Hamstring woes. (The Clinic).

I am a 37-year-old male who runs four to five days per week, totaling about 25 miles. I recently injured my right hamstring, playing football. I made a sudden, quick dash and felt it pull right in the middle. I fell to the ground immediately. I iced it on and off for four hours. I now wear an ace bandage, and follow the RICE treatment. What else can I do to help this heal quicker? What shouldn't I be doing? Should I stretch it? Is weightlifting ok? How long before I should try to run again? How can I prevent this from occuring again, especially given that it has already happened once?

Mark DiGiorgio, San Francisco, CA

The hamstring consists of three muscles in the back of the knee that cross both the knee and the hip joint. It functions both to flex the knee and extend the hip. When the muscles in the quadriceps are much stronger than the hamstrings, they can be injured, as well as when they are tight with limited range of motion and flexibility. Rest, Ice, Compression and Elevation are good first steps toward healing. Massage therapy often expedites recovery.

When the pain subsides (and it may take some time), you should add a stretching and strengthening exercise program for full range of motion in the hip and knee joints. Start with gentle isometrics such as tightening the quads to straighten the knee. Proceed to wall slides in which you straighten your leg against a wall while lying down and moving forward until a gentle stretch is felt. Finally, stand with your leg extended and supported on a table (or similar object at a comfortable height) and lean forward from your hips. All stretches should be performed slowly and held 15 to 30 seconds for three to five repetitions (see stretches below).

Strengthening is also essential for full recovery and can be accomplished with hamstring curls. Start with 60% of normal maximum weight (for one repetition) and work up to three sets of 10. Add weight when this becomes too easy.

Carol Hamilton Zehnacker, M.S., P.T., O.C.S., Frederick, MD

My experience has been that people rupture a hamstring muscle on the functionally shorter leg (and quads on the longer leg). If there is no history of fracture in the leg to cause the leg length difference, you might check for a lumbo-pelvic dysfunction as well.

Mitch Goldflies, M.D., Chicago, IL

Lying on your back with a doubled pillow under your knee and flattening it by straightening your leg and exerting force toward the floor is relatively isometric and good for both the quads and hamstrings. Be careful not to overdo hamstring curls. I've found they shorten the functional muscle length and can predispose you to cramps or injury.

Marvin Bloom, M.D., Burlingame, CA