This blog post had a very organic origin. In the last few weeks I have seen/heard of too many people ‘pulling their hamstrings’ then I can recollect. In my little world, it seems to have reached epidemic proportions (not quite really, but thanks for indulging me). So let’s intervene. Now this is a big topic to tackle. For the purpose of keeping it short, we will only discuss exercises here. Before we start though I would like to make a disclaimer for my non-physio readers, please consult your physio if you have already injured your hamstrings. These exercises may not be the best approach to your rehab goals depending upon what stage of recovery you are at. For the rest of you proactive people who have no pain and want to train for injury prevention or just try some new exercises and are tired of the same old hamstring curls etc, give these a shot.
For the most part, hamstring injuries are seen more in a ‘generally’ active, athletic population. Research seems to indicate that most of the hamstring strains occur not when the muscle is contracting (concentric) but when it is lengthening under tension (eccentric). An example during running would be when the heel of the forward leg is about to hit the ground. During this motion, the hamstring muscle is lengthening under tension.
Now logic dictates that we train this muscle similarly (eccentrically). Over the years, more and more research seems to indicate that eccentric exercises are a good option for injury prevention and hamstring strain rehabilitation (other muscle strains too). Plus, your athlete patients will love the challenge as it breaks the monotony and are difficult to perform. So start slow and gradually progress. If it hurts, do listen to your body and stop.
So here goes-
Hamstring walkouts –
2. Bilateral hamstring sliders-
3. Single hamstring sliders-
4. Eccentric hamstring on physio ball-
5. Eccentric hamstrings on TRX
5. Nordic Hamstring Curls- This one is modified/ scaled down to make it easier. Its a difficult movement to perform so I begin performing this by not going down on the floor completely. Start small as you develop control and strength and then work through the full range of motion.
Worth a try? Now work those hammies.
Woods, C., Hawkins, R.D., Maltby, S., Hulse, M., Thomas, A. & Hodson, A. (2004) The Football Association Medical Research Programme: an audit of injuries in professional football – analysis of hamstring injuries. British Journal of Sports Medicine. Vol. 38, No. 1, pp. 36-41.
Chumanov ES, Heiderscheit BC, Thelen DG. Hamstring musculotendon dynamics during stance and swing phases of high speed running. Med Sci Sports Exerc 2011;43:525
Today’s blog post is a follow up on the last blog post ‘Strength matters’ where I wrote about why its a great attribute to work on strength and its benefits. If you didn’t get a chance to read it, I recommend going through it first (You can find it Here). What is the difference between hypertrophy, strength and power and how to train for each of these attribute? Let me give this a shot-
Hypertrophy– it is a form of resistance training which primarily focuses on increasing muscular size. The by product of this is also an increase in strength no doubt. It is most often seen in the sport of body building where the competitors are judged based upon biggest muscular development, definition etc. This training can help athletes during off season to gain some mass and is can be utilized by athletes to jump to a higher weight classes in sports like wrestling, boxing etc. Also, a great option for patients recovering from injury or individuals who have no prior experience with weight training. This training ‘generally’ utilizes isolation exercises to focus on very specific group of muscles like dumbbell chest press for pecs, bicep curls for bicep brachii, tricep extensions for triceps, hamstring curls etc etc. Most of us our fairly familiar with this kind of training. Here’s a good example of someone training for hypertrophy.
In my opinion most of us are fairly comfortable with prescribing exercise for hypertrophy, but know this, the most ripped guy is not the strongest or fastest, he just has better muscle definition and less body fat then the rest. This does not dictate improved athletic performance.
Here is where it gets interesting!
Strength– in its simplest definitions means the ability of the muscles to generate/produce force to overcome resistance. This form of resistance training is different from hypertrophy in a way that it helps build strength in a person without gaining a lot of muscle mass. In other words, here the primary focus is on getting stronger, not bigger (muscles). The intention of this training is force production and activation of neuro-muscular pathways. The strength is generally measured by the amount of weight a person can press (bench, overhead press), lift (squat, deadlift) etc. It is generally trained with compound multi joint movements which are specific to the athlete’s sports. Strength training is given preference during off season (few months prior to games, series, matches) as it utilizes high intensities and loads. Here is a video of a strongman competition from Europe. Notice how these guys are not ripped and muscular like Arnold but they could outlift most of the bodybuilders. These are the men that break world records and are also summoned by Queen Cersei, queen of the seven kingdoms and the protector of the realm to be her queens guard (hope you recognize the giant from game of thrones. I’m sure he will put his strength to display this season cracking some more skulls).
Power– is work done per unit of time. Earlier, I would often use the terms strength and power interchangeably but know that both are not the same. The key difference is that power training requires generation of force as fast as possible (Strength training focuses on force produced but not the speed). This form of training has great benefits in athletic performance as it works on explosiveness. When does an athlete need the above mentioned power you ask? They need it the most in the first 2-3 seconds of a hundred meter sprint as soon as the shot is fired, the sprinter’s lower body must produce the maximum amount of force as fast as possible, they need it to produce enough speed to throw a short put or a javelin as far as possible (upper body strength alone wouldn’t be enough), a batsman needs the upper body explosiveness to swing the bat hard and fast on a relatively slow/spin bowl to make it go the maximum distance and cross the boundary. There are many examples as most of the sports require some sort of explosive power. Some exercises that can be used to develop power are Olympic lifts (snatch, clean and jerk), plyometrics (box jumps, lateral hops, clap push ups, broad jumps etc) However, unlike hypertrophy and strength training which can be very beneficial for our patients and the average joe/jane, power movements are highly skilled movements (as you will see in the videos below) which require weeks if not months of training and are generally used to improve athletic performance. This kind of training does not carry as much benefits for the patient population. Here are a just a few examples of power exercises-
Understanding these concepts is great but lets discuss how can we train for these attributes individually in terms of sets, reps and weights lifted. What I present to you below are NSCA general guidelines (slightly modified) that are followed by most of american college level strength and conditioning coaches, physical therapists and personal trainers.
Type of training Load (%1RM) Repetition Sets
Hypertrophy 65-85 6-12 3-6
Strength > 85 < 6 2-5
Power 85-95 1-3 2-5
(Needless to say, one must calculate the 1 repetition maximum of a person before prescribing the above.)
I don’t know how you feel about all of this information, but the first time I was introduced to all of these concepts I was bewildered but extremely excited. I realized I knew so little and there was so much to learn. After all, up until I started to delve into this subject had someone asked me to train a high school basketball or cricket team for sports specific fitness, I would have most likely advised the team to go hit the weights in the gym doing bodybuilding exercises like bicep curls, leg extensions and other fairly unproductive isolation exercises along with some running around the cricket field to train cardio. This would be just very bad exercise prescription on my part which would barely improve any physical preparedness for these school athletes. Lets be honest, in college we learn how to treat low back pain, knee pain etc etc but as physios we are often expected to prescribe training protocols to athletes and I know that a lot of us are not fully prepared for this. I also want to reiterate that even though I have been harping about athletes, using strength training safely on our patients has tremendous benefits.
My hope with this blog post series is to help shed some light on this aspect of our work so we can be more multi faceted physiotherapists. We have just barely scratched the surface here, in the following blog posts in this series I would like to talk about what exercises have the maximum influence on increasing hypertrophy, strength and power and how they can increase athletic performance; training cycles, sports nutrition etc etc, the list is endless. Meanwhile, I hope this blog will stir some discussion which is mutually beneficial to everyone as I would love to hear inputs from other sports physios who are already in the trenches. Leave a comment.