakdown or inflammation in your knee joint.
  3. Biomechanical faults in your hip, knee, or ankle. Your foot and ankle have a lot of control in what forces are placed at the knee joint. For example, if you have flat feet that pronate your knee will tend to have greater stresses placed on the inside. If your patella has bone spurs, is tilted, or is sitting too high in your femoral groove you can get excessive wearing of the kneecap. Your hip joint angles can also affect your knee. If your knee is rotated in or outward it can affect the placement of the kneecap in the femoral groove.
  4. Past Injuries and current structure of the knee. If you have damaged the cartilage of your knee or kneecap in the past you may likely be suffering from it now. You have a certain level of cartilage to cushion and protect your knee. If this has worn out over the years than you may be developing early arthritis which can lead to patellofemoral pain.
  5. Tightness in quadriceps, hamstrings, or calf muscles. Those muscles all effect the knee joint and an imbalance in flexibility overtime can cause increased pressures on the knee and cause the kneecap to track more laterally or medially.

What can you do to prevent runner’s knee?

Staying strong and flexible can be key to keeping this painful condition at bay. Your body loves to be symmetrical and balanced, and when one side is weaker or less flexible than the other it will eventually throw the whole chain off which can affect you anywhere from your spine to your feet. You need to perform strengthening and stretching exercises that not only improves the muscles you think will help you but also those that you may not even be aware of. For example, when running most people think training your calves, quads, hamstrings and your large glute maximus muscles are the only ones you really need and use. But this can lead to weaknesses in your other muscles that can help stabilize your joints during a run.  The best way to do this, cross-training. Cross-training is doing other exercises that are outside of your typical training regime can help boost the strength of your stabilizers and reduce fatigue in the primary muscles you use during your event. This can not only prevent injuries, but also help improve your speed or time! (I will be writing a blog on cross-training in the near future)

If you want to know more about Runner’s knee, various exercises or stretching to prevent it, or if you need physical therapy to treat it, please call or stop in one of our clinics today. We will provide a complete assessment of your entire kinetic chain from your back to your feet to truly find what has caused your runners knee and guide you through a treatment program to not only get you back to running pain free, but also make sure when you are pain-free you do not continue the mechanics that lead you do develop this debilitating condition in the first place.

We look forward to hearing from you!

- Synergy Physical Therapy Team

Synergy Manual Physical Therapy

North Office (map)
4105 Briargate Parkway
Suite 255
Colorado Springs, CO 80920
phone 719.282.2320
fax 719.282.2330

South Office (map)
600 South 21st Street
Suite 130
Colorado Springs, CO 80904
phone 719.634.1110
fax 719.634.1112