Here at ATUNE Health Centres, we strive to provide Lake Macquarie sportsmen and women with holistic, patient-centred care. This story follows the journey of one of our patients, Sarah (not her real name) and her return to competitive sport. Sarah had previously competed as a junior elite athlete in triple jump, however this was some years ago and a lot of work had to be done before Sarah could hope to compete at this level again.
As Sarah began her training in May 2016, she was already suffering from the usual aches and pains that had plagued her in the past. Things just weren’t going according to plan. She had a frustrating niggle in her hamstring that wouldn’t get better with stretching, and her lower back pain had flared up again.
Sarah initially came to see me for osteopathic treatment of her lower back and hamstring pain. I assessed Sarah and discovered that she had poor gluteal muscle activation and a tight hip flexor, which was causing the Left hamstring and lower back muscles to work harder than necessary to create movement. There was also some irritation of the pelvic and spinal joints on the Left side. My treatment for Sarah involved promoting optimal alignment of her lower back and pelvis and restoring range of movement to her lower back and hips with the use of massage, manipulation, stretching and dry needling therapy. I provided Sarah with some stretching and basic strengthening exercises, but I knew that our work was not done here and I suggested that Sarah see ATUNE physiotherapist Michael Corrigan in addition to myself to address her specific muscle activation and strength issues.
Michael explained to Sarah that the major problem was that she was trying to train at a high level without laying down the basic foundations. You can’t build a house on a foundation of sand! Put simply, we can’t function above the level of what our body is currently capable of. Our muscles may not be switching on in the right sequence at the right time, or they may not be strong enough yet. We can’t try to be an elite athlete like Michael Jordan until we’ve at least mastered the basics of muscle activation and strength and conditioning. This is why so many injuries occur. Unfortunately for Sarah, her desire to run faster and faster led to her sustaining a Grade 2 tear of her Left hamstring, which occurred due to the imbalances in her pelvic alignment and muscle strength as identified earlier. Michael helped Sarah to focus on exercises to improve her gluteal muscle control to take the strain off her hamstring and improve her strength and power output while sprinting. He also released her tight psoas (hip flexor) muscle, which was preventing her hamstring and gluteal muscles from working as they should.
The hamstring’s job is to bend the knee as well as slow down movement of the lower leg during sprinting, hence it is subject to very high forces. Put simply, Sarah’s hamstring was under too much strain while sprinting because it was already in a stretched position, resulting in a muscle tear. Once a hamstring has been injured, the risk of re-injury increases and continues to increase with subsequent injuries.
Sarah’s return to training was a lengthy one however she learned some valuable hamstring rehabilitation exercises along the way including Nordic curls, which have been shown to be valuable in improving eccentric hamstring strength, an important factor in sprinting. Three months post-injury Sarah was back in full training. She continued to receive 3-4 weekly osteopathy, massage and physiotherapy treatments to address these areas and attempt to prevent injury.
Sarah’s training was going really well until one night Sarah tore her Right hamstring while at training. Closer analysis revealed that the injury occurred due to fatigue, another major risk factor in hamstring injuries. Doing a very heavy weights session at the gym the night before an intense sprint session is never a good idea. This is why some athletes apply periodization to their training, in order to avoid training overload and fatigue and maximize their performance. It can be helpful to reduce the training volume (including the volume of weights sessions) when entering the competition phase of the season. Here’s a diagram to illustrate the concept of block periodization, where training is arranged into blocks depending on the phase of the athlete’s season and their specific goals at that point in time:
Thankfully this hamstring injury only took 6 weeks to rehabilitate before return to training due to it being in a different location to the initial injury. Also, Sarah’s gluteal muscles were already strong from all the strength work she had been doing prior to the injury, which helped accelerate her return to training. The next step was to get ready to compete…
References and further reading
Brukner, P and Khan, K (2010) Clinical Sports Medicine, (3rd), North Ryde, McGraw Hill
de Visser, HM, Reijman, M, Heijboer, Bos PK (2012) Risk Factors of recurrent hamstring Injuries: a systematic review, British Journal of Sports Medicine, 46, 124-130
Arnason, A, Bahr, R, Mjolsnes, Osthagen, T and R, Raastad (2004) A 10 week randomized trial comparing eccentric vs. concentric hamstring strength in well-trained soccer players, 14, 311-317
Bartolomei, Sandro; Hoffman, Jay R.; Merni, Franco; Stout, Jeffrey R. (2014) A Comparison of Traditional and Block Periodized Strength Training Programs in Trained Athletes. Journal of Strength and Conditioning Research, Volume 28 https://journals.lww.com/nsca-jscr/Abstract/2014/04000/A_Comparison_of_Traditional_and_Block_Periodized.17.aspx?sessionEnd=true