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Recovering From Upper Hamstring Tendon Injuries

A careful recovery plan can help you move back to a full practice.

By Roger Cole

What should you tell your students to do if they have an injured upper hamstring tendon? The recovery program below is based on the physiology of healing and the principles of yoga. It has three stages, corresponding to the three phases of the healing process: 1. Rest during the inflammation phase (72 hours). 2. Align during the repair phase (6 weeks). 3. Strengthen and lengthen during the remodeling phase (up to a year or more).

Stage 1: Rest. For 72 hours after the initial injury, the student should rest the area completely. This gives the body time to remove damaged tissue and bring in cells that will produce new capillaries and collagen. The student should not attempt any stretching or strengthening activities and should not apply heat. To prevent excessive inflammation and swelling, apply ice (20 minutes on, 20 minutes off) as often as is practical, compress the upper thigh just below the sitting bone (using an elastic sleeve), and elevate the pelvis above the heart.

Stage 2: Align. Over the next six weeks, very gently align the newly forming connective tissue fibers. Do this by gradually introducing modified asanas (see Asanas for Hamstring Recovery below) that provide micro-strengthening actions with the hamstring muscles in the neutral, slightly shortened, and slightly lengthened positions. These asanas should apply just enough tension at just the right angle to induce the healing tendon to grow strong and flexible in the desired direction. Practice with subtlety. Do not perform the asanas too vigorously or stretch too far, because this can damage the delicate molecular/cellular matrix that is being created. If pain increases during this stage, back off and start over with Stage 1.

Stage 3: Strengthen and Lengthen. Over the next year or more, very gradually strengthen, then stretch, the injured hamstring tendon. As in Stage 2, practice asanas that contract the hamstrings against resistance in the neutral, shortened, and lengthened positions (see Asanas for Hamstring Recovery). Start out where Stage 2 left off, then gradually increase the load and length demands on the muscles and tendons. Done properly, this systematically adds high-quality, correctly aligned collagen fibers to the injured area. Back off if pain increases. One of the key benefits of this program is that it strengthens the hamstrings not only while short, but also while in progressively longer positions, for several months before introducing full stretching postures.

Additional Tips

Wrap a strap tightly around the uppermost part of the thigh just below the sitting bone while doing the asanas in Stages 2 and 3. This may help keep the healing tendon fibers aligned and close to the bone. You can create a similar effect when you finally reintroduce seated forward bends by having the student sit on a sharp ledge that presses into the hamstring just below the sitting bone.

If the student has an old hamstring injury that has not healed properly, certain types of therapeutic massage may help break down scar tissue. Some students have reported success applying their own massage by sitting and rolling on a tennis ball. Be careful with this, though, because massaging too hard or too often can cause injury. Also, do not practice massage on its own, but couple it with asana and rest to align and strengthen the new connective tissue that will replace the scar tissue. Remodel this scar tissue by applying gentle, sustained tension rather than sudden, sharp tension.

Yoga teachers recovering from hamstring injuries can set a valuable example to their students by not practicing complete forward bends while healing, and instead focusing on other aspects of their practice. They should explain to students what they are avoiding and why, and what they are practicing instead. When appropriate, they can have students demonstrate forward bends in class rather than demonstrating themselves. Such restraint provides students with a positive role model for dealing with their own injuries. It also demonstrates other qualities of a yogi, including discipline, nonviolence (to the body), and humility.

Asanas for Hamstring Recovery

Stage 1: First 72 Hours

Purpose: To Elevate the pelvis and rest the hamstrings.

Supported Setu Bandha Sarvangasana (supported Bound Bridge Pose)

Place two bolsters (or long folded blankets) end to end. To enter the pose, first sit in the middle of one bolster, then turn your body to align your legs over the other bolster and lie back so your upper back drapes over the end of the first bolster. Lengthen your lower back, place your shoulders and head on the floor, and extend your legs straight. Do not enter the pose starting with your pelvis on the floor, because lifting it up onto the bolster would require a strong hamstring contraction. Also, take care not to stress the hamstrings while adjusting position or exiting the pose. Hold the posture for 10 minutes or more (but exit sooner if it causes discomfort). Do this pose during the first 72 hours after an injury. It's OK to repeat it several times a day, and to continue to practice it in Stages 2 and 3.

Stage 2: Next Six Weeks

Purpose: To gently pull the delicate, new collagen fibers of the healing tendon into alignment without tearing them.

The first time you try each asana in this sequence, do it just once, with the mildest possible muscle contraction, and hold it only briefly. If it does not cause pain, build up over several days to three repetitions, holding the pose for 30 seconds each time. Start with extremely mild muscle contractions, and build force gradually until you achieve moderate contraction strength at the end of six weeks. Never contract or stretch with great force in Stage 2. It may also be helpful to apply ice after your asana session.

To maintain standard alignment, point your knees straight ahead (no internal or external rotation of thighs) and align your feet with your knees (no internal or external rotation of shins at knee joint). You may also wish to try variations in some cases to focus strength and stretch on particular parts of the hamstring tendons.

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Reader Comments

Kris Blum	Research the Graston Technique, its great at breaking up scar tissue.
Cara	Fantastic article! As a Yoga teacher I definitely relate, find this very informative and super useful. Thank you so much for providing this, Yoga Journal and Roger Cole, you guys rock!
Vanessa	Anyone have an idea about how to tell if it's sciatica or hamstring pain? I've had pain for a month now that swear started as sciatica (as I've had it before) but it keeps moving around, and some days mild stretching makes the pain go away and some days its very throbbing in the mid hamstring.