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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


Partial Salabhasana (Partial Locust Pose)

Effect: Alignment and micro-strengthening in the neutral position.

Lie prone. Keep your knees straight. Keep your forehead and hands on the floor. Contract your hamstrings very gently as if to lift your legs without bending your knees, but do not lift your feet or legs off the floor for the first few weeks. Instead, use just enough effort to lighten the weight of the legs on the floor by a small amount. Gradually increase the strength of the lift until, after a few weeks, you lift your legs slightly off the floor. At the end of six weeks, your legs should lift a few inches only.

Dhanurasana Preparation (Bow Pose preparation, without hands)

Effect: Alignment and micro-strengthening in the partially contracted position.

Lie prone. Support your ankles on a bolster with your knees bent. Keep your forehead and hands on the floor throughout this practice. Contract your hamstrings very gently as if to bend your knees and lift your feet off the bolster, but do not lift the feet for the first week or two. Instead, use just enough effort to lighten the weight of the feet on the bolster by a small amount. Gradually increase the strength of lift until, after a week or two, you lift your feet slightly off the bolster. After holding your feet off the bolster for 30 seconds, bend your knees to 90 degrees and then slowly lower your feet back to the bolster. Over the next four or five weeks, support your ankles on a progressively lower and lower prop (such as folded blankets) as you perform the same sequence (30 second hold slightly off prop followed by 90 degree bend, then lower to prop again). By the end of six weeks, practice without any prop (start and end with feet on the floor).

Supported Partial Supta Padangusthasana (Supported Partial Reclining Big Toe Pose)

Effect: Alignment and micro-strengthening in partially stretched position.

Lie supine. Support the heel of your injured leg on a block. Keep both knees straight. Press your heel gently straight down into the block. Over six weeks, gradually increase the height of the heel support (for example, with folded blankets, a bolster, chair seat, door jamb, etc.), but do not lift your leg beyond 45 degrees from the floor (if a 45 degree lift causes the sensation of stretch in the hamstrings, use less lift). Gradually increase from a mild to a moderate push on the heel. Hold for 30 seconds, repeat three times.

Stage 3: Subsequent Year (or longer)

Pupose: To systematically strengthen the healing tendon by adding high-quality, well-aligned collagen fibers to it, and to build long, strong, flexible hamstring muscles to prevent re-injury. Stage 3 normally lasts about one year, but it can continue for a lifetime.

This stage starts out where Stage 2 left off and includes some of the same asanas, practiced at a slightly higher level of difficulty. It then proceeds to asanas that demand muscle contraction against greater and greater resistance, in neutral, shortened, and increasingly stretched positions. When practicing, align the poses carefully, as in Stage 2, and practice both sides of one-sided poses, so both the left and right hamstrings benefit.

Assuming an asana does not cause pain, perform three repetitions, holding for 30 to 60 seconds each time and resting for a minute between repetitions. Contract the hamstrings moderately at the beginning, and build gradually to a strong contraction over several months. However, never apply strong force to stretching the hamstrings; rely instead on conscious release during a sustained, modest stretch.

When the student can practice all of the Stage 3 postures deeply, strongly, and without pain, he can return to the practice of conventional, full hamstring-stretching postures. However, the Stage 3 practice remains valuable indefinitely.

Salabhasana (Locust Pose)

Effect: Alignment and strengthening in neutral position.

At the beginning of Stage 3, continue to increase the lift of your legs from where it left off at the end of Stage 2. Work gradually up to a full lift of the legs, then to a full lift of the upper body.

Setu Bandha Sarvangasana (Bridge Pose)

Effect: Alignment and strengthening in shortened position.

This pose replaces Dhanurasana preparation from Stage 2. Lie supine with bent knees. Lift your pelvis off the floor, emphasizing a contraction in the hamstrings near your sitting bones. Lift the pelvis only a few inches at first. Gradually work up to the full pose, over weeks or months. After several months, when strong in the pose, you may elevate your feet on blocks (milder), then on a chair seat (stronger) to put greater strength demands on the hamstrings. Finally, for the greatest challenge, you may introduce Eka Pada Setu Bandha Sarvangasana, which is the same pose with one leg lifted straight up.

Supta Padangusthasana against Resistance (Reclining Big Toe Pose against Resistance)

Effect: Alignment and strengthening in stretched position.

At the beginning of Stage 3, continue to increase the height of the leg prop from where it left off at the end of Stage 2. Work gradually up to a 90 degree elevation of the leg supported by a door jamb. Then work past 90 degrees, holding the leg in place with a strap around the ball of the foot. At all angles of the leg lift, remember that your goal is to push the straight leg away from your body against the resistance of a support prop in order to contract and strengthen hamstrings, not to pull the foot toward the body and stretch the hamstrings.

Purvottanasana (Upward Plane Pose)

Effect: Higher-resistance strengthening in neutral position.

Introduce this pose only if full Salabhasana is achieved without difficulty. Sit in Dandasana (Staff Pose) with your hands about six inches behind your hips. Keeping your legs straight, press your hands and heels down firmly to lift your hips and chest as high as possible. When your hips are maximally lifted, slowly drop your head backward.

Parsvottanasana against Resistance (Side Stretch Pose against Resistance)

Effect: Higher resistance strengthening in stretched position.

Stand facing a wall. Place both of your palms on the wall at shoulder height. Step one foot forward so your toes are six to 12 inches from the wall. Step the other foot back about three and one half to four feet from your front foot. Face your front foot directly toward the wall and turn your back foot out one third of the way (60 degrees to the wall). Center both feet on a line perpendicular to the wall. Bend forward at the hip joint of your front leg, keeping your spine in a neutral position (not flexing). Bend only enough to apply a mild stretch to the hamstring of the front leg. Adjust your foot and hip distances from the wall and from one another, and adjust your thigh rotation to maintain a mild stretch while strictly keeping the front knee squarely over the front foot, and the two hips square (equidistant from the wall and the floor). Keep both knees straight.

Simultaneously press the bottom of your front foot into the floor and pull it backward toward the back foot, using the friction of the floor to keep the feet from sliding toward one another. This will isometrically contract the hamstrings of the front leg. After 30 seconds, keep this same alignment but place your hands on your pelvic rim and slowly stand upright. This will isotonically contract the hamstrings of the front leg against the resistance of gravity. If you don't experience any pain, repeat the same sequence with both feet slightly farther from the wall, so the pose creates a deeper forward bend at the hip joint. Remember, however, that the purpose of the practice is to contract and strengthen the hamstrings, not to maximally stretch them.

Roger Cole, Ph.D. is an Iyengar-certified yoga teacher (http://rogercoleyoga.com), and Stanford-trained scientist. He specializes in human anatomy and in the physiology of relaxation, sleep, and biological rhythms.


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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.

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