Towards the Prevention of Hamstring Injuries for Runners

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Photo credit: SSC Yoga with Eoin Finn by Flickr user lululemon athletica under a Creative Commons Attribution 2.0 Generic license.

Hamstrings are a common vulnerability for runners, ranking up with Achilles tendonitis, iliotibial band syndrome (ITBS), and plantar fascitis as leading causes of lost time.  I’ll admit to not being an exercise physiologist, physical therapist, sports medicine practitioner, or chiropractor.  However, I think that my recent experiences in developing and recovering from a hamstring strain has provided me with a wealth of input as to potential causes and appropriate prevention techniques for such an injury.  While I’ve previously covered this topic in numerous posts as new advice was received, I thought it might be helpful to consolidate and harmonize all such advice in a single post.

Causes

There is a lot of contradictory information as to what causes hamstring strains; as Runner’s World itself points out, it can be caused by too-tight, too-flexible, too-strong, or too-weak of a muscle.  This implies conflicting approaches for preventing hamstring strains – stretch more, stretch less, eliminate strength training, or increase strength training.

The reality is that it doesn’t matter what the cause is – the key point is that hamstring injuries aren’t just about the hamstring.  They are about an imbalance between the various muscles and ligaments employed in running.  This is the case for most such injuries.  It may just be that the hamstring is the weakest link for many runners.  As this article points out, if you push yourself hard enough, without doing the proper preventative work, the weakest link will fail.

With this in mind, most of the prescriptions below are not strictly focused on the hamstring – they are focused on all the balancing muscles around it as well.

And yes, other factors may play a role, from ignoring the risk of repetitive road camber (or cant) when you run, to running while stiff from traveling, when your body really isn’t in a condition to run well, or from not warming up appropriately.  But if the rest of your prevention techniques are solid and rigorous, the risk of any one of these factors pushing you over the precipice is significantly reduced.

Strength

The most typical exercise used for developing hamstring strength is the leg curl. This exercise isolates on the hamstring but neglects other key muscles, so it is insufficient to use on its own. It is better to include exercises that focus on the glutes and, for some runners, adductors.  The former is important because, as a much larger and potentially more dominant muscle, developing the ability to utilize the glutes appropriately while running can significantly relieve pressure on the hamstring.  The latter is more important for runners with overdeveloped abductors, specifically those who tend to underpronate or are bow-legged, and thus have overcompensated by swinging their legs more outward than their natural tendency would dictate (such is the case for this runner).

The best exercises for targeting the glutes while also addressing the hamstring and, to a lesser extent, quadriceps, are squats or leg presses.  Squats can be performed without weights using the Two Hundred Squats program discussed previously, but they are more effective if you have access to weights.  Like all exercises, proper form is important – avoid the deepest knee bends, going no more than parallel to the floor with your thighs.  If you do have access to the appropriate equipment, adductor exercises can also be a helpful part of the routine.

If you don’t have access to weights on a regular basis, consider adding bridges to your routine. Bridges involve lying on your back, bending your knees and placing your feet flat on the floor, and then arching your back so that you are up on your shoulders and feet. These can also be done squeezing a ball between your knees to simultaneously address adductor strength.  A good set to work up to is 20 repetitions of 10 seconds up / 5 seconds rest for standard and adductor versions. Should you need to work on abductor strength for any reason, tying a resistance band around your knees and pulling your knees apart against the band during the bridge.

Runner’s World, in the same article mentioned above, suggested a few other exercises like single-leg deadlifts and three-way leg raises; my initial experiences with these exercises have been that they do seem to isolate the glutes relatively well and are worth doing.

One exercise to consider avoiding, particularly if you have a history of hamstring issues, is leg extensions.  Most runners have well-developed quadriceps, and this exercise takes what is already a potential imbalance and exaggerates it further.

Flexibility

The proverbial image of a runner stretching involves putting a leg up on a fence or hurdle, straightening as much as possible, and leaning into it to stretch the hamstring.  This is far from sufficient for most runners and is another typical case of over-focusing on one type of flexibility, at the expense of others.

The muscles that are often not flexible enough in runners are the same ones that are imbalanced from a strength perspective – the quadriceps.  A lot of your stretching should focus on the quadriceps, using the typical “pull your leg up behind you” approach.  These can be modified into a hip flexor stretch – also an area of particular inflexibility for runners – by putting the foot on a surface like the back of a couch and moving the grounded foot further forward.

Other areas to consider stretching include the piriformis (part of the glutes) and the calves – both the soleus and gastrocnemius, which are addressed through the typical “lean forward and keep your heel flat” approach (the gastrocnemius, or lower calf, is targeted by bending your knees slightly during this stretch).

Many yoga routines, particularly those that revolve around hip-opening lunges or quadriceps stretches, provide great flexibility improvement for runners.  As always, you should listen to your body during such routines and avoid any stretches that feel uncomfortable – the common downward-facing dog pose, for example, does tend to aggravate already-strained or overstretched hamstrings.

Warm-Up and Cool-Down

Like all muscles, the hamstring benefits from being properly loose and warm before undergoing the stresses of a challenging run.  The typical “one- to two-mile warmup” may not be enough if you are vulnerable to injury (and, let’s face it, most of us are).  Instead, there are several routines developed by Jay Johnson (hat tip to Jason Fitzgerald, the online running coach behind Strength Running, for pointing these out) that help get you ready to run and help you cool-down appropriately, while providing for strengthening and improved flexibility.

For warm-ups, the myrtl routine helps to loosen up the hips while incorporating some glute-strengthening exercises; this routine involves such elements as donkey kicks, hurdle legs, and leg swings and is achievable in under eight minutes.  This can be combined or alternated with a lunge warm-up that is even better from a strengthening standpoint, and can be finished in under five minutes.  It is after these warm-ups that some stretching of the quadriceps and hip flexors can be even more effective in getting you prepared to run and reducing the risk of injury.

For a cool-down, the somewhat lengthier cannonball routine incorporates some of the same exercises as the myrtl routine, with enough different twists to be both more interesting and comprehensive in the muscles it targets.  Even if you don’t incorporate such routines into every run, making the investment three days a week for each not only improves you resistance to injury, it is likely to lead to passive improvements in your running form.

Running Form

Having just discussed this topic in length on a previous post, I’m not going to dwell much on it here.  I would only like to point out an outstanding post on the “SOFT” system, which gels nicely with the “one step at a time” approach I discussed.  Even the mnemonic itself is helpful, as thinking about running softly or quietly is a major step in the right direction.

Beyond this, having the right degree of balance in strength and flexibility among your running muscles, and even your core, can only help in reinforcing proper form – another area where the gains go far beyond just injury prevention.

Cross Training

The consensus seems to be that the bicycle is the best cross-training equipment for runners with hamstring vulnerabilities.  Riding with the seat high and head/handles low is an effective way to target strengthening of the glutes while still gaining aerobic benefits.  Obviously, one must be sensitive to any back issues that may arise from such an approach and adjust accordingly.

My experience with the elliptical trainer is that it seems to strain the hamstring in a more insidious manner than running does.  It may seem as though the hamstring is not being impacted by time on the elliptical, but this is because the effect seems masked by the forced motion of the legs in keeping rhythm with the machine.  This, and the fact that some doctors are expressing concern about the long-term impact of the motion of the elliptical trainer on the hips, makes it a device I’ll tend to avoid.

Preventative Massage

Even the best efforts to follow the recommendations laid out above will not completely eliminate the formation of scar tissue over time in your hamstrings.  It is here were preventative massage can play a role in keeping you healthy.  This is not the “day spa” with soft music, natural scents, and “breath like a tree” type of massage – this is the deep tissue variety, maybe along the lines of ART or the Graston technique, employed by a qualified practitioner on a monthly to quarterly basis.  In between, treatment of any lingering soreness after a workout with a foam roller (I’m experimenting with the TriggerPoint GRID – I like it’s reported rigidity and compactness) or tennis ball may be enough to head off potential issues.

Paying Attention

Finally, even if you follow all of the recommendations laid out above, your hamstring issues may occasionally resurface.  In such cases, it is critical to identify when a hamstring strain may be beginning quickly and adjust your training accordingly – preferably taking a few days rest from any activities involving your legs, if possible or, failing that, cutting out running and switching to the bike, while making sure you are appropriately focused on the flexibility of the hips and quadriceps.

It is my hope that this post will provide runners that have suffered or fear hamstring injuries with some ideas to implement that will help ward off such problems.  If you have any further suggestions, your comments are more than welcome.

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  • http://www.strengthrunning.com Jason Fitzgerald

    Wow, wealth of info here – great stuff Greg. I didn’t know I also had a site called strengthtraining.com too! :)

  • http://predawnrunner.com Greg Strosaker

    Oops – sorry about that. Like I mentioned, I was working way too late. Will fix it when I can get to my computer.

  • http://coachjayjohnson.com CoachJay

    Great post Greg.

    I love your comment describing this blog: “I designed this blog to help provide tips and inspiration to those of you who already live a full life and want to make your running a bigger part of it, without having to sacrifice the other things that matter to you (except maybe some sleep).” Well put and I think it’s so important that runners be honest that there are only so many hours in the day and that they need to figure out how to use those hours.

    Take care and best of luck with your running.

  • http://coachjayjohnson.com CoachJay

    Great post Greg.

    I love your comment describing this blog: “I designed this blog to help provide tips and inspiration to those of you who already live a full life and want to make your running a bigger part of it, without having to sacrifice the other things that matter to you (except maybe some sleep).” Well put and I think it’s so important that runners be honest that there are only so many hours in the day and that they need to figure out how to use those hours.

    Take care and best of luck with your running.

  • http://predawnrunner.com Greg Strosaker

    Thanks for the comment Coach, appreciate your kind words. I’ve become a big fan of your myrtl and lunge matrix routines and look forward to adding the cannonball routine as a cool-down. Thanks for developing and sharing them so broadly, I think they have made and will continue to make a big difference in my training, so I’m happy to point them out to others as well.

  • Chip

    Been meaning to post on this one a while. I’d love to add a couple of my own findings to this list, from over the years.

    1. You are right that squats are a more quad-dominant exercise. If you want to hit the hamstrings and glutes primarily, deadlifts are the way to go. However, doing it with barbells is a bit equipment dependent. One great exercise to master would be the one-legged deadlift, which can easily be done with bodyweight.

    However, don’t forget the hamstring attachment at the knee. To hit that without machines (i.e., leg curl), all you need is a stability ball (at least, that’s what I like to do most). You can then do leg curls on the ball (shoulders on the ground). Working that up to single-leg variations is very good.

    2. The other thing I find helps a ton is foam roller work. And as you note, it’s not just the hamstrings that can cause problems, but parts all up and down the kinetic chain. I go from arch (plantar), 2 sides of the calf, 3 different angles on the front of the femur/hip, ITB, hamstrings, and 2 different angles on the glutes. All of that done in about 5 minutes. A great activity if you veg in front of the TV in the evening. In all honesty, once I started this, soreness and stiffness in the legs became greatly reduced.

    I make no guarantees that either of these are a cure-all. But they definitely would be something anyone with issues might want to try.

  • http://predawnrunner.com Greg Strosaker

    Thanks for taking the time to comment Chip. I like your stability ball leg curl suggestion and it’s definitely something I’ll try, and I have recently started the one-legged deadlift as well. Ironically, I used a foam roller for the first time last night (doing so while “vegging” in front of the TV, as you suggest). I limited the focus to just the hamstrings but definitely need to expand beyond that, and I hope to find the same benefits that you have. Look for a future update on the progress.

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