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

 

The next phase of the treatment plan concerns micro-strengthening movements around the area of the injury using isometric contraction of the hamstring muscles. This phase is about allowing the tendon to heal but also, very gently, laying down the foundation needed in order to eventually build strong hamstrings.

 

The research evidence varies on how long this stage should last (anywhere from 2 – 6 weeks). When you can perform all of the stage two exercises (with the recommended sets and reps) with no pain, discomfort or fatigue then progress to stage three of the strengthening programme. However, if you have 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 proceeding to the next stage.

 

Stage Two Recommendations

 

(1) Continue to avoid deep hamstring stretches or any which cause pain to the injured tendon

 

(2) Introduce basic isometric hamstring exercises (in an isometric contraction there is an increase in muscular tension without a change in muscle length) 

 

Stage Two Hamstring 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. 

 

Modified Locust (Shalabhasana)

 

(1) Lie prone (on the belly) on the floor with the legs straight and toes pointed

 

(2) Keep the forehead and arms on the floor

 

(3) Engage the hamstrings by forming the sensation of lifting one leg away from the floor without bending the knees BUT do not actually lift the leg or the foot away from the floor. This is an isometric movement so the legs and feet will not move. The aim is to feel the hamstrings engage

 

 

(4) Complete one set of five (each side) and then over the space of 7 – 10 days, increase to 3 sets of 10 lifts

 

(5) After 2 – 3 weeks, begin to lift the legs slightly off the floor (no more than two inches and ensure you are engaging the hamstrings in order to lengthen and raise the legs and that you are not using the lower back)

 

Modified Bridge (Setu Bandhasana)

 

 

(1) Lie supine (on your 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) This is an isometric movement so the legs and feet will not move. Begin the sensation of pulling your feet toward your hips (but they do not actually move), you should feel the hamstrings engaging

 

(4) Hold for 3 – 5 seconds and then release

 

(5) Complete 2 sets of 5 initially and then over the space of  7 – 10 days, increase to 3 sets of 10 isometric hamstring contractions (as if you are pulling the feet towards the hips but nothing actually moves).

 

Modified Straight Leg Bridge

 

 

(1) Lie supine with the legs and knees straight and the heel of the injured leg on a yoga block

 

(2) Press the heels into the floor (again, this is an isometric exercise with no actual movement of the legs), engaging the hamstring muscles, for 3 – 5 seconds at first, gradually (over 4 – 6 weeks) increasing the hold to about 30 seconds as you become stronger

 

(3) Also, over the next 4 – 6 weeks begin to increase the height of the yoga block up to an angle of no more than 45 degrees (use other props such as towels or stools). Complete 3 sets, holding for 30 seconds each time (30 – 60 seconds rest in between sets)

 

(4) Make sure you work both legs and not just the injured leg

 

When you are able to perform the stage two exercises with no pain, discomfort or fatigue then progress to stage three of the strengthening programme. 

 

 

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