Healing a Hamstring Strain (From Injury to Back to Sport)

Show Notes

In this episode of the Dr. JJ Thomas Podcast, Dr. JJ dives into how she helped Penn State Lacrosse player, Kyle Lehman, overcome a challenging hamstring injury. Dr. JJ shares the innovative treatment strategies that facilitated his rapid hamstring recovery, emphasizing the effectiveness of dry needling and tailored rehabilitation exercises. The goal for all athletes is to get them safely back to play as soon as possible. These are the techniques to do it!

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Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.

Kyle Lehman: 00:00

I recently pulled my hamstring on the cross game and I met with JJ the day after. It hurt to walk and she said let's do a body scan. So we figured out that my hips are extremely tight probably causing my hamstring to be pulled. She she immediately said that we need to try needle therapy. And she said that you're gonna find immediate results after.

Kyle Lehman: 00:19

And so I said let's give it a shot and it only took a few minutes. And immediately when I got up, I could walk with no problem. And I could also lift in my legs and everything was a lot looser. I've never been to a doctor's where I've seen immediate results like the time I met with JJ. I'm very pleased to meet with JJ, and I'm looking to meet with her soon.

Kyle Lehman: 00:38

And I'm very happy with the work she did on my body, and it was a great experience. Welcome to the doctor JJ Thomas podcast.

Dr. JJ Thomas: 00:50

Hey, everybody. Welcome to the doctor JJ Thomas podcast. I'm doctor JJ Thomas. Today's podcast, we're gonna do another clinical rounds. And in the clinical round scenarios, what I'm doing is sharing with you guys real life scenarios from the patients that I treat, and taking you through the evaluation process, to the treatment process, to the thought process of how we're gonna get them back to their activities as fast as possible.

Dr. JJ Thomas: 01:15

Today's rounds is one of my favorite, groups of of athletes. It's, yesterday I had the pleasure of heading up to Penn State to see 4 of my favorite lacrosse players, and one of them had an acute hamstring injury. So, injuries like that I love to address, because if you're if you do it deliberately, you can really get them back to play faster than most people really realize. So I'm gonna talk you through how we did that yesterday. This athlete, he's an attack, he's an attack man, and what he said to me is that, he said, JJ, he said, I injured my hamstring about 2 weeks ago.

Dr. JJ Thomas: 01:56

I think it was actually in practice. And he's like, I felt like I did great. I felt like I recovered it. I rehabbed it great, was working with the team guys here. I really felt like it felt a 100%.

Dr. JJ Thomas: 02:07

But they had a game, on Saturday, so today's Monday. Sunday I saw him on Saturday was the game. He's like, and during the game I tweaked it again. He's like, I was, just about to change directions, and I just felt it grab. And it was like that high hamstring strain on the right side.

Dr. JJ Thomas: 02:24

And so I said, alright, well let's look at you. So I look at him and he's for sure limping, Definitely favoring it a little bit. Not, not transferring his weight well, and not swinging the leg through well. So we look at him further, and yes, he's tender at the high hamstring, not really swollen, no bruising. And motion wise, he's obviously very tender into hip flexion.

Dr. JJ Thomas: 02:48

Tender, I say cautious, like as I, you know, he's he's supine, as I bring him up into hip flexion, you can see him like wincing, like, Oh God, I don't want it to stretch. And I can feel the resistance. I also felt incidentally, not not incidentally though, but I also felt, like a pinching in the right anterior hip as I was doing that. So I said, alright, let's keep looking. So I check his external rotation, and external rotation is limited a little bit, a lot actually, and tender.

Dr. JJ Thomas: 03:18

Faber is limited, internal rotation wasn't too too bad, more limited by the hip flexion piece of that. And so I take him to palpation, I'm like, let's see what's going on here. Definitely tender as I strum across that high hamstring attachment, but also very tight at the distal lateral hamstring, and in adductors, especially adductor magnus, as it attaches in that common attachment of the high hamstring there. So, with my experience what I've seen is that often times a true muscle strain is inflamed at that area. Right?

Dr. JJ Thomas: 03:55

But what we wanna do is think out of the box. Like, how can we yes, if it's strained there, there's been, there's been a stress upon it. How can we take that stress upon it off, so that it can heal faster? So what we did was I put them prone, we did, dry needling, I let them sit in the lateral hamstring, biceps femoris, and I focused on the distal mid belly and also the short headed biceps femoris on the outside, because that's where my evaluation led me with palpation and other things. And then I also came up and did, so if actually I should show you on this.

Dr. JJ Thomas: 04:30

Let's, let's get to this. So if we let me just get my glasses on. So here's the body, and I'm gonna zoom in for you. Here's hamstrings, right? Here's lateral hamstring, and if I remove that you'll see under it is short head of biceps femoris right there.

Dr. JJ Thomas: 04:50

Okay? So I stuck 2 needles in the distal lateral biceps femoris, short and long head, and I let them sit there. And then I also did, I came in from the medial side and angled in towards the femur, and got medial hamstring up high where it was tender. And then I came in on the medial side, and if you'll see here, this is semitendinosus. I'm gonna remove that so you can see under it is semimembranosus, the other part of the medial hamstring.

Dr. JJ Thomas: 05:21

And then under that is this huge massive adductor magnus. So his limited faber, his limited external rotation and faber, I could feel the tension in adductors in general. So 2 needles coming from medial, from medially in towards the femur, letting them sit along these top bands here. And remember, if I move this, all I'm gonna remove glute max for you, so you can see. This is getting in my way.

Dr. JJ Thomas: 05:51

Here's adductor Magnus at that ischial tube attachment as well. So it shares that attachment with all the hamstrings. So we needle adductor Magnus, medial hamstrings on the medial side, and then biceps femoris on the lateral side, and I left him with needles in for about 15 minutes, at a alternating slower frequency, so 3 hertz, and higher frequency, ten ish hertz. So high ish frequency, not really tetanus, but, approaching that. Alternating so that it didn't accommodate.

Dr. JJ Thomas: 06:24

So that way we got both things. We got blood pumping mechanism with the slow frequency, and we got closer to muscle recruitment with the 10 Hertz. And so it alternated those frequencies for 15 minutes. Then we got him up, off the table, needles out, and we had him walk. And actually, first I checked hip flexion, which was way better.

Dr. JJ Thomas: 06:43

He still had that pinch in the front rectus femoris, so that's in the back of my mind. But he was less, hesitant and painful with that passive hip flexion, and then when we got him up to walk, you could see it was dramatically better. He his limp was way reduced. He was like, I can't believe how much better I feel. That that for me is one of the best things about our job is, like, being able to surprise a patient.

Dr. JJ Thomas: 07:07

Like, he thought he was out 4 to 6 weeks, and now all of a sudden you see that light, like, oh my god. All of a sudden they're like, maybe I can play sooner than I thought. Maybe I'm not gonna be out as long as as I thought. And that's exactly right. So I wanted to get them even more, even even, further with our treatment, so I said, alright.

Dr. JJ Thomas: 07:24

Great. I'm so glad that you're doing better, Kyle. Let's get you back on the table. What I did next was I needled the rectus femoris in the front. Now you might be thinking, why would you needle the front for an injury in the back?

Dr. JJ Thomas: 07:38

Remember, all we wanna do is take stress off that joint. If he can't hip drive well so imagine running gait. If they can't hip drive well because their rectus femoris is inhibited or not firing well because of, issues or limitations in it, then they're gonna over flex that knee. They're gonna basically over stride instead of hip driving, they're gonna over stride or do this. So improving that range takes the stress off the attachment the extension technique of the rectus femoris and a little bit of the quad here, and then I finished those needles, and I had him get up again, and he's, like literally, his face is lighting up now.

Dr. JJ Thomas: 08:17

He's like, oh my god, I might be able to play. And so I didn't wanna push it too much though. I still wanna respect, you know, some healing time considerations, but I do wanna load him at that point. So I'm like, okay. Look, Kyle.

Dr. JJ Thomas: 08:31

We got your range significantly better in just, you know, 25 minutes. Your gait is significantly better, you feel better, your hamstring is less painful. Let's see if we can load it now. And honestly, I wasn't sure how this was gonna go, but that's the only way we know is to start to test it. So I had him grab a light band, we tied it to the, you know, to the table, and I had him do just standing, you know, slightly knee bent hamstring curls.

Dr. JJ Thomas: 08:56

I would have had him sit, to be honest, but I didn't have anything with me at the time. So I just had him do standing, the band is that way, and he's pulling hamstring curls. He is one of those orange super bands at first. Honestly, it was too light. So we went up to a red one, that was much better.

Dr. JJ Thomas: 09:12

I said do 30 to 50 reps of that. And that's not a lot. Fifty reps, sometimes I think people look at me, they're like, 50 reps? If he's gonna run on a field, he's gonna do a lot more than 50 reps of an exercise, of of extra working a muscle. So 30 to 50 reps.

Dr. JJ Thomas: 09:26

I had him break it into sets of 10 to 15 now. Do 10 to 15 and then walk, make sure it still feels good. We have to still test, retest, and make sure that his body is okay with it. And sure enough it was. So so I said, Okay, good Kyle, that was a good thing, I want you to do those every day, I want you to do a couple sets a day of 30 to 50 reps of those hamstring curls, loading it at a at a decent level, but not at a level that feels like it's outside your capacity and aggravates you.

Dr. JJ Thomas: 09:55

So the other thing I gave him though is that Brezel stretch. So I've I've made I've made videos on this before, how important it is for all these athletes, but this is one of my favorite exercises for the lacrosse players. And, it's really for him, it was to address that rectus femoris tightness. So since it was his right hip, I wanted I had him lie on his, right side, pull his left knee up, lock it down, and then grab his bottom foot, and then IQ them not to think about bringing heel to butt, but instead think about uncissoring the legs, because I really wanna get that hip flexor. Remember, they have to lock this leg down first.

Dr. JJ Thomas: 10:36

If they don't lock this leg down first, then they're gonna end up arching their back and they're gonna miss that rectus femoris on the front. So lock this leg down, then they can grab, and then instead of knee flexing here, I want them to pull this back. And then if they can, I want them to roll the opposite way? And then they're gonna get a nice stretch in their thoracic region as well, which for these lacrosse athletes, especially attack men, who are constantly here and here, they have to get out of that. They have to get their rotation out this way.

Dr. JJ Thomas: 11:09

So, so those were my 2, like, yes let's go for it, exercises to start working him back into loading. Now I will say I after he he was feeling excellent after this. He's like, I can't believe how good I feel. I'm so pumped. So I said, you know what, let's go try to load it more.

Dr. JJ Thomas: 11:27

We were in like the strength and conditioning area, so I said, go go hit the hamstring curl machine, see how it is. And I was working with some other guys too, so I said, just go do that and come back. He went over there, and he's gone a little bit, and he came back and he said, you know what, JJ, that was that felt like too much. Like, I £15 on the hamstring machine actually felt like it was bothering it a little bit, so I just stopped. So I said, you know what, I think that was wise.

Dr. JJ Thomas: 11:51

I would say that we can load it more isometrically, or with something like BFR, than we can isotonically on like a heavy, knee curl machine. So, but for him, I said, you know what, stick with the bands right now, go back to your strength and conditioning coach, go back to your PTs and trainers that you're already working with, let them know that we loosened up the muscles around that area, which is gonna take stress off that hamstring attachment and allow you to return to play faster. Because think about it, the way I described it to him, it's like a scab. Like, a a strain, a muscle strain or a tendon strain is like a scab. If the scab keeps getting picked off, it's gonna take longer to heal, and things that are gonna create that scab to keep getting picked off are the other muscles, the the other functional unit around that area.

Dr. JJ Thomas: 12:43

So by us coming in and cleaning up the range of motion around that, so cleaning up the distal lateral hamstring, cleaning up the adductors, cleaning up the anterior hip, and then maintaining those range of motion gains through the exercises and reinforcement with loading, we're actually allowing that scab protecting that scab and allowing it to heal, so he can get back on the field faster. You know, this is this in my opinion is the single number one reason why, other than the severity of the injury, number one differentiator for how fast someone can go back to sport. If we just wait for if we just completely rest and wait for the muscle or tendon to heal, we're missing the boat. We need to facilitate it, we need to support it, by making all the other muscles in that functional unit work better. And then they're gonna be able to get back as soon as that muscle's healed, they're gonna get back to sport and and succeed in it.

Dr. JJ Thomas: 13:37

So that's the story. I had a lot of fun working with him. I know they have a game coming up this weekend, again. I'm hoping he can get on the field. I feel like it's definitely a possibility.

Dr. JJ Thomas: 13:48

So stay tuned. I'm looking forward to seeing how he does, and, if you have any questions on this clinical scenario, or any of the other clinical rounds, as always, I'd love to hear from you. Leave a question in the comments below or just DM me or reach out. Talk soon.