bandhayoga-hamstrings

Case study: hamstring strain (or something)

In early 2014, I strained a left hamstring muscle near the origin. Or an external rotator in the left hip. Or something.  It snuck up on me. There was no acute injury.

bandhayoga-hamstringsI simply noticed less range of motion (ROM) in straight-legged, forward-bending poses, marked by a pulling sensation on the lateral side of the sitting bone. Initially I was sure that whatever I’d tweaked would resolve in a few weeks, as my injuries typically do.

By April, however, it was still bothering me. While not prohibitive (I continued to attend weekly classes, to teach m own classes, to “do everything”), my more-flexible left leg suddenly had less ROM than my right–and that grippy spot persisted.

A habitual self-diagoser, I looked up other possible conditions. Could it be piriformis syndrome? Could it be sciatica? (Since I had no nerve-related symptoms, I ruled out these conditions, which apparently are common among runners.)

Here’s a short list of remedies I tried:

  • Ice I’m a fan of ice/cold therapy. So, if the area was tender, I’d sit on an ice pack (not everyone’s cup of tea). Ideally I would have alternated cold and hot packs.
  • Rest I never took complete rest, I initially held back in my forward bends. Over time I found that rest was either unhelpful or neutral. I was reminded of senior-level Iyengar yoga teacher Chris Saudek‘s answer to a question about healing an injury. She said that she first tries rest but, if she sees no change, she does the opposite and intensifies her practice.
  • Massage I splurged on three massage therapists with high hopes of finding a miracle worker. The first, known for deep myofascial release, was knowledgeable but spent more time on diagnosis than on massage. The second therapist was a bit too New Agey for me, and the third was good but not great.
  • IMS My final experiment was Intramuscular Stimulation (dry needling) done by a physiotherapist. I have pretty high pain tolerance, thank goodness, because IMS is excruciating! But I found it curiously cathartic. Did my four treatments help? Possibly. I resumed kicking up to handstand with my left leg (after a couple of months’ kicking up only with my right).

In July I left for Indiastretch_highlight, hoping for the best. In Pune, I practiced more than I do back home. There were times when I had to modify: In Trikonasana, I used a block while the majority were prop-free, fingertips on floor. In Paschimottanasana, I did a 45-degree concave forward bend while others rested forehead to shins.

One day, while practicing Supta Padangusthasana I, II, and crossover (two-minute holds per variation per side), I repeated the first upright variation (my usual “test”) found that it felt different after the series. The target spot at my left outer hip felt more diffuse, and I had more ROM. The parsva (side) and crossover variations seem to release the grip on my hamstrings–perhaps by engaging my psoas or by resetting my femur head in its hip socket. (See Ray Long’s articles, linked below, on optimal stretching techniques.)

From that day, I did this Supta Padangusthasana series daily and, by the time I returned to Vancouver in early September, I had turned a corner. My left leg was almost back to normal, and I didn’t feel that pulling restriction anymore. Then–a big sign–I could “pop” my left hip joint again. During my injury, it had stopped popping; I missed that visceral release and was thrilled when it returned!

Today, my left leg is as flexible, or more so, than my right. It took seven or eight months to heal. Diagnosis? With nagging “minor” injuries, there’s rarely a clear-cut answer. By changing our mechanics, our routines, or our attitudes, we must find our own solution.

Further reading by Ray Long, Bandha Yoga:

Images: Paschimottanasana, Bandha Yoga on Facebook; Uttanasana, Bandha Yoga

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6 thoughts on “Case study: hamstring strain (or something)

    1. Hi Jim! Click the links to Bandha Yoga; excellent anatomical illustrations! Ray Long, founder, is an MD and Iyengar yoga practitioner. More realistic than the bears. LY

  1. Luci, thanks for sharing about your hamstring injury. It is not surprising that ice was not much help and recently the man who brought out the RICE or rest, ice compression, elevation protocol has changed his story. Ice slows down healing so better not to use it for hamstring tendon inflammation or tears.

    There are many attachment sites that connect the hamstrings to the ischial tuberosity and also a structure called the sacrotuberous ligament that connects the hamstrings via tendons all the way to the erectors or back muscles continuing all the way up the back of the neck, over the cranium to your eyeballs. Basically the bottom of your feet connect all the way to your eyebrows and this line of pull is important for walking and stabilization.

    This posterior chain keeps us upright and it also helps mitigate and stabilize the curves of the spine. There’s also many ligaments connecting the femur and sacrum to the hip joint. These forces can get overstretched from being pulled on when we do straight leg seated forward bends.

    Something you might consider is that when one is in a forward bend with the knees straight, the entire posterior chain is not recruited as this would prevent the forward bend which is why men with a strong tight butt cannot do a forward bend with straight knees. His gluteals wont let him go that far forward. The stretch is often coming by way of tendons and ligaments, which are avascular type structures and lack sensory enervation so one cannot feel when the pull from a forward bend is too much. Collagen bonds began to weaken when we pull on these structures as they are not designed to stretch and they provide a ‘necessary tensional force’ that keeps us upright. Also the hamstrings help to keep the pelvis down and the gluteals are needed to stabilize the pelvis when walking in opposition to the hip flexors. Oftentimes the hamstrings actually need to be shortened as forward bending can make the posterior chain too loose.

    Try getting on all fours on a mat. Lift one leg at a time pointing your foot with a deep inhale to the level of your hip only. Make sure to point or ‘gas pedal’ your foot only. Do not flex your ankle or you will again pull on the hamstring attachment site. Do about 3 or four breaths here and switch sides. This will help your sore, stretched out hamstring and ligaments to shorten and help to create length in your groin and psoas. The more the hamstrings get loose, the more your hip flexors will try to grip.

    The click in your hip is a huge concern and I would be careful about damaging the labrum or connective tissue of the hip. Here is a great video testimonial of a woman who had warning signs but kept going until she pulled her hip rotators off the bone. https://www.youtube.com/watch?v=BLVb0klaris

    1. Aloha Michaelle: I have read about the new METH (mobility, elevation, traction, heat) protocol, which some believe is more effective than RICE (rest, ice, compression, elevation). It does seem practical to use heat to increase circulation and to keep mobile (too much rest seems to “set” scar tissue).

      I know that you advocate no straight-legged forward bending. But might there be a right/wrong way to do a straight-legged stretch? Did you read the links by Ray Long at the bottom?

      Thanks for the link featuring Diane Bruni, Toronto-based Ashtanga yoga teacher. Interesting story, but she is an extreme case, and her history is specific to Ashtanga yoga (which she somewhat rejects due to injury). Also, I am baffled by her belief that the gluteal muscles are not engaged in asana! In Iyengar yoga, “buttock” is perhaps the oft-most mentioned body part in instructions. It is impossible not to engage the glutes in certain poses (Salabhasana, Dhanurasana, and Chatushpadasana immediately come to mind). I watched the related videos by Raza Awan and Matthew Remski; while valuable, many of the issues simply don’t relate to Iyengar yoga teaching. Standing on a student’s back in child’s pose? Classes of 50+? Pushing through pain? Not in my reality.

      Mahalo and may I visit Kauai again soon, LY

  2. Because I’ve had a torn hamstring attachment that flares up periodically, I was really interested in your post. I find Ray Long’s work very helpful for healing and learning how to activate different muscles. I also found something that I overheard yesterday in class very helpful. The teacher said to one of the students that for a hamstring tear she should concentrate on the sitting bones going down. I had heard “into the body” before, but I think that I often lift the sitting bones too high. It’s a delicate balance, to not over lift them while still lifting the sacrum into the body. But it seemed to help when I concentrated on that!

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