Guidance with right leg after going through consult and repeating rehab

Hello BBM team,

Hope you all have been doing well! I am writing this in regards to my right leg that I have been dealing with for quite some time since the beginning of January. During my time in January I developed some pain in my right glute and hamstring after a really rough training day (most likely due to load/fatigue management) and days after it got to the point where it would be quite painful and it would be tough for me to pick up heavy things off the ground, standing on my right leg (pretty much activities where I would have to press down on the ground with my right foot), and even had a hard time walking at first. When it came to training, I tried training through normally hoping it would just be some acute pain that would just go away but it got to the point where the more weight I put on, the more painful it was and got to the point where it was clear the barbell was rising up asymmetrically with the left side rising up quicker than the right. I decided to reach out to Dr. Ray and Charlie for a consult.

On February after speaking with Dr. Ray and Charlie who have both been extremely helpful, I was then running a modified rehab version of the 7 day hypertrophy with 3-1-0 tempo exercises to replace my normal pulling and its variations for high reps starting with 10 reps then dropping it down by 2 reps every 2 weeks until I got to 6 reps. At the end of the rehab, things were feeling great. I was able to do all daily tasks and activites at work with not much issue. I was symptom-free towards the end of my rehab during training and if I did feel symptoms, it was pretty rare and only happened once or twice at my RPE @ 8s but it was 100% tolerable. However, outside of my training, I will say that from time to time I still got some light discomfort/light dull nagging pain outside my training frequently and it did get annoying. This can happen when I’m both sitting down or when I’m walking. The positive thing about this is that the discomfort is extremely minimal that I would just give it a <1-1.5/10 pain scale and in no way does it affect with my daily activities, working tasks, etc. I also took their advice for were trying to focus on the current task you are doing at hand and trying to ignore it. I will say that it has worked many times where I just abruptly ignore the discomfort area, which is great. Once I got back to my normal training, I started feeling frequent flare ups again and I honestly did not know why this was happening all of a sudden after I just went through the rehab process. My thought was I may have added too much weight making a sudden big jump from rehab to my normal training? That’s what I was thinking. However, after having to go through the rehab, it has taught me to be patient with these kinds of things and reading Charlie’s article has def helped me as well. So I decided to repeat the rehab again but starting from 8 reps rather than 10.

After going through the rehab again, I got back into training normally except this time I was doing all my working sets all the way up to @7, and avoiding the @8 sets for now and will slowly work my way back. This is currently on the BBM’s group programming 3x/week. As of now, I am still getting frequent light dull nagging pain on my right hamstring. I still feel it, especially when walking almost every step I take on my right leg, standing (ex:waiting for the bus). And am still feeling very light symptoms when training. This is pretty much identical to what I was feeling the first time after my first run of the rehab, the only difference is that the symptoms aren’t as serious in my training now compared to before.

I guess the main thing I am asking assistance on is whether to rehab or not rehab? To be honest, in my opinion, I feel that a majority of my pain is coming from a psychological aspect due to me constantly thinking about my right leg even outside of training. Then pain is very minimal for the most part. It just comes up frequently. I try my best to not put it in mind, but it’s something I still need to work on. When I’ve been dealing with symptoms both in and out of training, I always ask myself these questions and this is what it is currently:

Am I feeling symptoms?: Yes
If so, can I tolerate it?: Yes
Am I able to do my activities with no interruptions?: Yes
Pain scale?: 1-2 in training.
0.5 - ~1.5 outside training
(Most times I would say the comfort is quite minimal)

I would love to hear your thoughts and recommendations/tips. Based on the information I’ve given, do you think I should do another form of rehab? Please let me know if I need to provide additional information. As always, thank you so much for everything you guys have done!

Best,

Sean

Good morning guys,

Just a quick update:

Today I went in training normally for RDLs for 11s and I started feeling pretty darn sensitive during my warm up sets and I just stopped at my warm up sets. I was feeling extremely unmotivated this morning to train anyway, but I feel like I should still tamper it down regardless and do some rehab again with 3-1-0. I was thinking of repeating my rehab but instead of starting it at 10 reps, I may bump it to 12-14 reps and lower the reps down by 2 every two weeks. Intensity going for @5, @6, @7, and @8.

In addition to doing that, do you recommend any specific isometric exercises to target my right glute and hamstring? If so, what would you recommend for exercise, volume, and frequency? I noticed BBM posted a Nordic hamstring curl video not too long ago. Would that help with other exercises you’d recommend?

Does this sound like a reasonable plan, or would you recommend something else? Again, thank you!

Hi everyone,

Just wanted to follow up on this and give a quick update, and hopefully get some guidance on the current situation. Within the past 3 weeks of training the Deadlift and supplemental deadlifts, things have been going quite well. I’ve been able to RDL and Deadlift following the prescribed sets and volume, with just a few moderations

The first week of 3: RDL - 10 reps @6, @7, and @8 with one repeat @8
Deadlift - 6 reps @5, @6, @7 w/ one back off.

2nd week: RDL - 10 reps @6, @8, repeat @8 3x.
Deadlift - 6s all the way to a single @7. w/ 4 back offs all being @ RPE 5-6. Haven’t done a single in months which overall felt great. No pain at all. :slight_smile:

3rd week - RDL - Prescribed for 8reps but instead, I did tempo RDLS 3-1-0 @5, 6, 7 @ 8x2 for 10 reps
Deadlift - Worked up to a single @8 w/ slight pain (Pain lvl ~2) at first 1-2 sets of warmup but overall felt fine afterward and not much pain at my single and backoffs.

As I’ve been returning back, I’m still being cautious with my right hamstring just so I don’t apply too much stress on it too quickly, which is why I purposely aimed only @7 for my Comp. Deadlift first 2 weeks as well as throwing in a 3-1-0 RDL because my right hamstring still feels sensitive at times. I’m sure I could complete the sets @8 without much discomfort as well, but I decided to play it safe.

Overall, Deadlifts and the supplementals have been feeling a lot better during my training. Hardly any pain, but I still get some extremely light pain (~0.5-1) which is like a dull nagging pain feeling outside the gym quite often, but it’s def tolerable and I can perform daily activities. It has me focusing on my right leg a lot, but I am working on not constantly thinking about since I know it has def played a role in the past and still is. The issue with my right hamstring has been going on since January, but I’m feeling more confident as I haven’t trained like this since December, and of course, still being patient with the process. I may decide to alternate w/ tempo exercises at high reps every other week or so depending on how I’m feeling.

Just wanted to hear your thoughts and see if there is anything you would disagree w/ or any suggestions you would make for my plan. Also, just wanted to hear what your thoughts are on the Nordic Hamstring Curl for someone who has been dealing with this chronic pain in the hamstring for quite some time. I was thinking of doing 3-4 sets 2x/week for 6-8 reps. Thoughts?

Thank you, guys!

Sean,
First off let me apologize for just getting to this now. Your original post was exception as far as our ability to offer advice and I am sorry I did not see this prior. I haven’t talked to @Michael_Ray about your case specifically, but from the information you provided, it does sound like you had a hamstring strain. The crappy part about this type of injury is it typically does feel good before it is good and tends to predispose us to episodic overreaching and getting symptoms. I think overall your plan looks good but I would offer two pieces of advice:

-I typically do advocate for my athletes to work on Nordics in instances like this. I will put them in 2x/week for 3-4 sets of 6. Any more than that and it tends to detract from other training. Initially there is also a pretty substantial learning curve to the exercise and most of us lifters tend to be a little more top heavy than the soccer players for which they were originally set up for.

-If you have access to a hamstring curl machine I will have my athletes run tempo on it (prone, seated, or standing does not matter) single leg. Part of the issue with a strain is the reoccurrence rate is about 30% so having a setback isn’t uncommon. The other issue is there typically is a strength deficit side to side. While I don’t think you need perfect symmetry, if one side is an RPE 8 and the other is an RPE 4, it is probably worth addressing. When our sport/training is predicated upon generating top end strength some deficits like this likely need addressed specifically. If you don’t have access to a hamstring curl machine I’ll often just have athletes run a single leg deadlift instead but this tends to call in a balance component as well.

Some of this will also be about getting some confidence back in pulling. Sometimes, if there has been a setback it really is just being able to walk up to the bar and know you have the lift as well. This will come with some time.

Once again, I apologize for just getting to this now. If you have more questions please “@” me so I can see them.

Derek

@Derek_Miles ,

Thanks so much for the input, I greatly appreciate it! I most likely will incorporate the Nordic Hamstring Curl and the hamstring curl machine on my GPP days 2x / week. I just have two questions

  1. I plan on keeping my strength training days the way it is as I mentioned in my last post. I’m currently doing two days of GPP a week following w/ 6-7 min of upper back, ab work of AMRAP, followed off w/ 13-15 reps of triceps and biceps for 3-4 sets @8. Since I will start adding these two hamstring exercises after, is it ok to keep everything the way it is in terms of not applying too much stress?

  2. Real dumb question, but just want to double check. For the hamstring curl machine, I will run a tempo 3-0-3 for ~8 reps for 3 sets @ RPE 7-8. If one side, feels much lighter than the other, then I should adjust the weight and ensure that both legs are being hit at the same intensity for my working sets, correct?

Again, thank you all so so much for the help :slight_smile:

Sean

In terms of what you listed for 1) that should be fine in terms of stress.

For 2) that actually is a great question and one without a truly definitive answer. I do tend to advocate for switching the weight between extremities so as to hit the ideal intensity on both sides but I can also see a case for pushing the affected side more. We don’t have any good evidence one way or the other to my knowledge.