Hello everyone!
Some brief background on my training history: I am a former division 1 collegiate football player now in my early 20s who has been lifting consistently for almost a decade. I have had hamstring and groin pulls in the past, and they lingered for a while. I have not had an injury in almost two years, until now.
While performing Bulgarian split squats the other day with a moderate load, I felt a tear in my front leg and there was an audible pop during the end of the eccentric. I managed to drive back up, and then had a sharp, painful sensation in what seems to be a hamstring/adductor group muscle. The pain is proximal, just below the Ischial tuberosity, and medial. At first I had a hunch that it was an adductor muscle, but the pain isn’t exacerbated during adduction exercises like Copenhagen planks. Rather, what seems to cause pain is hip flexion while the knee is flexed (the bottom of a squat or a lunge). There is also pain during hip extension when the knee is flexed, such as with a single leg bridge.
A few days after the injury seemed to subside, I returned to the gym to squat. The pain was minimal with the empty bar, then gradually increased as I continued to increase the load until it was sharp again during a somewhat heavy set. After, I performed 3 sets of 6 on slow eccentric nordic curls with no additional pain from that movement, but any type of squatting or hip flexion caused pain, no matter the load or range of motion.
So, with that in mind, am I reasonable in my assumption that I’m dealing with a hamstring tear (likely semitendinosus)? There is no visible bruising, and my symptoms are minor outside of the gym. Based on what I’ve learned through BBM resources and looking for people experiencing similar injuries on this forum, I assume that I should start squatting and deadlifting off pins again with a minimal load and a reduced ROM, utilizing slow tempos. I was wondering what kind of frequency and progression would be optimal. I understand if it cannot be determined without face to face assessment, but I figured I might as well ask knowing how great of a resource this forum is.
Thank you everyone, and apologies for such a long post.
Hey man, first off, do not apologize for the long post. Posts like this actually make it way easier to offer advice. Without a physical assessment I’m disinclined to guess which specific muscle you did strain, but the subjective report certainly does make it sound like there was a hamstring strain. Your report of symptoms is relatively typical as well as strains tend to be aggravated more by quick movements/intensity and tolerate slower speed better (this is among the reasons we recommend tempo). I would recommend starting from pins with a modified load doing tempo squats. The word association that comes with suspected hamstring strains is Nordic curls and I do think you are right to start those now. The issue with this in terms of strength athletes is all of the studies utilizing Nordics are with soccer players. Kinda an apples to oranges comparison in terms of sport demand. The recommendations from those papers are 3-4 sets of 6 2x/week of Nordics. I also tend to throw in some tempo sets of single leg hamstring curls for my strength athletes. The reason for this being by definition a strain is a torn muscle and there is good evidence that strength deficits persist on that side for some time afterwards. Utilizing a hamstring curl can let you pick up that deficit side to side and start working on addressing it. While the evidence would say that the eccentric portion is the most protective, addressing any big asymmetry in strength (yes forum members, asymmetries do sometimes matter) can be beneficial. You don’t need to shoot for Vitruvian man symmetry but if you start on the hamstring curl and 60# is RPE 4 on one leg and RPE 8 on the other, it’s likely worth keeping them in until it evens out. Plus, with the reduced overall tonnage on your primary lifts while you’re building back up, it can be a good way to get some accessory work in to satiate your desire for a good workout.
I would throw Nordics for 3 sets of 6 and single leg hamstring curls 3 sets of 8 at RPE 7 3-0-3 tempo in 2x/week and run that for at least 6 weeks. For my athletes coming back from a strain that still have some perceive side to side deficit I will keep the curls in on GPP day until it starts to even out.
Thank you so much for your reply, Dr. Miles. I began implementing the tempo single leg ham curls and, as predicted, there is a disparity between strength in each leg - nothing too extreme, but still noticeable. I will continue to progress on those as well as the nordic curls twice per week. Once again, I greatly appreciate your advice; I’m already in a better position after this strain than I was weeks after strains in the past.