Hamstring Strain Rehab for Runners: Why Rest and Stretching Haven’t Worked (and What Does)

Hamstring strains and injuries are some of the worse.

They linger for months, leaving you thinking you've turned a corner, you can finally embrace speed workouts again and..

PSYCH!

You're limping back to your car or your front door.

It can feel like no matter how much time off you take, how easy you keep your runs, or how low you drop your mileage, you can begin to get scared to run.

Terrifying, right?

Not only annoying because you're stuck in no-man's-land trying to decide whether to sign up for that marathon or not, but being scared to return to what you love...

...can feel heart breaking.

Yes, the facts are true:

injury recovery from hamstring injuries takes time and re-injury risks is high, like 43% high after 4 weeks of return to running or sport.

BUT...what if we threw the RIGHT exercises into the mix?

Not just "the best hamstring exercises for runners" pulled from Dr. Google's AI brain,

but hamstring exercises based on recent evidence, solid research, and ones that target very specific parts of your hamstring.

Let me give you those exercises in this blog, in addition to the hard facts of how you got injured in the first place and what happens to your hamstring muscle after a strain.

Let's dive in.

HOW YOU INJURED YOUR HAMSTRING

FAST ANATOMY:

Hamstrings are the giant muscle group on the back of your thigh.

And if we move from the inside towards the outside, we find your medial hamstrings which are called semimembranosus and semitendinosus followed by your lateral hamstrings called biceps femoris short head and long head.

Spoiler: the biceps femoris long head is what you care about

More than 80% of all hamstring injuries occur in biceps femoris long head and usually happen while running.

The scary part: >50% of re-injuries occur within 4 weeks of returning to run and unfortunately, the re-injuries tend to be more severe than the original injury.

But to give you the right perspective, hamstring injuries can range from generalized muscle soreness that literally only feel like DOMS to tears extending from the hamstring muscle into tendons, specifically the musculotendinous junction.

What You Care About: the most common mechanism of injury for hamstring string injuries (how you get injured)

Typically running-related hamstring injuries occur while running at max or near submax speed (where interestingly, your bicep femoris long head is most active of all your hamstrings).

And while that's doesn't seem related at all marathoners, let's deep dive into the next level.

Your hamstring gets injured during a VERY SPECIFIC part of your stride call your swing phase.

This is the moment in your stride where one foot is NOT touching the ground; you are actively bringing your back leg forward.

The reason this is the "danger zone" for your hamstring:

• as your leg swings forward and is your foot is about to touch the ground, your is hip flexed (or bent) and your knee is extended (or straight)

• This doesn't seem like a big deal until you realize, your hamstring is running the show. It's working double time, contracting eccentrically as the swinging leg travels forward.

• It's preparing your body to accept the load of initial contact (aka the moment your outstretched leg gets slammed back into the earth thanks to gravity)

• And the kicker: there's not a lot of time to do this. Your hamstring has to handle decelerating your entire body mass in <100milliseconds.

The short version:

Your biceps femoris long head experiences way more strain in swing phase compared to the rest of your hamstrings.

Compound this with higher speeds during your speed workouts and the over all load of higher mileage training especially during marathon training, and you've created the perfect storm.

Why Rest and Stretching Haven’t Worked (and What Does)

What the internet typically suggests when you end up with a hamstring injury:

Foam roll, stretch, rest.

What evidence based research says you should do in order to get back to running in as soon as 15 days:

Rest but don't delay your rehab, and take advantage of the biggest-physiological-bang for your buck: eccentric strength training.

But, your choice.

Here's why this strength training works:

We know hamstring strain injury-prone runners present with:

• poor eccentric hamstring strength and power

• hamstrings that are quick to fatigue

• hamstrings that exhibit decreased fascicle length*

*That last one means essentially the individual "fibers" or cells of your bicep femoris long head muscle are too dang short.

When they're short, they're injury prone, weak, and can't handle the continued, repetitive load of running miles and miles every day during your training cycle.

HOW YOU FIX THIS:

You expose the muscle to eccentric strength training. This creates some microtrauma, which your experience as DOMS.

However, as you repeat this type of strength training, you experience decreased DOMs response, meaning you get used to eccentric exercises and become less and less sore. This can even be seen as a sign of "it's working!" as your muscle is under going remodeling.

I need you to read that again.

Because one of the biggest gripes I hear from runners is "those strength exercises will make me too sore to run!"

You get a choice then:

be sore for 1.5 weeks and get back to running at full strength faster or continue to gimp and be frustrated with your runs for 4 months.

The reason YOU NEED eccentric strength training:

Remember above how we mentioned your muscle fibers, or the fascicles, in your biceps femoris long head are too dang short?

We fix that problem by lengthening the fascicle with "building blocks" called sarcomeres.

The typical strength training you're probably used to falls under the concentric contraction category.

The problem: concentric hamstring strength training decreases the number of sarcomeres (or building blocks) in series.

*yea, making it stronger but potentially shorter. NOT the direction we want!

However eccentric strength training increases sarcomeres in series series.

THE SHORT VERSION: eccentric strength training not only makes you stronger, but adds more building blocks (sarcomeres in series) to your hamstring muscles, making them less likely to over-lengthen and become injured.

Hamstring Strain Rehab Exercises for Marathoners:

Circuit:

2-3 week// 4 sets // Medium to Heavy weights

Double Leg Slider --> Single Leg (SL) Slider

• 6 Reps X body weight

Double Leg Hip Thrusts --> SL Hip Thruster

• 6 Reps X medium to heavy

HEAVY Deadlift --> RDL

• 6 Reps X HEAVY

Runners: How to Rehab your Hamstring Strain In Time for Your Upcoming Race

Double Leg Slider --> Single Leg (SL) Slider

• I want you to notice a trend with all these exercises: they go from two legs to one leg.

• THE SECRET: we have to start somewhere. And when you're rehabbing a hamstring injury, it's always better to start early than wait 3 weeks. And if that means using 2 LEGS, then just do it. Don't worry, working your way up and progressing to "the exercise finally looks like running!" is the smart way to do things.

• The reason we love this evil exercise: your hamstring cross two joints- your hip and your knee. This slider exercise is what's called "knee dominant". Basically, we need to train your hammies over both joints. So as much as you may want to skip this one, DON'T.

  
  

Double Leg Hip Thrusts --> SL Hip Thruster

• You're one job: don't get hung up on fancy gym equipment.

• PRO TIP: you can easily use a couch or a foot stool to do this at home. What matters the most is adding load. Remember the slider exercise being a "knee dominant" exercise? This one is "hip dominant", meaning we're targeting your hamstring strength as it crosses your hip joint.

• As you move from the double leg hip thrust so the single leg hip version, it becomes a lot easier to see how this looks like running. But be mindful: you're probably going to need to drop the weight, and that's ok! Progressing all of these exercises to single leg is MANDATORY for full hamstring rehab. But never be ashamed of the time it takes to progress to single leg versions or the amount of weight you have to back down to.

HEAVY Deadlift --> RDL

• It's an oldie but a goodie for a reason.

• THE KEY: there's a reason we don't start immediately with RDLs. Many well-intentioned runners jump straight to an RDL for hamstring strength after a strain, and they're not wrong, but many find it...aggressive and uncomfortable. I prefer to start you all with a regular deadlift, but make it appropriatly heavy. Like stated before, starting with 2-legged versions is smart and safe, allowing you to continue to build strength and increase hamstring fascicle strength while mitiaging risk for overtraining, pain, and set backs.

• The cool part about moving to the RDL is now it not only really looks like running, but you're actively asking your hamstring to work over both joints: your hip and knee. It's a great combination of all your all hamstring needs.

WRAPPING UP

There is one more detail you should know...

Across many studies it was found that running athletes who sustained hamstring injuries and trained with the exercises above or ones similar to them made pretty quick progress!

But this was due to strength training 2-3 a weeks. (read: consistency)

It was also found that if a runner experienced some pain (think 4/10), discomfort, soreness while performing the exercise, there were no adverse reactions.

In fact, they seemed to hold onto their muscular gains for longer!

THIS IS YOUR WARNING: Do not go so crazy hard you're cramping and screaming in pain. I am NOT advocating for this.

But some slight discomfort from working hard, is ok.

But here's the kicker:

in order to keep these beneficial, injury-proofing, physiological changes you've worked so hard to create, you have to keep going.

Meaning, across studies, it was found that running athletes LOST or began to loose their hamstring gains any where from 2 weeks to 2 months after they STOPPED strength training.

Again: consistency.

If you are a runner who has frequently fought hamstring strains, you truly need to be strength training them at least 1x a week.

No, you're leg won't fall off if you miss a week.

Or even 2.

But you're consistency will be what will save you.

You got this.

Until next time, running fit fam...

Dare to Train Differently,

Marie Whitt, PT, DPT // @dr.whitt.fit