Healing hamstring injuries

7/29/2019 Healing hamstring injuries

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84 yoga+joy ful liv in g no vem ber - dec emb er 200 6 yo gap lus .o rg

For people who practice yoga, ham-string injuries develop over time, usually

where the hamstring attaches to the sit

bone. This is a tendon injury, and unlikea muscle tear, it doesnt happen suddenly.Instead, it is death by a thousand cuts:each tiny rip in the tendon is relativelyminor by itself, but because it does notfully heal, repeated injuries accumulateover time, until an ill-considered bit ofoverstretching or an overly aggressiveadjustment from a teacher finally putsthe injury over the edge.

Tendon injuries are in a classby themselves. They require aspecific regime for healing that is

very simple but requires time,patience, and persistence. Thealternative, however, is even lessattractive. Left alone, an injury tothe hamstring attachment cantake six months to a year to stophurtingand even then it doesnot mean that it has fully healed.The attachment remains farmore susceptible to re-injurythan a tendon that has beenproperly treated.

Each little cut in the ham-string attachment occurs whenthe muscle is not engaged andthus cannot protect itself.Immediately after the injuryhowever tiny it isadhesive scartissue forms. While this scar tis-sue is meant to protect the ten-don as it heals, quite often thescar tissue hampers the healing process,preventing a full recovery. Scar tissue lim-its circulation and stiffens the tendon,leaving it more vulnerable. We tend to

dismiss each little injury after enduringsome soreness, but the injury is reallycumulative. Repeated re-injury and theformation of more scar tissue can extendover years, progressively weakening thetendon.

In yoga, there is ample opportunityfor this to happen, usually in the process

of doing forward bends. As beginners, ware taught to fold forward at the hip join(rather than at the waist) with a straighspine, maintaining a natural arch in the

lower back through most of a forward

Ask any room of yoga students whether they suffer from pain at one or both of their sit bones, and you can

count on a showing of hands. This kind of pain comes from injury to the hamstring attachment. Of course,

hamstring injuries are not unique to yoga, though the cause and treatment of this particular problem often i

The more dramatic hamstring tears occur in sports and especially while running, when athletes are tightly

wound and move in sudden bursts that wrench and tear at the hamstrings, usually in the belly, or middle

part, of the muscle. In yoga, the injury occurs in a different way and at a different place.

{ asana solutions }

Healing Hamstring InjuriesYoga students are vulnerable to overstretching the hamstring muscle and thereby tearing the connecting

tendon. Injuries can be avoidedand even healedby following a few simple guidelines.

By doug keller

Doug Kellersyoga journey includes 14 years ofpracticing yoga in Siddha Yoga ashrams, inten-sive training in the Anusara method, and nearly decade of teaching both in the United States andabroad. He has a masters degree in philosophy

from Fordham University.

HAMSTRING

INJURYThe most

common hamstring

injury for yoga

practitioners

occurs just below

the sit bone.

>

2006Yoga + Joyful Living magazine.All rights reserved.


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bend. Students with tight muscles arerightly encouraged to bend their kneesto release their hamstrings somewhatand maintain a flat back as they bend for-

ward. This helps protect the lower backand gives a better stretch to the otherwisehypercontracted hamstrings.

As we get more flexible, we continue

the same habit and even overdo it. This isespecially true for students who were nat-urally limber to begin with. The naturalarch we sought becomes an exaggeratedlumbar curve, and the forward bendbecomes more of a swan dive in whichthe sit bones flip upward as the pelvistilts forward. Because the hamstrings

have learned to release to allow thisfree fall, they start to act more likebungee cordsrelatively slack on the

way down through most of the dive, sud-denly pulling taut at the far extreme ofthe bend. Each sharp tug causes a littlerip that frays the hamstring where itattaches to the sit bone, because this isthe place of the greatest leverage and

thus the hardest pull.Were taught to engage the quadriceps

to protect our knees; indeed, Lift yourkneecaps! is repeated like a mantra by

yoga teachers. But no one tells us toengage the hamstrings to protect themfrom this injurious yank. Learninghowand how muchto engage the

hamstrings is the first step toward pre-venting this injury or healing the injuryit has already occurred.

THE MECHANICS OF THE MUSCLE

We can start by looking at how the hamstrings function. One of their duties is tbend the knee and pull us through our

stride as we walk or run, which is whyrunners typically have such tight ham-strings. The muscle is used in this way

when the lower leg moves freely.But the hamstrings also have a pos-

tural functionholding us uprightwhich works the other end of the musclat its origin at the sit bone. The ham-strings anchor the pelvis by drawing thsit bones toward the backs of the legs.If the hamstrings were to completelyrelease their hold at the sit bones, we

would flop forward at the hips like a rag

doll. The hamstring performs this actiowhen the lower leg is fixed (i.e., not freeto move), and for this reason, the ham-strings can get tight simply from stand-ing a lot or doing work that involvesbending forward for long periods.

We feel this postural action of the hamstring as a contraction of the tendon wheit attaches to the sit bone, at the lower


SWAN DIVE Overarching the back in forward

bends exerts a dangerous pull on the hamstringattachment.

HAMSTRING

ANATOMYThe ham-

string muscles, which

connect the lower leg

bones to the sit bones,

serve to anchor upright

posture and need to be

properly engaged when

we bend forward.

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crease of the buttock. At its extreme, thiscan cause a tucking of the pelvis when thehamstrings are hypercontracted. Goodposture comes about through balancedtone between the quadriceps and thehamstrings. Bad posture throws off thisbalance, causing tightness and chronichypercontraction either at the front or

the back of the hip joint.

PREVENTING HAMSTRING INJURIES

In a forward bend, this postural action ofthe hamstring needs to be engaged justenough to protect the muscle from over-stretching. If this idea of engaging yourhamstrings at your sit bones seems hope-lessly abstract, try the following exercise.Stand with your feet separated and slightlybend your knees. Isometrically pull back

with one of your feet. Youll feel yourhamstring engage, and your sit bone will

want to tuck under somewhat from thecontraction at the top of the hamstring.

In this case, the hamstring draws orpulls from your sit bone down toward

your knee. If you were bending your knto lift your foot, the direction of energy

would instead be from your lower legtoward your sit bone.

For the hamstring attachment to beprotected, we want to draw the energy

from the sit bone toward the knee, sothat the hamstring will act as a brake inthe forward bend. This action is of the

essence in yoga; it is known as eccen-tric (pronounced eecentric) stretching, meaning that the muscle remainsengaged as it is lengthened. For exampif you were to curl a barbell up using

your biceps and then very slowly lower

it down, extending your arm until it isnearly straight, the lengthening that

yogaplus.org november - december 2006 yoga+jo yfu l liv in g

HAMSTRINGS

AND POSTURE

Tight hamstrings

pull down at the sit

bones, causing the

back to flatten.

Hamstring injuries develop over tiIt is death by a thousand cuts.

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takes place in the biceps is known as aneccentric stretchone in which the mucle is both contracted and lengthened athe same time, in measured coordinatioThis brings greater strength to the muscle in the very process of stretching it. Ia forward bend, the hamstring stretcheeccentrically, acting as a brake as it

lengthens, thus balancing strength andsuppleness while sparing the hamstringattachment from injury.

HEALTHY HAMSTRINGS IN YOGA

Lets apply this technique in a yoga posWe can take as an example the wide-legged forward bend (prasarita padot-tanasana). Step your feet apart wide ankeep them parallel to each other. Whilemaintaining a straight back, bend for-

ward at your hips to touch the floor.You can bend your knees to protect

your back as you fold forward; once inthe pose, your legs should be straightunless tightness in your hamstringsmakes your back round.

Once in the pose with your legsstraight, make sure your knees are notlocked or hyperextended. Engage yourquadriceps, drawing energy up from yokneecaps toward your hips. You can conect that engagement of the quadricepsto a complementary engagement of youhamstrings: imagine that energy is trav

ing in a circle down through the backs oyour legs. Engage the hamstrings bydrawing your sit bones just slightly dowtoward the backs of your knees, so thatthe small spaces just beneath your sitbones firm. Your intention to draw yousit bones down will also engage your butock muscles. You can isometrically dra

your feet back to get the action going,though the action is actually initiatedfrom the sit bones turning downwardtoward the knees. Once you learn theaction, you can maintain the balancedengagement between the quadriceps anthe hamstrings even as you bend forwain the pose, controlling how quickly an


Learning howand how muchengage the hamstrings is the first stoward preventing or healing inju

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how deeply you move. This sameapproach can be used in seated for-

ward bends, too: draw your sit bonesjust slightly toward your knees as you

lengthen upward through your spine andfold forward. Applying these techniques

will help protect your tendons as youmove through the asanas.

HEALING A TORN TENDON

But what if the damage is already done?How do we heal an injury that has beenbuilding up for months or even years? Asimple and effective system for healingtendon injuries has been detailed by DrBen Benjamin in a series of articles thatappeared inMassage & Bodywork maga

zine in 2004. As a healing regimen, itaddresses two aspects of the injury: thebuildup of adhesive scar tissue and thehealing of the tendon itself.

The scar tissue can be progressivelycleared by a simple massage technique calls frictioning. Its purpose is to breup the irregularly formed scar tissue inorder to restore circulation and facilitatthe healing process. To friction a tendorub or pluck your finger crosswise onthe tendonin one direction only, notback and forthwith a degree of pres-

sure that is enough to be uncomfortablbut not so great as to be painful. Do


PROTECT THE HAMSTRINGS A proper balance between engaging the quadriceps and drawing

the sit bones toward the backs of the knees tones and protects the hamstring attachments.

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this for 5 to 15 minutes, taking breakswhen your finger gets tired.

How might you reach the injury tofriction it? You can recline on the floor

with your knee bent and foot on the floor(or with the calf supported on a chair, sothat the leg is at 90 degrees), and thusreach the exposed tendon to friction it

with your fingers. It is possible to usesubstitutes such as a tennis ball or mas-sage ball, reclining with the leg nearlystraight and the ball on the tendon. Inthat case, bend the opposite knee andplace your foot on the floor to help yourock your hips from side to side to get themassaging action from the ball. The ball

will be less accurate and thus less effec-tive than the finger; the plucking actionis preferred.

The second part of the processinvolves small strengthening exercises,

often combined with gentle stretching.The most effective strengtheners are sim-

ple backbends such as the locust andbridge poses, in which the hamstrings areused to extend the hips.

For the locust pose (shalabhasana), lieon your stomach (with a folded blanketfor padding under your hips) and extend

your legs behind you, with toes pointed.Work one leg at a time. Rather than sim-

ply attempting to lift your leg, which canstrain your lower back, work in the fol-

lowing way to concentrate the action inyour hamstrings. On the injured side,point your toes and reach back through

your big toe as if you were trying to pusa button with it. Keep lengtheningthrough your leg and big toe as the wayto begin to lift your leg. Youll feel yourhamstring working, particularly beneat

your sit bone. You can actively engagethe tops of your buttock muscles, lengt


STRENGTHEN AND STRETCH

Reach back through the big toe and lengthen asyou lift to tone and strengthen the injured leg.

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STRENGTHEN TO HEAL In the

bridge pose, ground through the heelsand draw them back isometrically to

engage and strengthen the hamstrings.

ening from your waistline toward yourtailbone to protect your lower backbut

youll probably find this happens auto-matically in this exercise. Your foot needsto only lift four or five inches from theground; work up to three sets of five orsix lifts. You can increase the strengthen-

ing action by putting a small weight, suchas a small bag of rice, across your ankle.Work both legs to maintain a balance ofstrength.

For the bridge pose (setu bandhasana),lie on your back with both knees bent,thighs parallel to each other and your feeton the floor. Bring your feet close to yourhips so that your shins are perpendicularto the floor. Maintain a natural arch in

your lower back, leaving enough room toslip the tips of your fingers into the space

just above your waistline. To feel theaction of the hamstrings, isometricallypull your feet toward your hips (your feetdont move) and feel how your ham-strings engage, especially at your sitbones. This exercise alone can be enoughif your lower back is tender.

Keeping your weight centered in yourheels, lift your hips off the floor. Press

your shoulders and upper arms into the

floor as well to lift and open your chest,but be careful not to push your head intothe floor or tighten your neck in any way.Isometrically pull your feet toward yourshoulders just enough to engage yourhamstrings; at the same time, engage thetops of your buttocks to draw your tail-bone toward your knees. Hold for a fewbreaths and then release, maintaining anatural arch in your lower back on the

way down. Work up to three sets of fouror five lifts. Keep your thighs parallelthroughout and avoid pushing exces-sively through your feet to lift up.

A simple and safe way to stretchthe hamstrings in between exercises isto bend one knee slowly toward your

chest while reclining on your back, thenswitch legs.

The program is always completed byapplying ice to the injured area for 5 to 10minutes and then resting it.

In summary, the basic program is:1. A gentle warm-up of the hamstring

muscle, which can be accomplished bystanding (with support) and swingingthe leg forward and back like a pendu-

lum;2. Frictioning of the injured muscle

attachment;3. Strengthening exercises, combined

with gentle stretches;4. Ice and rest.

The key to healing the hamstringattachment is consistency in followingthis program over several weeks. Workfairly gently and consciously. Sharp orsevere pain indicates a more serious tear,requiring rest and medical attention.

Injury is a great teacher, most oftenarising not from a single miscalculationor moment of abandon, but from patternsand habits of movement developed overlong periods of time. Injuries awaken usto these patternsand to new ways ofmoving and being within our body. For

yoga practitioners, a hamstring injuryis a wake-up call that hits us right where

we live!+

Tendon injuries require a specific regime for healingthat is very simple but requires time, patience, and persistence.

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Healing hamstring injuries