Running Doc: tips to avoid and treat hamstring injuries include ice, compression, stretching

Celebrity Chef Bobby Flay stretches for his training run on the West Side waterfront in Manhattan last year. Flay was training for the New York Marathon.  Stretching exercises can help runners avoid hamstring injuries.

Dear Running Doc:

I was tripped at the start of a 5K and pulled my hamstring, and now I can’t run without pain. Friends tell me to try to run taking small steps. I want to return to running as soon as possible, as I’m preparing for a spring marathon. Any suggestions? – Jon G, New York City

Dear Jon: Thanks for the question. Every runner I know has had a hamstring issue at some point. Knowing exactly what to do is important if you want to return to running quickly. If your long-term goal is to keep running and racing without pain and constant re-injury, ignore your friends’ advice initially, unless shortening your stride can produce normal running form for you. Running in pain that changes your running form can make an injury worse, or lead to another injury. You also run the risk of permanently reducing your performance potential by preventing proper healing of the muscle fibers.

When you pull or tear a hamstring, the healing process shortens the muscle fibers and causes scar tissue to form. Yes, you can try taking shorter steps, but as soon as you try to extend to your normal stride length, you’ll risk another pull.

The day you hurt the hamstring, use ice and compression. Take a plastic freezer bag, fill with ice and water (which raises the temp to 32 degrees, so you don’t get freezer burn), and place on the hamstring for 20 minutes three times a day (for three to five days). Stay away from heat, which adds swelling. Wear an Ace bandage to compress the hamstring. Starting on day two, gently stretch and start prone hamstring curls at home. Lie on your bed face down with your feet hanging of the end. Using no more than a five-pound ankle weight, lift your ankle toward your butt, hold for three seconds, then slowly back down to full extension. This works the whole muscle. Do 50 reps, each leg.

To properly heal your pulled hamstring, you must stretch and strengthen the muscles with exercises carried out under the guidance of a knowledgable physical therapist starting day two or day three. This treatment will encourage the muscles to retain their pre-injury strength and length – or even become stronger and longer. But be patient, 4-6 weeks of treatment is needed to heal the muscle in this way.

I suggest you visit a sports medicine doctor to have your injury evaluated and get a referral for physical therapy within two or three days post-injury. You will most likely be able to run during this treatment, though it’s wise to avoid racing and speed training.

If you want to greatly accelerate healing, PRP injections work remarkably well. I have used these and found within two weeks, the hamstring (or any muscle tear) has healed significantly.

To reduce your risk of re-injury, take time to stretch the hamstrings after every run. Running causes microtears between the hamstrings’ muscle fibers, and without stretching the fibers heal back shorter. Over time this decreases your stride length – so you run slower – and makes the hamstring vulnerable to a serious pull or tear.

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