As an update to my recent post describing my efforts to recover from a strained hamstring, I have begun working with a physical therapist to identify ways to both heal from the current strain and reduce the risk of future issues with my (in my perception) highly vulnerable hamstrings. Any encounter with a medical professional in which running is the topic offers the opportunity for valuable lessons, so I’d like to share what I’ve learned thus far here. In fact, there are so many takeaways from just the first two sessions that I’m breaking this up into two posts. The first summarizes the initial session, which focused on treating the symptoms and developing fixes to typical causes of strained hamstrings.
Now first the caveats: I would bet that if you visited a dozen different physical therapists, you would learn at least a half-dozen different ideas on how to fix and prevent what ails you. Like runners, therapists have their own biases, based on their experience, education, and, probably too often, anecdotal evidence of “what works” for their patients. Even when they refer to “scientific” results, quality studies on what works for runners are hard to design and interpret, as there are so many variables that either are not or cannot be controlled. Thus, a major part of benefiting from physical therapy is finding an approach you “buy in to” – in other words, the new approaches have to fit with, but challenge, your perspectives on what can make you a better runner. This mental aspect of adopting your approach to incorporate new elements is every bit as important as understanding the physical evidence that such approaches work. If you don’t trust in your therapist and advice he or she is providing, then your likelihood of success is low; you will either not properly incorporate their advice, abandon it immediately after recovery, pilfer away many of the gains through improper execution, or allow doubts to limit the effectiveness.
In my case, it helped that my therapist was roughly the same age, was a prospective father, was from the area, and, most importantly, was a runner. Our instant rapport (he also had a sister who works with my wife) made trust easy to build, and at no point did he question my goals or past habits. He seemed to gain an instinctive grasp of my aggressive nature to training (maybe it was The Running Manifesto T-shirt I was wearing?), and, before I stated any concept of how soon I hoped to be able to run again, he stated his own goal of two weeks to get me back to running pain-free. This was no accident; the sports medicine doc (who also knows about me through my wife) hand-selected this physical therapist based on our similar backgrounds and his experience with runners.
We started with a general conversation about my training, the timeline of the injury and activities since it occurred. We discussed my goals at a general level. This is the first point where the therapist’s own bias began to show (as well as mine, I suppose), as he began discussing the benefits of yoga. He specifically mentioned a study comparing results from runners who “only” ran (5 or 6 days a week) and those who ran 3 times a week while doing yoga and other cross training on off days. The latter group performed better (if you’ve gotten those weekly “run less / run faster / run better” spam emails from Runner’s World, this is the same concept). Here is a case where context may well matter – are we talking marathon distance? What were the backgrounds of the runners? What type of training did the “all-running” runners do? Was it really the yoga or the rest that gave the “improved” performance of the 3-day-per-week group? Frankly, I’m not interested in running only three days per week, even if it gives better results – I like running.
We moved on to an evaluation, and I knew the answer before we started – I am not particularly flexible. My wife (who minored in sports medicine in undergrad) has harassed me about it for years – she feels that stretching your hamstrings holds the key to the universe. I knew we were heading this direction when he asked “is this all the further you can straighten that leg?” He stated that we needed to be very careful in working around the area of the strain not to create any stresses which could lead to an outright tear, and he repeated this several times during the later massage/gouging. He also carefully checked out my back strength and inquired about any pain I might be experiencing there (none), as hamstring problems can sometimes be related to back issues. The evaluation was very quick, and we finished with some trial jogs the length of the facility. Encouragingly, he called over other therapists to watch me jog lengths of the facility, at which point he commented on how smooth and fluid my cadence and stride were. However, I later began to suspect he was just softening me up for the pain he was about to inflict on me.
We then moved on to massage, at which point he warned me that “you might be bruised for a few days,” in sort of the same tone used by a dentist warning that “this might hurt.” He left to get his “tools”, and brought back what looked to me like the “tools” used in the final scene of Braveheart (you know, the torture?). To make matters worse, he stated he was going to perform some German- or Swedish-named massage technique on my hamstring (started with a G, couldn’t fine any reference when Googling “torture technique that starts with “G” so I don’t have the exact name). “You might get some bruises,” he helpfully warned. Actually, the first round with basically a rolling-pin type device on my hamstring wasn’t bad – I could feel (as could he) some nodules being rolled out. It was phase 2 that was blindingly painful, wherein he dug some tool into the no-man’s land between the IT band and the hamstring, resulting in pain that radiated ALL THE WAY THROUGH TO MY INNER QUAD. “Is this too much?” he asked. “No,” I stupidly murmured between clenched teeth, and prayed I didn’t pass out. (Photo credit: Thai massage at Rama Day Spa Frankfurt) by Flikr user Thomas Wanhoff, used under a Creative Commons Attribution 2.0 license.)
After this (and note I am still bruised a week later), we started to work on some drills to help not just the recovery, but also the long-term maintenance of an injury-free hamstring. This is where the most profound learning of the day came. “The problem with amateur athletes,” he began, “is that we initiate our action through our hamstrings. Pro athletes originate it through their glutes. Think Cecil Fielder,” he helpfully stated, providing a not-so-necessary visualization. Obviously, with the glutes being a larger muscle, it would seem that such an approach would not only reduce injury but improve performance. It is difficult to do this psychologically, he emphasized (i.e., you can’t just think about firing your glutes instead of your hamstring), so it has to become physiological. In other words, we need to strengthen the glutes. He taught me how to do bridges – standard, adductor (squeezing a ball between the knees), and abductor (stretching an stretch band tied around your thighs, near the knees) and emphasized the need to make them a regular part of my exercise routine.
We finished by going over (but not practicing, as we were tight on time) some stretches he recommended; when I asked which ones I should prioritize, he said that you should generally rotate through different stretches each time as there is benefit in mixing up your approaches to address different muscles and motions. And at the end, I did a brief spell on this experimental (apparently – I can’t find any reference to it online) device called the HRM 2000, which was provided by a German company in return for some future studies to be performed using the machine. It’s basically a vibrating cylinder, roughly 10 inches (25 cm) in diameter. He first had it treat my upper hamstrings, then lower hamstrings, then calves, for about 90 seconds each. Greg swore by it as providing the fastest recovery from lactic acid buildup that he has ever experienced.
So I began diligently performing my new bridges (standard, adductor, and abductor) and stretches on a daily basis, and based on the recommendations for Vern Myers on Dailymile, started incorporating some yoga into my routine (more on that at a different time). I can’t promise it will stay, once I’m back to running, but maybe it’s something I can do with my wife. And she’ll see that yes, for once I am listening to her about stretching.