Question
I was in Track when I hurt my hamstring.  I am in overall good shape and rated 5th in the state.  The coaches had me sprinting and weightlifting.  The weightlifting for the 1st time.  The first day after they had me jog that was 4 weeks ago.  My hamstring hurts worse and I have pulled out of track for the season.  I am now following doctors orders and taking a month of no running, swimming, and biking.  How can I stay in shape?  How soon can I and how should I start to run again?  

Answer
Dear Jill,

Hamstring injuries can really be tough, but I agree that you need to limit your activity, but I would disagree that you need to stop all your activities completely.  Pulling out of track for the season is probably a good idea depending on how bad the hamstring injury is, but muscles have great blood supplies and heal quickly when supported with good nutrition and a slow return to stress activities.  

After two weeks rest from the initial injury, I would start with a week of gentle passive, then active stretching of the hamstrings (both sides)...when you rehab one side the other must go through the process as well to limit further injury.  It is important to retain as much flexibility in the muscle as possible while scar tissue is forming.

After the initial week of stretching, I would then begin some mild active movement such as the recumbent bicycle and the elliptical machine to start regaining stamina and endurance.  The entire leg needs to be involved in activity as well as the lungs to fully oxygenate the blood and increase oxygen carrying capacity to the muscles.  You are not training heavy or even moderate, only mild cardiovascular and nothing for strength yet.

After another two weeks of this light training you should be ready fro some strength training.  This will be very mild with your body weight only...absolutely no weights.  Exercises such as wall squats to about 45 degrees, leg curls, and leg extensions should be fine, but again without weight...you are retraining the motions and the action of the muscle.  As you progress to more repetitions, and continuing with light recumbent bike and elliptical machine work.

After another tow weeks of this the addition of swimming would be good and things like the stairmaster which will incorporate more strenuous activity and more hamstring stress.  Exercises such as standing lunges can be added, and wall squats down to 90 degrees.  Remember you are still only using your own body weight at this point.  Also continue your active and passive stretching protocols and cardio work.  

Six weeks into the rehab program is when you get to add demanding exercises such as light jump rope, light jogging, and utilizing actual workout machine and free weights to build strength.  Remember although you may feel like you can do a lot of weight, you are still training the muscular system with proper movements due to continue scar tissue generation.  The weight should be easy to lift and controlled at all times.  You should not be working hard and the requirements of the lifts should be minimal.

Once you hit the 8 week mark, then you can incorporate more strenuous lifts and runs, but these should be like pre-seasons workouts...conditioning.

Activities such as plyometric training, sprinting and heavy demand lifting should not be attempted until after 10 weeks of rehab type training and even then you need to be careful.  I would suspect you will not be ready for competition level workouts until after 12-14 weeks.  Remember that you are the best gauge of how your body is functioning, and not to rush the process.  It is likely that your initial weightlifting was overkill and that you were not conditioned enough for the physical demand, and that is what precipitated this current injury.  Take this all slow, and realize what I have written is only a template and not a replacement for a qualified trainer if you have one available.

Take your time Jill, condition your body over time, and work at an even pace.  Make sure that you cross train the hamstring for flexibility, and endurance first, then add stamina and strength.  Good Luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net