Preventing, Treating & Recovering from Hamstring Injuries

Dr. Gregory Nicholson of Midwest Orthopaedics at Rush and Steve Kashul talk with John Sauer about the prevention, treatment and recovery of hamstring injuries. John Sauer is a Physical Therapist, DPT, OCS and endurance program manager for Athletico Physical Therapy in Chicago, IL.

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Treating a Different Kind of Achilles Tendon Pain

By Sarah Ryerson, PT, ATC, CSCS for Athletico Physical Therapy

Calf stretching, ice and activity modification are commonly used as treatment for those who suffer from Achilles tendinosis. However, when traditional treatment fails to relieve symptoms, the problem may be in the diagnosis.

Achilles tendon pain localized in the heel (known as insertional Achilles tendinopathy), can benefit from different treatment than when Achilles pain is present in the mid-portion of the Achilles tendon (known as intertendendinous Achilles tendinopathy). Mid-portion Achilles tendinopathy is primarily a tensile loading problem involving the ability of the Achilles to resist stretching, while insertional Achilles tendinopathy is a compression issue.

When the ankle is loaded, which occurs when placing full weight on the foot during walking, the Achilles tendon is stretched and becomes compressed against its attachment site on the heel. This flat foot loaded position, placing the ankle in a position of maximal dorsiflexion, is also the position for stretching the calf. It is easy to understand why calf stretching would only compress the tendon and exacerbate the condition further. Therefore the best treatment includes avoiding stretching the Achilles. Other helpful treatment strategies include:

  • Discontinue running, especially if symptoms are provoked for more than three hours following a run
  • Avoid running uphill or extensive stair climbing
  • Avoid wearing minimalist running shoes, flat shoes such as flip-flops or walking barefoot
  • Use a heel lift in shoes, wear shoes with a heel (wide sole tennis shoe or wedge < 2″), or tape the Achilles or ankle to avoid excessive stretch on the Achilles
  • Use ice as needed to manage symptoms
  • Strengthen the calf in a protected position

Once the symptoms have resolved during general walking and stairs, calf strengthening can be initiated. Begin with calf raises in a shorted position (small book placed under heel) and progress to single leg calf raises from the floor. Avoid calf raises incorporating a heel drop off the edge of a step. Instead work to develop the amount of load the tendon can withstand by adding weight using a weighted backpack or weight vest. Pain should always be a guide with avoidance of soreness for greater than 2-3 hours following exercise.

It is important to note that these guidelines provide a basic recommendation for treatment and all conditions are unique, so always seek a comprehensive examination should self-management fail to resolve the symptoms. The entire lower extremity often contributes to the cause of the pain and the tendinopathy may return if the source of the problem is not properly addressed. Therefore, an evaluation or free injury screening by an experienced physical therapist at Athletico Physical Therapy can help you target the source of the problem and get you back on your feet and running.


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Minimizing the Risk of Running Injuries with Strength Training

By Rebecca Weiner, PT, DPT, ASTYM certified for Athletico Physical Therapy

The days are longer and the weather is finally nicer, which means more people will be out running. Thinking about running that neighborhood 5k or half marathon this summer? When deciding between which training program to follow, make sure you don’t forget to incorporate strength training. Strength training is believed to help with injury prevention in runners.

In fact, research shows that a strength training program including resistance and plyometric exercises performed 2–3 times per week for 8–12 weeks is an appropriate strategy to improve speed and form for middle and long distance runners. What’s more, runners who performed resistance training three or more times per week were approximately 50 percent less likely to experience a running-related injury. The study also showed that the combination of running and resistance training increased both short- and long-term  endurance performance in sedentary and trained individuals.

Based on the facts stated above, it is important to strength train while training for your next run – whether it’s a 5k or 26.2 miles. This does not by any means mean that you have to bulk up. You just need to make sure you are working the muscles that support you during your run to make you more efficient and less prone to injury.

Here are some exercises to help strengthen your lower extremities:

Leg raises: Begin lying on your back with one knee bent and your other leg straight. Engaging your thigh muscles, slowly lift your straight leg until it is parallel with your other thigh, then lower it back to the starting position and repeat. Try to keep your back flat during the exercise and keep your leg straight. Complete three sets of 15 and add ankle weights to make it more challenging.

Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training

Sidestepping with resistance: Begin in a standing upright position with a resistance band looped around your ankles. Step sideways, maintaining the tension in the band. Walk about 10 feet and then repeat in the opposite direction. Make sure to keep your feet pointing forward and to keep your trunk upright.

Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training

Squats: Begin with standing tall with your feet shoulder width apart. Bend your knees, sitting your hips back with your chest upright. Return to standing and repeat. Add dumbbells to make it more challenging. 

Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training

Bridge with ball squeeze: Begin lying on your back with your legs bent, feet resting on the floor, and a ball between your knees. Engage your abdominals as you gently squeeze the ball between your knees and lift your hips off the ground into a bridge position. Hold for about 2-3 seconds and then lower back down to the ground and repeat.

Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training

Crossing the Finish Line

These are great exercises to get you started with strength training and to help you avoid running injuries when preparing for your next race. Don’t forget to also cross train and take days off from running. If you do experience any aches or pains during your training, please consult a physical therapist at your nearby Athletico for a free injury screen.


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Long Distance Running Won’t Kill Your Knees

By Dev Mishra, M.D., President, Sideline Sports Doc , Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • There’s a common belief that running leads eventually to arthritis in the hips or knees but evidence shows that runners have no increased risk for arthritis and in fact may have lower risk than the general population
  • The biggest risk factors for developing arthritis are prior injury or surgery to the joint, family history, and high body mass index

I see a lot of folks in my clinical practice with hip and knee arthritis and many of them have extensive running histories. Most of these folks believe that it’s the long term running that eventually led to the arthritis, but the belief that running causes knee arthritis is probably a myth.

The idea that running can lead to arthritis makes sense. You run on a hard surface for long distances and over many years the impact leads to wear and tear. Seems pretty logical, right? Well the available evidence points us in a different direction.

There have been several good quality medical studies done over the years to study the relationship between running and arthritis. I want to highlight three that have some interesting and relevant points.

This study published earlier this year specifically studied marathon runners. These were experienced high mileage runners, average age 48 years, typically training about 36 miles per week. They’d completed an average of 76 marathons! About 47% reported hip or knee pain but only about 9% had arthritis. The strongest predictors of hip or knee arthritis were older age, family history of arthritis, and any prior surgery on the joint. But marathon running itself was not predictive of arthritis.

This study of about 75,000 runnersis pretty impressive for the number of people who participated. It’s incredibly difficult to get information on that many individuals. The author used the National Runners’ Health Study and the National Walkers’ Health Study. During a multi year follow up, about 2.6% of the runners reported arthritis, and about 4.7% of the walkers reported arthritis. These are pretty low numbers since the generally accepted prevalence of arthritis amongst all U.S. adults over 55 years of age is about 18%. The author believed that the most meaningful reason is that the body mass index (BMI) of the runners was less than the walkers, and presumably both are lower than the average BMI for the general population.

And here’s another interesting study titled “Why Don’t Most Runners Get Knee Osteoarthritis?”These authors used motion capture imaging and force plates in the ground to estimate forces across the knee joint with running and walking. They found as expected that there’s quite a bit more load across the knee joint with running (8x body weight) vs. walking (3x body weight). But the runners have longer stride lengths than the walkers, which meant that they took fewer steps over a given distance than walkers and had fewer impacts. The runners also experienced any pounding for a shorter period of time than when they walked, because their foot was in contact with the ground only briefly with each stride.

The net effect was that the amount of force moving through a participant’s knees over any given distance was equivalent, whether they ran or walked. It’s an interesting mechanical explanation.Logo

So these and other available scientific evidence indicate that running itself is not a risk factor for developing hip or knee arthritis. The strongest risk factors appear to be prior surgery or injury to the joint, a family history of arthritis, and a high BMI. If you start out running with a healthy joint there’s good reason to believe you can run healthy for many years. This myth is probably busted.

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