Dealing with a Yoga High Hamstring Tendon Injury (Stage Three)

 

Stage Three Recommendations

 

(1) Continue with the hamstring strengthening programme increasing exercise intensity as you become stronger.

 

(2) Introduce eccentric strengthening exercises which encourage co-activation of the glute and hamstring muscles (eccentric exercises are those which work the muscle when it is in a lengthened state).

 

(3) Gentle hamstring stretches can be gradually introduced but intense hamstring stretches, such as seated forward fold (Paschimottanasana)  should be avoided for about a year post injury.

 

(4) If you experience moderate to severe pain, or pain that persists despite a period of rest then you need to seek treatment from your GP or physio before continuing with stage three.

 

Stage Three Hamstring and Glute Strengthening Programme

 

Warm Up

 

Warm up the hamstrings with movements which will not exacerbate the existing injury. For example, gentle legs swings:

 

1. Hold onto a chair or stable surface

 

2. Keep a microbend in both knees (do not lock the knees out)

 

3. Begin to slowly and gently swing the leg forward and back, keep control of the leg at the knee and hip joints (do not allow the knees or hips to swing out)

 

4. Work each leg for 20 seconds each side and then repeat two more times

 

Do not stretch the hamstrings after the warm up, move directly onto the next three exercises. The research evidence tends to favour not stretching the hamstrings at all during this phase of the treatment programme because it can make the injury worse. Instead, the focus is on micro-strengthening the hamstring and glute muscles. 

  

Double Bridge

 

Start to focus on glute engagement now as keeping these muscles strong will take the pressure off the hamstrings during hip extension.

 

This Double Bridge exercise will work the hamstrings and glutes eccentrically and should be performed in a slow, controlled manner.

 

(1) Lie supine (on the back) with the feet on the floor, knees bent and in line with the ankles and thighs parallel to each other. Do not let the knees or feet fall in or out to the sides

 

(2) Keep the spine in a neutral position (don’t press the lower back into the mat) and the feet quite close to the buttocks

 

(3) Peel the pelvis about 3 inches off the floor (you should feel the lift coming from the hamstrings AND also the glutes) and hold for 3 – 5 seconds. Squeeze the glutes to hold you in position. Start by doing 2 sets of 5 and gradually building up to 3 sets of 12

 

(4) Over the next few weeks go a little higher, peeling away the lower, middle and upper back continuing to hold for 3 – 5  seconds for 3 sets of 12

 

Advanced Bridge

 

(1) As you become stronger in the double leg glute bridge you can challenge yourself by increasing the height of the feet using blocks or bolsters

 

(2) Eventually keep one leg raised straight into the air as you perform the lifts

 

 

(3) When you can perform 3 sets of 12 with the leg raised into the air then progress to the next level which is to perform the exercise using an unstable platform such as a Swiss ball

 

Swiss Ball Curls

(1)  Lie supine with a ball under your straight legs

 

(2) Bend the knees but keep the hips and torso stable and still as you roll the ball towards the body using your hamstrings and glute muscles (the back will lift away from the floor)

swiss-ball

(3) Perform the movement slowly, at first keeping the range of movement quite small. Try to perform 2 sets of 5, gradually building up to 3 sets of 12

 

(4) As you become stronger, increase to a full range movement and, eventually, single-legged Swiss ball curls

 

Gentle Hamstring Stretches

There is no agreed time when the hamstrings may be stretched again. However, all the research evidence is in agreement that any hamstring stretches should be very gradual and gentle. Intense stretches such as seated forward fold (Paschimottanasana)  should be avoided for about a year post injury. 

 

Gentle Hamstring Stretch

 

Lie supine, keep one knee bent on the floor and bend the other knee slowly toward your chest, switching legs after 15 seconds.

 

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