Hamstring Rehabilitation and Running Mechanics – Part 1
– Derek M. Hansen –
A few months back, I had the opportunity to do some hamstring rehab work on an athlete I had worked with in the past. He had been training another city for the past year and had torn his hamstring in a 30 meter sprint test. Four days later, he eventually made it back to my city and we had to undergo some pretty intensive hamstring rehabilitation. He had four weeks to be ready for his first competition (bobsled). This would have been more than enough time for us to work with him. Having worked with sprinters and speed athletes for some time, it was pretty familiar territory for me. I had no doubt that we would successfully rehab him in time for him to compete in top condition. It is important to note that the process we undertook is no different from the framework I outlined in a recent article on Rehab and Dating Success.
The first day he was back under my supervision, we started with evaluation and observation. Simply speaking with the athlete and asking him about the injury and how it feels (standing, walking, sitting, getting out of bed in the morning, etc.) can yield a lot of useful information. Given that we were five days out from the initial injury, inflammation was not a significant concern for us. It was more about determining the athlete’s level of mobility and comfort.
Working Around the Injury
After letting the athlete walk around and passively test the hamstring, we had him lie down on his stomach. I carefully probed around the hamstring to determine the extent of the injury. He had indicated that the main injury was located around the middle to upper portion of the left hamstring, specifically in the semintendinosus. I performed light massage on the hamstring using massage cream to ensure that the passes were superficial and not stretching the muscle and fascia too much. My main intent was to determine the status of muscle tone for the strained muscle (above and below the injury site), as well as the tone of surrounding muscles (biceps femoris, semimembranosus, gracilis, adductors, soleus, gastrocnemium). As you might expect, every muscle was hypertonic and bordering on spastic. I continued to work all of these muscles, including the gluteal muscles, to not only bring down muscle tone but also increase circulation around and toward the injury site to facilitate healing and increased suppleness.
It is important to note that I did not work into the injury site on this first session. There was a lot of work to be done elsewhere in the surrounding tissues. I did not feel that it was prudent to work into the site, given that the athlete was only five days out from the injury and endured a 12 hour drive the day before. Another consideration was that I did not have to get him ready in 10-14 days. I had a much longer time-line and exercising caution was the best possible option.
Implementing Acceleration Work and Drills
After loosening him up sufficiently, we had him perform some easy accelerations over 5 to 10 meters to see what he could do. I made it explicitly clear to him that he only needed to exert himself in a safe manner at 50-60% of his top acceleration rate at best. As you can see from the first video below, his running stride is significantly hampered by the injury and his foot placement on the left side is very guarded. This is normal under these circumstances. The intent of each run is to run as naturally at possible, at a conservative pace, without putting the hamstring in danger of re-injuring. I tell the athlete that he should feel a slight tug on the hamstring, as if it is being worked lightly, but not to the point that it becomes sore.
After performing a number of sets of 5 repetitions over 10 meters, the athlete indicated that he felt the hamstring getting noticeably tired. In this situation, you have a number of choices. You could have him take longer recoveries to ensure there was little to no fatigue in the muscle, or you could change the type of work. We decided to change the type of work. In the video below, you can see that we decided to do a running high knee drill (Running ‘A’). This drill allows him to perform dynamically without putting the hamstring in danger of re-injuring. The action is primarily vertical in nature, unlike actual sprinting which requires a greater horizontal extension component. He is permitted to work aggressively in a manner that bolsters good running mechanics, builds lower leg elasticity and rigidity,and gives him the feeling of performing a full workout, as this is an important psychological factor in rehabilitation.
Initially, working over 5 meters is sufficient to work the running motion, which should work out to 15 to 20 steps when performed correctly. Recoveries between repetitions, in this particular workout, may be between 1 to 2 minutes, over 4 to 5 reps total.
Week Two
By the beginning of the second week post-injury, we had made significant improvements. Continuing along with the iterative process of performing running drills and accelerations, along with constant manual therapy, we were able to effect big improvements from day to day. Warm-up would include light jogging, dynamic flexibility and PNF work around the hips, and light, flushing massage throughout the lower extremities. Accelerations have gone from 10 meters in the first week, to 20-25 meters in the second week. In between sets, we are continuing to perform massage on the hamstrings, calves and glutes to ensure they are available for recruitment, and that any kinetic chain disruptions are minimized.
I have found that hamstring rehabilitation is primarily about restoring proper intra- and inter-muscle coordination. When a hamstring is injured, the involved and surrounding muscles tend to seize up and minimize range of motion in a protective response. The massage repetitions we are performing help to reduce spasticity and enhance circulation in the region, while the acceleration reps and drills help to re-activate and re-educate the hamstrings and connected muscles (glutes, calves, hip flexors) to recruit in proper amounts and the proper sequence. I am a firm believer that if you free up the muscles to do their proper job, the appropriate sequence of movement will return. While many individuals will say that the prescription requires strengthening protocols, I would go much further to say that an appropriate coordination pattern must be restored. Obviously strengthening is part of the process, but it is a very specific form of strengthening (specificity of velocity, load and order of recruitment). This is why sprinting must be the primary source of work in a hamstring rehabilitation program. It is not a problem that can be adequately resolved in the weight room or physio clinic.
The acceleration repetition in the video clip below shows the athlete not only running faster, but striding through more naturally, with much less apprehension than the previous week. If you look very closely, you can see that the left leg is still not extending as it normally would. Prior to ground contact, you can see the stride shortening on the left side, whereas the right foot extends and lands slightly in front of the center of mass. Similarly, on the extension phase of the stride, the left leg is shortening the cycle ever so slightly and not extending as fully as the right leg. The result is a slight anomaly in the stride cycle that you can pick up through a visual sampling of the entire 20 meter run.
Feedback from the athlete revealed that he felt only a slight, subtle stiffness in an isolated area of the hamstring, but not any pain or discomfort. By this time in the rehabilitation process we were beginning to work deeper into the tissue with massage techniques to break up and mobilize any scarring in the area. It is important to remember that we were not constrained by a short timeline and we had enough time to gradually effect a positive result. I was determined to make sure that when the athlete was ready to push at 100%, there would be no doubt in my mind or his mind that the hamstring would be ready to handle the load over many repetitions. This meant that the sprint workouts were drawn out gradually in terms of adding both distance and intensity for the runs. The same approach applied to manual therapy on the hamstring. We did not force the issue with deep tissue massage until I was sure that the muscle tone had appropriately been reduced through a gradual means. In some sense, we had to “peel the layers of the onion” until the whole of the muscle had been stripped of spasticity and discomfort.
One measure that always seems to work well with muscles that have not fully “released” or joints that still feel tight is to have the athlete apply a heat rub on the injury in the evening and then lightly wrap it with a tensor bandage. The athlete then sleeps with the light wrapping. This basically enhances blood flow to and through the injury site. I always use Tiger Balm ointment for this process, as I’ve had very good personal success with it. It does, however, smell pretty bad and I recommend showering it off in the morning. This process is akin to the wrapping of the legs of thoroughbred horses after intense workouts and when a trainer suspects there may be a slight strain or sprain. In the case of horses, they may refer to wrapping of the legs as stable bandages or sweat wraps.
So the first 8-10 days of rehabilitation went very smoothly with no mistakes on my part. I have learned over the years to be extremely explicit in my descriptions of intensity and velocity to the athlete when preparing him for runs. I would say that I significantly overstate the need to be cautious in each individual run. I have had too many occasions when the athlete told me that he was feeling good and then proceeded to push it a little too hard on the very next repetition, resulting in a minor re-strain of the muscle. Placing significant restrictions on the athlete is critical, regardless of how good or normal they feel. The coach is always the best judge of the rate of progression, whether it is through visual assessment, tactile sensation of the muscle itself or even something as simple as the amount of time that has passed. The progression must always be smooth and gradual.
In Part 2 of this discussion of hamstring rehabilitation, I will discuss how we progressed the athlete to full speed runs. We will also cover the other types of work that were being done in the weight room and with explosive work, taking into consideration the status of the hamstring and the stage of rehabilitation.
Product Review: Casio EX-FH20 – High Speed at a Budget
– Derek M. Hansen –
Just when you think Casio was going to leave the high-speed video market alone for a while with their EX-F1 offering, they introduce a lower-priced, similarly-featured Casio EX-FH20.
The Casio EX-FH20 can capture 40 high resolution, 7 megapixel images in one second providing many more images to choose from than a DSLR. The camera also provides a 20x optical zoom starting at 26mm wide-angle. It’s predecessor, the EX-F1 only provided a 12x optical zoom, stating at 36mm. A push of a button enables you to shoot high definition 720p video and switch to high speed slow motion video. The EX-F1 allowed you to shoot standard definition video,switching to 300 fps video with the push of a button. The high speed function allows for more flexibility than the EX-F1, with capture at 30-210fps, 420fps, and 1,000fps. To read my initial review on the Casio EX-F1, click here.
Advantages of the EX-FH20
Right of the bat, you can see that the EX-FH20 is smaller in size than the bulky EX-F1. The EX-FH20 weighs in at 17 ounces, while the EX-F1 is a much heavier 23.7 ounces. The EX-FH20 takes a smaller carry case with the dimensions as follows:
- EX-FH20 – 4.83” (W) x 3.20” (H) x 3.33” (D)
- EX-F1 – 5.03” (W) x 3.13” (H) x 5.12” (D)
So, carrying around the EX-FH20 will be a lot easier, but it still won’t fit in your pocket.
As a digital still camera, the EX-FH20 shoots at 9.1 mega-pixels, a step up from the 6.1 mega-pixels of the EX-F1. Although the high speed burst mode shoots at 40 frames per second (20 less than the EX-F1), the shots are at a higher resolution (8 mega-pixel) than the EX-F1.
The EX-FH20 also has a much longer optical zoom at 20x (26mm to 520mm) as opposed to the EX-F1 at 12x (36 to 432mm). Whether or not 90mm makes a difference to consumers depends on the type of shooting you are doing. For parents wanting to shoot video and photos of their kids playing soccer, it may be the best combination of video, high speed video and digital still camera.
Why People May Stick with the EX-F1 for the Time Being
The video modes for these cameras are different with the EX-FH20 providing HD mode in 720p, while the EX-F1 provides up to 1080p HD. The resolution for the EX-F1 high speed modes are also slightly better resolution (likely because the lens is larger):
- EX-FH20: 480 × 360 (210 fps, 30-210 fps), 224 × 168 (420 fps), 224 × 56 (1000 fps)
- EX-F1: 512 × 384 (300 fps, 30-300 fps), 432 × 192 (600 fps), 336 × 96 (1200 fps)
I find that for indoor shooting with EX-F1, use of the high speed modes results in darker and grainier results than if I were outside in regular daylight. I could see the EX-FH20 providing less favorable results, particularly when zooming in on subjects. The EX-FH20 does appear to have a high speed “Night Scene” mode and other image stabilization features, but I can’t properly comment on those until I get my hands on one of these suckers.
The EX-F1 records video with stereo audio, while the newer EX-FH20 records in monoaural. However, the video recording formats do differ as follows:
- EX-FH20: AVI format, Motion JPEG, IMA-ADPCM (monaural)
- EX-F1: MOV format, H.264/AVC, IMA-ADPCM (stereo)
However, if you don’t mind not having stereo recording, then you may benefit from the fact the file formats for the EX-FH20 are AVI and likely more compatible with a broader spectrum of video editing packages.
Final Remarks
I was hoping that Casio’s next iteration after the EX-F1 would have the same high speed abilities as the EX-F1, but with higher quality video (I’ve seen professional research cameras with 1000 fps at HD quality – albeit at a very high price). It doesn’t appear that this is available with the EX-FH20, but it has been bundled with some other features not found on the EX-F1. Will I go out and buy an EX-FH20 to replace my EX-F1? Not likely. I like my EX-F1 and I’m accustomed to it’s feel and features. However, for the high speed video enthusiast that doesn’t want to shell out close to $1,000, the EX-FH20 is more than a suitable substitute, retailing at under $600US.
I am very glad that Casio has continued on with trying to improve (and bring the price down) on this technology. I love watching the high speed video of simply activities like running, jumping and throwing. Just the other week, I was using the camera to determine ground contact times for plyometric jumps. Great fun! I’ll be glad to see what they come up with next with this line of cameras. If they can produce a camera that shoots 100, 500 and 1000fps at standard definition or (dare I say) high definition, I’ll be the first in line.
Find the new Casio EX-FH20 at BH Photo and Video below:
Honda Unveils “Walking Assistance” Robotics Technology
– Derek M. Hansen –
Every now and then you see something that is just ’science-fiction’ cool. Something that you may have seen in the movies and, eventually, becomes a reality. If you’ve seen “Iron Man” starring Robert Downey Jr. this year, you couldn’t help but leave the movie theater wondering when a super-suit would be available in the near future to enhance your strength and power.
On Friday, November 7, 2008, Honda Motors announced it will begin real-world testing of its second experimental walking assist device designed to reduce the strain on a user’s leg muscles and joints such as hips, knees and ankles. The mechanics device will support a portion of the user’s body weight for activities such as crouching, walking or climbing stairs and is meant to help both those physically weakened with age or injury as well as workers who would need to reduce the stress on their bodies from heavy work or postural conditions that are unsafe.
The device, including its lithium ion battery and shoes, weighs 14.3lbs, and uses two electric motors to assist users’ leg movement for up to two hours before a re-charge is required.
Honda began research on a walking assist device in 1999 with the goal to provide more people with the joy of mobility. The first walking assist device, announced in April 2008, has a stride management system and was designed for people with weakened leg muscles, due to reasons such as aging. The research and development of Honda’s advanced humanoid robot, ASIMO, including the study of human walking, provided Honda with the knowledge necessary to develop the walking assist device. This research has been conducted by the Fundamental Technology Research Center of Honda R&D Co., Ltd. in Wako, Saitama. To evaluate the effectiveness of the experimental model of the walking assist device with bodyweight support system, Honda will test the walking assist device at its Saitama Factory (in Sayama, Saitama) starting this month.
Implications
Now that we are actually on the cusp of this type of technology, it will be interesting to see what useful applications arise. As reported, use with mobility-challenged populations and factory workers will be the first applications. The elderly and persons recovering from stroke could benefit from this device. I could also see this type of robotic technology being used in rehabilitation for lower limb injuries. This apparatus, although pricey, could replace crutches. In the first week following ACL surgery, patients could strap on this device and avoid significant weight bearing, while introducing much needed flexion and extension movement in the knee joint, much like a Continuous Passive Motion (CPM) device. It would ensure stability while incorporating movement and accessibility. I could foresee it being used for assisted movements as part of a strengthening and muscle re-education progression, enabling squatting, lunging, walking and, eventually, running.
I could even see exoskeleton robotic technology being integrated into a whole new classification of sport. I would love to see the robotic, cyborg 100 meter sprint performed in under 6 seconds. And then there are the military and policing applications for these types of robotics, much similar to the “Iron Man” concept.
I will be watching closely to see how this technology evolves and if more and more investment is directed at these types of projects.
To find out more on the Honda Walking Assist project, visit this link.
Rehabilitating Injuries and Dating Success: Parallels and Progressions
Posted by Derek Hansen on November 3, 2008 · 1 Comment
– Derek M. Hansen –
I spend a lot of time working with young athletes in the age range of 18 to 25 years. Most of them are male, but many of them are also female. While most of my work with these athletes involves getting them bigger, stronger and faster, I also spend a lot of time managing injuries and restoring movement – probably more than I would like, but it has to be done to move forward. Interestingly enough, my athletes very rarely get injured while I am working with them. The injuries mostly occur while they are playing or practicing their sport.
When an athlete incurs an injury, I am the first one to jump in and teach them that they need to view their injury as an opportunity to rapidly improve their situation. I let them know that we have a plan in place that will yield success. And once they are over the initial shock and awe that accompanies a significant injury, we begin to put that action plan into motion. But athletes are still wary of their prospects and tend to be less optimistic about the outcome.
Rehabilitation Realities
Unfortunately, many people believe that rehabilitation is about lying on a physiotherapy table and receiving treatment, usually in the form of electro-stimulation, ultra-sound, ice, hot-packs and other modalities. I spent the summer of 2007 in Spain working with a client, and had the opportunity to meet a skilled massage therapist that worked with famed cyclist, Miguel Indurain. When I asked him what he did to treat injuries and get his athletes ready, he simply showed me his hands.
While the Spanish massage therapist is on the right track, I have also learned that rehabilitation is also about putting the athlete into a position where they can heal themselves. This may sound like a strange concept, but when examined more closely, it is not a difficult goal to attain. Often I hear about doctors and therapists telling athletes what they cannot do as part of their rehabilitation (i.e. don’t lift weights, don’t run, don’t move). I’ve learned from experts like Charlie Francis, Al Vermeil and Rob Panariello that there are many opportunities to train injured athletes in a way that not only furthers their recovery, but also gets them prepared to operate at full capacity when their injury has fully recovered. Rehabilitation must be about realistic opportunities, not restrictions.
Putting this process into words that an athlete can understand can sometimes be difficult. The athletes are depressed and only know how they are feeling at that particular point in time. They are cautious and pessimistic.
The Process Revealed
One athlete in particular, who recently suffered a significant medial collateral ligament (MCL) strain, required a comprehensive explanation of what to expect for his rehabilitation under my supervision. I chose my words carefully and came up with an analogy that I felt he could relate to. Here is a summary of my explanation:
“Imagine that you are on a first date with a girl that you’ve been trying to get together with for quite some time. You want to impress the girl, perhaps get some limited physical contact (even for a symbolic victory), but don’t want to offend her or send the date into a downward, flaming tailspin. This scenario is no different than your knee rehabilitation process.”
“With the rehab of your knee, we are trying to do as much work as possible to regain joint range-of-motion, muscle strength, muscle coordination and general function. In some cases, we need to be aggressive in order to make progress. However, we are also going to be very careful to not engage in activity that puts you at risk for further or more severe injury. So, like the first-date scenario, we are looking for a good rate of progress, without the risk of rejection, unnecessary pain and humiliation.”
“On the first date, you may make some compliments to your date. These are safe bets that should only result in positive impressions on your date. This is similar to doing unloaded knee flexion and extension drills to gain range of motion. Not much risk and lots of benefit. If you take your date out to dinner and make a point of ordering her food for her, this could be as risky as trying to do a body-weight squat without making sure that the quad can contract forcefully enough to stabilize the knee. Additionally, if you try to kiss your date on the first outing, you may be putting yourself at significant risk if you haven’t made sure that the right circumstances are in place. Do you have the green light – based on other cues that you have picked up – to do some linear acceleration drills at moderate velocity?”
“The whole point is to get to the next date – or workout – with an opportunity to further your fortunes. You want to be constantly moving in the upward direction. You do not want to be flat-lining and going nowhere. You want to make sure you gain range of motion, strength, coordination and confidence with every workout. Similarly, when dating, you want to feel like you are getting closer to your date, gaining trust and connecting on several levels. If you don’t do enough work on your date, you will also go nowhere fast. And, you will be lucky if you get the opportunity for a second date. This would be similar to simply getting ultra-sound on your knee, with the odd ice-pack and hot-tub excursion, expecting fantastic results.”
“An overly aggressive approach is also bad. A premature butt-pinching or taking off your shirt in the middle of the date could result in a very quick end to the evening. This would be equivalent to trying to do lateral shuffles in cleats on a turf field. Additionally, unwarranted grabbing motions toward a date’s upper torso area would be right up there with weighted-vest box jumps one week after the injury. Stupid, stupid, stupid!”
Conclusions
Being well removed from the “dating” scene, I’m not sure if all of this information is still relevant with today’s young people. But my athlete quickly got the picture that he should be aware of his progress and what he had accomplished in his previous day’s workout – as it would set the tone for the next workout. My analogy may not be as well received by female athletes, but it might still provide general picture of what to expect in their rehabilitation process. Getting to the next date and eventually hitting a home run is what we would hope can happen with all of our rehabilitating athletes. Through careful guidance, a common sense approach to choice of exercise and an awareness of tissue adaptation, you can ensure that all your athletes recover in a timely fashion – as well as have a healthy social life.
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