Pulled your hamstring? Whether it happened sprinting, lifting, or slowly over time, proper rehab is the key to avoiding setbacks and returning stronger. At Vertex PT Specialists, we treat hamstring injuries every week at our clinics in Columbia, Cayce, and Irmo—from first-time strains to chronic tendon pain that hasn’t responded to rest.
In this post, we’ll walk you through the exact rehab progression we use in the clinic, with video demonstrations, pain guidelines, and return-to-sport benchmarks.
What Are the Hamstrings?
The hamstrings are a group of three muscles on the back of your thigh:
- Semimembranosus
- Semitendinosus
- Biceps femoris
They help extend the hip and flex the knee. Hamstring injuries typically happen due to eccentric overload (lengthening under tension), especially during sprinting, deceleration, or high-speed lifting.
Common symptoms:
- Sudden pain or “pulling” sensation in the back of the thigh
- Tightness, swelling, or bruising
- Pain with stretching or walking
- Stiff-legged gait
The 6-Phase Rehab Progression We Use at Vertex PT
Step 1: Calm Down the Pain
Goal: Reduce discomfort to improve movement and re-engage the muscle.
Interventions may include:
- Dry needling
- Body tempering
- Soft tissue mobilization
- Foam rolling
- Isometric exercises
Isometric holds are one of the best ways to decrease pain and keep the muscle engaged. Here are two you can try:
Isometric long lever bridge
Isometric elevated bridge
Step 2: Bridging Progressions
Once pain improves, we progress to bridging to reintroduce movement without over-lengthening the hamstrings. These build foundational strength across the hip joint without stressing the knee.
Key tip: Move your heels away from your glutes to shift the load to the hamstrings.
Long Lever Bridge to Single Leg Progression
Elevated Bridge to Single Leg Progression
Step 3: Controlled Lengthening & Mobility Work
At this stage, we add exercises that lengthen the hamstrings across both the hip and knee—but in a safe, graded way. Start light, and use reps to build tolerance.
Banded Primer
Hamstring Slider
Step 4: Loaded Eccentrics
This is where real progress happens. Eccentric loading helps rebuild strength and reduce reinjury risk. We teach and load proper hinge mechanics, progressing from bodyweight to heavy compound lifts.
Progressions include:
- Hinge with Dowel (drill technique)
- Goat Bag Hinge
- RDL
- Deadlift
- Single-Leg RDL
Goat Bag Hinge
RDL
Deadlift
SL RDL
Step 5: Plyometrics
Once eccentric loading is tolerated, we increase the speed and reactivity of the hamstring. This is essential for return to sprinting, cutting, or lifting explosively.
Examples:
- Banded Kettlebell Swing
- Russian Kettlebell Swing
- Hamstring Slam
- Hamstring Med Ball Kick
Banded KB swing
Russian KB swing
Hamstring slam
Hamstring Med Ball Kick
Step 6: Sport-Specific Activities
Depending on your goals, we reintroduce:
- Sprinting mechanics
- Agility and change of direction
- Jumping and cutting drills
- Advanced deceleration work
Key Tips for a Full Recovery
Pain Should Be Tolerable—Not Zero
A little discomfort is okay. We aim for pain 3–4/10 or less, and use that to guide loading. If pain increases with each rep or set, modify or regress the movement.
Don’t Rest Completely—Use Relative Rest
Rest doesn’t mean stop training. We encourage patients to stay active with:
- Upper body training
- Cycling
- Squats/lunges within tolerable range
- Daily activity and walking
Avoiding deconditioning is critical to a strong return.
Progress Isn’t Always Linear
You might fly through phases 1–4 in one session, but need to back off the next day. That’s normal. Hold onto the drills that work for you and continue using them for warm-ups and recovery, even after you’re “cleared.”
Every hamstring recovers on its own timeline.
Hamstring Physical Therapy in Columbia, Irmo, and Cayce SC
We treat hamstring strains, chronic tendinopathies, and high-level athletic injuries at all three of our Midlands locations. Every session is 1-on-1 with a Doctor of Physical Therapy—no techs, no fluff.
Ready to Start Real Hamstring Rehab?
Don’t settle for passive care and cookie-cutter plans. Get personalized physical therapy with real results.
Contact Us to schedule an appointment today.
Blood Flow Restriction (BFR) Training has been one of the most important recent additions to the worlds of orthopedics and sports rehab.
How It Works
By partially restricting arterial (“fresh”) blood flow to a working muscle, we can restrict the amount of oxygen available to that muscle. Exercise in an anaerobic environment (“lacking oxygen”) forces the muscle to produce higher amounts of lactic acid. We can “trick” the muscle into thinking it is working hard, giving you that deep high-intensity workout burn, while only doing very easy exercise. That build-up of lactic acid causes not only causes increased muscle fiber recruitment, but also causes the body to increase production of Growth Hormone (GH), and subsequently Insulin-Like Growth Factor 1 (IGF-1). These 2 hormones are extremely beneficial for rehab. Growth Hormone increases collagen synthesis throughout the body, which is a clear advantage when rehabbing an injured tendon or ligament. With larger, stronger tendons, it also doesn’t hurt to have larger, stronger muscles – IGF-1 has been known as a major driver of muscular hypertrophy.
They physiologic gains don’t stop there! Myostatin is a gene in the body that limits muscle growth. (Myo = Muscle, Statin = Stays the same). By downregulating the myostatin gene, BFRT can help the body grow more muscle, which is very important during rehab from some injuries and surgeries.
Why it is Relevant
There are 3 different types of muscle fibers in skeletal muscle:
- Type I, which are aerobic, slow twitch and low-force producing. Think “endurance” fibers that are small, but long-lasting.
- Type II X, which are anaerobic, fast-twitch and high-force producing. Think “explosive fibers” that are large, strong, and get tired quickly.
- Type II A, which are somewhere in between. They are fast-twitch, but medium-force producing and partially aerobic (though exhaust faster than Type I fibers).
Type I fibers are utilized for most of the low intensity things you do during daily life. You don’t need to access Type II fibers until you are doing high intensity sprints or heavy lifting. Using BFR allows us to access the Type II fibers during light activities, which directly leads to increased muscle strength and hypertrophy despite not being able to load the muscle adequately (due to pain, post-operative status, etc.). This will expedite the rehab from orthopedic surgeries, and will also help maintain muscle mass while dealing with various overuse injuries.
A study performed by Park et al. in 2010 showed that walking with blood flow restriction applied to the legs led to an 11% improvement in in VO2 Max over just 6 weeks. This experiment was done on Division II Basketball players, not un-trained individuals. This has major implications for endurance athletes rehabbing an over-use injury – keeping a high level of cardiovascular function during times of limited capacity is crucial for returning to peak performance.
Blood Flow Restriction cannot (and should not) replace heavy loading during rehab, but can act as an intermediary supplement with similar effects until heavy loading can be safely performed.
The last article post focused on building mental resilience. Now, let’s move on to physical resilience. Similar to our inability to internally withstand life’s stressors, physical injuries are basically the body’s inability to handle the external stress applied to it. Sometimes, injuries are sudden traumatic events like being in a car accident and will occur regardless of physical capacity. However, most physical ailments can be prevented if the person has the capacity to withstand the stress. For example, a stronger ankle will be more likely to avoid rolling when stepping awkwardly off the curb. An experienced runner will be able to withstand an acute increase in running mileage versus a novice runner. A mom who can lift and carry 150 pounds will be able to repeatedly pick up their 30 pound kid without excessively straining their physical system versus the mom who can only lift and carry 35 pounds. In order to reduce injury risk, your body must have more physical capacity to withstand the stresses applied to it. Makes sense, right?
So, how do we build physical resilience? The same way as mental resilience… by consistently stressing the physical system enough to challenge it without significantly overloading it. Avoiding physical strain and underloading the system does not challenge the body; therefore, the body does not have any stress to adapt to. Actually, avoiding physically demanding activities and living a more sedentary lifestyle will decrease physical resilience. However, when engaged in a physical training program, it is also important to not constantly overstrain/overtrain the system. Smart programming incorporates recovery periods to allow trained muscles, tendons, joints, bones, etc. to rest, rebuild, and adapt. This recovery is key to allowing the body to become stronger and, therefore, more physically resilient in the long term.
There are many ways to gauge how hard you are pushing yourself. And nowadays, there are a plethora of gadgets to monitor all sorts of data like heart rate, heart rate variability, recovery, sleep, and more. Having a gadget is nice but not necessary as research shows perceived exertion to be pretty reliable as well. For example, the Borg Scale of Perceived Exertion is a 6-20 scale where 6 is how you feel resting and 20 is extreme max effort. The numbers correlate with heart rate (6 with 60 beats per minute, 20 with 200 beats per minute). So, if you are doing aerobic/cardio training, you can wear a monitor or simply use this scale to see how hard you are pushing yourself. A useful tool for weight training is Reps In Reserve (RIR) where you perform enough repetitions to tax the system without going to complete exhaustion or muscle failure. For most people, I recommend performing sets where you complete as many reps as you can but quit when you feel you only have 1-3 reps left “in the tank”. This is the point where you struggle with the weight but not going to complete failure. This is applicable for muscle endurance, strength, and hypertrophy training. The last tool is another scale applicable to any training (cardio, strengthening, mixed) and is a simple 0-10 Rate of Perceived Exertion (RPE). If you find yourself always below a 7 out of 10, then you are unlikely applying enough stress to your system to build resilience. If you are always pushing yourself at 9 or 10, you may be applying too much strain. Though challenging, the goal is to find a good balance of tough workouts but allowing yourself to recover. I recommend an average of 7-8 RPE over the course of a week where some workouts may be a little lighter and some more strenuous.
Alright, the topic of resilience is clearly important to me and I could go on and on about this. However, we’ll leave it at that for now. To wrap this up, I’ll leave you with another quote. This one is from Mark Rippetoe, a well-known strength and conditioning coach. I feel this quote applies to both mental/emotional strength and actual physical strength:
“Strong people are harder to kill than weak people, and more useful in general.”
If you were to sit and watch a mass of runners going by at the local 5k race, you will see all sorts of varying running forms, techniques, and movement strategies. Noticeable differences include varying head positions, arm swings, elbow angles, spinal postures, hip movements, knee drives, stride lengths, and step cadences. A largely debated topic is landing mechanics, specifically if it’s a running sin or not to heel strike (land heel first). My goal with this article is to discuss the differences in foot landing positions as well as give my opinion as a runner and physical therapist on the subject.
The heel strike landing pattern (also referred to as rearfoot strike (RFS)) became a more widely-accepted and adopted technique with the creation of the cushioned running shoe. Prior to shoe companies adding extra cushion under the heel, it was near impossible for someone to consistently heel strike for miles and miles without crushing their calcaneus (heel bone) into oblivion. Therefore, most (if not all) runners “back in the day” were midfoot or forefoot strikers, allowing the soft tissue structures of the feet and legs to absorb more of the load. Many advocate a midfoot or forefoot landing pattern now since it is more “natural” when not influenced by the modern advancement of the cushioned running shoe.
So what’s the big deal between strike patterns? Great question!
Heel striking is exactly as it sounds and occurs when the runner lands heel first (usually on the outer heel) with their ankle flexed and toes up. Most runners nowadays are heel strikers. The benefits of heel striking include the naturalness of it for most runners (especially novice) and the decreased soft tissue strain when compared to the other landing types. However, heel striking increases the amount of force experienced by the leg bones, hips, and knees because the foot and ankle is unable to absorb some of the load like with midfoot and forefoot runners. Though the max peak force experienced is similar between the different landing patterns, heel strikers typically experience more overall forces due to 1) an increased initial peak force with landing (see image below), and 2) increased contact time with the ground required to go from landing to push off. The increased force exposure and absorption may increase a heel strike runner’s risk for general joint pains and boney stress injuries compared to forefoot and midfoot runners.
Midfoot striking occurs when a runner lands flat footed with relatively equal distribution of weight throughout the foot while forefoot runners land more on the ball of their foot. These landing patterns are commonly described as more natural styles of running because running barefoot would likely require adopting one of these landing patterns to help distribute the landing forces. Unlike with heel striking, the foot and ankle are able to absorb much of the force, reducing the forces experienced in the leg bones and joints proximal to the ankle. Additionally, these landing patterns usually result in a quicker step cadence, resulting in an overall decreased contact time with the ground. Though there may be reduced stress to the leg bones and joint structures, there is oftentimes increased strain to the soft tissues, especially those in the foot and lower leg. This is why runners transitioning from heel striking to midfoot/forefoot landing are advised to transition slowly. These runners do not experience the same initial contact peak force as heel strikers do; however, the max experienced force is relatively the same.
Source: https://www.researchgate.net/publication/319104024_Common_Running_Overuse_Injuries_and_Prevention
So, is one landing pattern better than the others? Well, it depends on who you ask. Below is this runner’s and physical therapist’s opinion.
If you have ever tried changing your own landing pattern or tried teaching someone else, it is extremely challenging and frustrating for all parties involved. It can be awkward for the runner and can take months to master a new running technique while slowing ramping up mileage to avoid overuse injuries. Plus, many runners cannot accurately identify their own landing patterns (many think they are midfoot/forefoot runners but on video analysis are actually heel striking). Therefore, I do not believe changing the strike pattern is necessary for most runners as there are other components of the running that may be easier to modify with bigger results: foot placement and stride cadence.
A common issue associated with heel striking is overstriding, meaning the landing foot is hitting the ground ahead of the runner. It’s hard to do so when landing midfoot or forefoot. The further out front the foot lands, the harder the impact typically experienced through the leg. Additionally, the foot will spend more time in contact with the ground as it becomes the supporting post for the body transitioning over into the next step. In general, increased time with an external force can increase injury risk. Also, when the foot lands ahead of the body, it creates a temporary braking force. Newton’s Law of Physics states a force will create an equal and opposite force, so a foot landing out in front will create an impact force right back at the runner. If the goal is to keep moving forward, eliminating opposing backward forces would be good, right? If a runner can decrease their stride length so that the foot lands more under their body instead of outfront, it can significantly reduce the overall force absorbed, decrease contact time with the ground, and reduce/eliminate the backward impulse generated.
Source: https://groups.google.com/forum/#!topic/just-south/KdopHHtEU2o
Increasing stride cadence (step frequency) is another fairly easy modification a runner can make to reduce strain and improve running efficiency. Given a set overall speed/pace, the runner with a slower cadence must have a longer stride length than a runner with a quicker cadence. This longer stride increases ground contact time and forces the body has to absorb. Purposefully increasing stride frequency helps reduce stride length and improves foot landing placement, resulting in a more efficient motion (less braking forces) and decreased load. I recommend a cadence of 160-180 steps per minute. If your cadence is significantly lower than this, do not immediately increase your step frequency to match it. Start by increasing your current step frequency by 10% and gradually increase as you get more comfortable with a quicker yet shorter step. I heard from a buddy once that a runner should pretend to be a ninja trying to sneak up on someone (think quick and quiet feet!).
In summary, there are many variances to running form and technique with arguably the most disputed being foot strike pattern. To me, there are pros and cons of each. However, I feel adjusting foot landing placement and stride cadence are more beneficial (and easier) than adjusting foot strike. By focusing on landing more under the body and quickly transitioning into the next step, a runner will likely be more successful in reducing overload forces, improving efficiency, and reducing injury risk. If constantly dealing with overuse running injuries or feeling inefficient with running, try modify one or both of these instead of focusing on how your foot is landing!
Shameless Plug: Having pain with running and issues with modifying running mechanics, come see us at Vertex PT Specialists to have one of our trained therapists evaluate your running form, help address any physical impairments you may have, and get you back to running sooner!
It seemed like for a while the biggest fitness craze was core stability training with every fitness and rehab guru flooding the internet and social media with exercises using every combination of positions, movements, and equipment possible. I’m sure I saw someone doing quadruped bird dogs with ankle/wrist weights with a resistance band pulling them one way while maintaining balance on a BOSU ball that a buddy was unpredictably tapping to create perturbations on an unstable service. Yeah, exercises like that can be effective and meet the intent, but it doesn’t need to be that complicated. Additionally, oftentimes such exercises can be too challenging and complex for the “Average Joe”. In this article, we’ll dive into a simple way to progress trunk and core stability exercises. But first, let us quickly dive into a quick anatomy review and the why behind the importance of maintaining a strong trunk.
The trunk musculature can be divided into two categories based on their primary function: movers and stabilizers (note: each trunk muscle can have both a mover and stabilizer function but has a primary role of one over the other). The movers are the bigger muscles located more externally and primarily work to move the body in different directions. This includes the abdominals (flex the spine), paraspinals (extend the spine), and the obliques (side bend and rotate the spine). Stabilizers are deeper and function to maintain a spinal trunk position at rest and during movement. These include the transverse abdominis (TrA), quadratus lumborum (QL), and the lumbar multifidi (LM) muscles.
When looking at the trunk and reviewing its function, it helps to view the entire system as a three-dimensional cylinder around the spine and guts. The abs and anterior portion of the TrA comprise the front of the cylinder, the obliques with the lateral TrA fibers make up the outer walls, and the LM and paraspinals solidify the backside. Like a soda can, this cylinder also has a top (diaphragm) and a bottom (pelvic floor musculature). A healthy and properly functioning cylinder will be able to generate pressure against all walls within it, locking down and stabilizing the trunk during exertion (like the stiffness of a full unopened soda can). A poorly pressured cylinder will not be as strong and stiff (like the walls of an empty opened can). Now, the cylinder does not need to be fully pressurized all day, everyday but only when needed to complete the task. And the amount of pressure generated can and should be based on the demand. For example, generating 100% pressure and stiffness is needed for a max deadlift effort but not for picking up an empty laundry basket. Having an appropriately pressurized cylinder will reduce injury risk by maintaining proper mechanics and evenly distributing the force to the right load-bearing structures.
Now, how do we initiate a trunk strengthening program correctly with a good progression? There are certainly different strategies and approaches out there. For the most part, there isn’t a necessarily “right” or “wrong” way as long as the exercise and dosing is appropriate for the person. For example, it may not be a good idea to perform heavy deadlifts right away for a deconditioned individual with acute low back pain. I personally view trunk strengthening progression as a three phase process:
Phase 1: Isometric holds maintaining a static position for a designated period of time, starting with a shorter time then increasing duration to build endurance and confidence. Examples include front planks, side planks, and back bridges.
Phase 2: Build off the isometric holds from Phase 1 by incorporating an unweighted or minimally resisted dynamic limb movement. The purpose is to train the trunk to remain stable and strong while moving the arms and legs. Examples include bird dogs, dead bugs, and rolling planks.
Phase 3: This phase is where I introduce more dynamic movements and heavier loads to challenge the trunk strength and endurance. These are oftentimes referred to as more “functional” exercises as they replicate natural movements and carry over to tasks we commonly perform during the day. With these exercises, the trunk is usually not the primary focus or working muscle group but serves more of a supporting role (but extremely important, nonetheless!). Examples include kettlebell swings, deadlifts, and weighted carries.
Check out the videos below for examples of this outlined progression for the lateral and posterior trunk musculature.
As you can see, phasing a trunk strengthening program like above helps progressively build up the trunk strength and endurance appropriately. It doesn’t seem smart to overload a patient or client with heavy deadlifts if they aren’t able to hold a basic unweighted back bridge for more than ten seconds, right? Overloading a patient or client too soon without the proper baseline strength and endurance will increase injury risk, aggravate an existing injury, create frustration, and/or compromise trust with the provider/trainer. Let’s train and rehab smarter!
This isn’t rocket science but hopefully seeing a phased trunk strengthening progression is beneficial for you. The goal is to start small and progressively build strength and confidence while keeping it simple!
So, your knee is starting to give you a little trouble when you squat. Many times, people come to us having been told they need to stop squatting and rest it, or that “squatting is bad for your knees, you should never go that low.” And don’t get me started on the “knees shouldn’t go past your toes” myth… All of this couldn’t be further from the truth! If your healthcare provider is telling you otherwise, it’s time to find someone else. A big part of getting you back to 100% is volume management. This means your recent squat volume may have been a little too much for your tissues to handle and we need to take some time to calm them down and build them back up. But in the meantime, we can still find ways to get after it in the gym!
An experienced PT will not only assess your knee and design an appropriate loading program, but evaluate your squat mechanics, make future programming recommendations, and most importantly, find a way to keep you moving! Our goal with physical therapy is not about telling you what you CAN’T do, but helping you figure out what you CAN do. Rather than telling you to stop squatting, we work with each patient to figure out a squat variation that allows them to continue moving without increasing their symptoms. This could simply be moving them toward a more hip dominant squat to decrease the demand on the knees.
An easy rule of thumb is to move across the squat continuum to variations that utilize a more vertical shin. For example, if you’re having symptoms when you front squat, try a high bar back squat. When the load moves from the front rack to the upper back, the torso angle changes and the squat becomes more hip dominant vs ankle/knee dominant. Having an issue with high bar back squats? Try a low bar variation, or try box squats. This will let you really load the hips and keep your shins more vertical. From there we can keep adjusting by increasing the height of the box, decreasing range of motion to further remove the demand on the knees. There is a variation out there that will let you keep squatting, you just have to find it!
Over time, as the specific interventions for the knee continue to progress, we can gradually work back into the variation of the squat that was causing symptoms. Your rehab should be an active process, and there is no reason you can’t keep squatting!
Have questions? Send us a message at josh@vertexpt.com
Most of us have experienced that sudden unexpected sharp low back pain and the inability to fully stand up erect afterward. If you haven’t yet, chances are you likely will at some point. Unfortunately, we oftentimes do not expect it to happen as it either occurs with the most obscure unthreatening activities (picking up a pencil, wresting with your kids, getting out of the car, etc.) or when we believe we are physically prepared to take on load (deadlifting, squatting, etc.) but the aftermath tells us otherwise. So, when it happens, what should you do?
First, don’t panic. Take a moment to catch your breath and evaluate the situation. Yes, it can be extremely painful and alarming but 99.999% of the time it isn’t life threatening. To assist ruling out more severe pathology (cancer, spinal cord injury, etc.), think about the how the pain started and the resulting symptoms. Below are some criteria to help:
- Is the pain associated with a low-traumatic specific cause or mechanism (picking something up, twisting, etc.)?
- Does the pain change with movement and/or position (ex: worsens with bending, better with sitting, better with walking, worse in the morning, etc.)?
- Are you experiencing any other concerning symptoms (ex: changes in bowel/bladder function, nausea/vomiting, numbness/tingling, unexplained weight fluctuations, paralysis or severe sudden weakness, dizziness, headaches, etc.)?
If you can answer “yes” to the first two questions and “no” to the third, then the pain is likely “mechanical”, meaning it is not life threatening and is associated with the movement-related parts of the body. More severe and worrisome causes of back pain typically present as a constant unrelenting pain without an identifiable cause, pain that does not change regardless of movement/position, and pain along with other worrisome symptoms like those in question three above. Additionally, high-velocity traumatic causes of back pain (high-speed car accident, fall from high surface, etc.) should also be medically evaluated to rule out fractures. If you deem your pain as life threatening or suspect a fracture, definitely get it medically evaluated as soon as possible. If not, then congrats! You are the proud owner of acute low back pain and should keep reading.
Next, keep moving. Old school medical advice directed back pain patients to stay off their feet and oftentimes prescribed “bed rest” for prolonged periods. Turns out this treatment strategy is more harmful than good. Current medical literature supports continued activity, starting with lower level activities and gradually increasing workload until back to prior level of function. Sitting and laying around avoiding aggravating movements may seem logical to allow the body to heal; however, it’s common for individuals to actually feel WORSE after prolonged periods of rest. The longer you stay away from being active, the higher the risk of becoming deconditioned, weaker, and stiffer while potentially developing fear avoidance behaviors and acute depression if avoiding activities typically enjoyed.
With that said, it is not wise to continuously push through painful movements with the “pain is weakness leaving the body” mentality. Doing so can aggravate healing tissues (similar to picking a healing scab) as well as increase your body’s sensitivity to movement, resulting in higher pain levels. (Note: Pain is a very complicated output of the brain after it receives/processes multiple stimuli, to include pain receptors. The complexity is a whole other article on its own, but you can trust me on this!). So, the goal is to avoid the far ends of the activity spectrum: not enough and too much. Like Goldilocks, you need to find the middle “just right” point that keeps you moving without overdoing it. Light range of motion exercises and stretching is typically recommended along with light cardiovascular exercise like walking or riding a stationary bike. Check out the video below for some good exercises commonly prescribed for acute low back pain.
While going through the recovery process, it’s crucial to maintain an overall healthy lifestyle to promote a good healing response. Because physical activity is usually restricted initially, maintaining a well-balanced diet is key to prevent unnecessary weight gain and provide the body the right nutrients to optimize healing. Binge watching Netflix and eating a tub of ice cream is not a good approach. Sleep, too, is very important. One of our biggest healing-promoting hormones is Growth Hormone which naturally spikes during our deep sleep cycles. Additionally, our biggest stress hormone Cortisol (which limits recovery) naturally lowers while asleep. Reducing and disrupting sleep patterns therefore decreases the body’s natural ability to heal by reducing the “good” hormone we need while maintaining elevated levels of the “bad” hormone. I also recommend avoiding tobacco use and heavy alcohol consumption as both can reduce blood flow and the oxygen/nutrients delivered by the cardiovascular system, resulting in delayed healing.
The last piece of advice I can offer is to stay positive, be patient, and embrace the roller coaster ride of recovery. You will get better, it may just take some time. Each injury and person are unique; therefore, timelines, progression, and symptoms will vary. And if you have a history of low back pain episodes, each recovery will be different. Mindset is HUGE when injured (go back to the previous comment about the complexity of pain output). Feeling down and out mentally can carry over to how you feel physically. Also, remember that recovery is not a smooth ride with predictable improvements each day but more like a bumpy roller coaster ride with ups, downs, and loopy-loops (see below image). It’s common to experience a “bad day” after a “good day”. This does not indicate further harm or reinjury but is a common response as the body progresses.
So, in summary, tweaking your back happens. And, unfortunately, it sucks. However, you will recover. The body is amazing and able to heal despite all the day-to-day abuse thrown its way. There are things you can do to promote the recovery progress as described above: stay moderately active, maintain a healthy lifestyle, and have a positive mindset. Typical acute pain episodes improve over one to three weeks. If your pain persists longer, intensifies, or progresses to include “red flag” symptoms (see question 3 above), you should consult a medical provider to further assist.
Shameless Physical Therapy Plug: Seeing a physical therapist early in the back pain episode can further assist in the recovery process. If your state and health insurance allow for direct access to physical therapy without a referral (like South Carolina), I encourage seeking a physical therapist first to avoid delayed care and possibly unnecessary imaging and medication prescriptions.
I hope this is helpful. Definitely reach out to us at Vertex PT Specialists if you have any questions or concerns. Or if you are in the Columbia, SC area, we would love to help you out if your back pain continues to nag you!
Dr. Pat Casey, PT, DPT, OCS, CSCS, SFMA, CF-L1
pat.casey@vertexpt.com
803.973.0100
Baseline Aerobic Capacity
At the heart of every tactical job is the need to escape or mitigate danger when it arises. It doesn’t matter the job: military, police, fire. You have to be able to chase down a suspect, escape an explosion, or go into and come out of a fire. All of that will take a toll on your cardiovascular system – whether it’s the stress on your heart immediately or if it’s your body’s process of using oxygen and expelling carbon monoxide. You have to be able to use your aerobic system efficiently to do your job well – which essentially means making sure you and your team is safe. Does this mean spending 20 minutes on a stair machine or running 5 miles a day? Absolutely not. Endurance based training is not what you’ll be doing on at a fire scene, while jumping over fences in a chase, or when doing obstacle courses. It’s a combination of power based and endurance based systems, so both need to be challenged to create adaptation. You have to create a mixture of long-runs or sustained movements combined with strength and power movements. And you have to work at a specific intensity, AS LONG AS YOUR MOVEMENTS ARE PROFICIENT. And you have to understand how hard your body is working – this is best assessed by listening to your body. We call this “ratings of perceived exertion” – or a rating of how hard you think you’re pushing it. If you feel like your workout is cake, you’re more likely to be at a 1-4/10; this would correlate to between 10-40 % of your heart rate maxium (the total your heart is able to pumped based on your age and other factors). If you felt like you’re working harder – not the hardest you’ve ever worked but definitely breathing hard, and getting tired of the movement, you’re more likely at the desired 6-7/10. This is about 60-70% your heart rate max and will help you push to gain aerobic capacity. You don’t want to get so hard that you can’t keep going – so hard you HAVE to stop is more along the lines of that 10/10, or 100% (at) your heart rate max. You don’t want to be here for long, if at all.
Baseline Load Tolerance
Tactical athletes don’t just run away form or towards danger. They also have to be able to manipulate certain pieces of equipment to do their job. For firefighters, this can be advancing a charged hoseline or moving debris within a home. For police, this may be physically fighting a suspect, carrying a variety of tools/equipment, or moving objects out of the way to apprehend a suspect. For military – this can be anything; carrying a battle buddy, carrying heavy ruck sacks, carrying specific equipment. All areas of tactical athletes do have heavy lifting. To lift heavy efficiently, you have to have a good baseline functional movement pattern. And you have to have a load tolerance. If you go from lifting chips to your mouth while watching TV and try to go directly to carrying your 160# battle buddy – you’re likely to get injured. Your body just doesn’t have a tolerance to that kind of load. You have to safely progress the amount of load/weight that your body is lifting and carrying slowly over a period of time. Any sharp increase in that load can and will lead to injury.
Nutrition
This should be pretty self-explanatory. You get out of your body what you put into it. If you’re consistently putting cheeseburgers and beer into your body, it will not perform up to standard. If you have to go out to a fire scene and your body is dehydrated because you only drink soda and you never drink water, with the amount of sweating you’ll do you’re more likely to pass out; at minimum you won’t be fighting a fire as efficiently as you could be. Whatever you put into your body that’s processed will take longer to be broken down, and won’t be broken down completely. Your body can’t take the nutrients from the food – the protein, fats, and carbs – to utilize them for fuel. And whatever excess you ingest will be turned into fat by your body. The more fat you have, the harder it will be to move with your gear. Not to mention there’s less cholesterol in your system to clog up your arteries. So, if it comes from a bag or a box – it’s probably not good for you. Be an adult, minimize your fast food chicken nuggets in favor of colorful fruits and vegetables.
Stress-Management Techniques
Here’s the topic that means the most to me! Stress management is so important in our tactical athletes. This is a population that sees the unimaginable and keeps going. They come to situation they may or may not live through, then once they do make it – there’s a memory lodged in their brain for the rest of their life. And the only thing they really have is the ability to talk to family members, chaplains, and their brothers (and sisters) to get some closure. A lot of tactical athletes turn to alcohol or other substances to quiet their minds, which obviously takes a toll on your body, dehydrates you, allows you to make bad decisions…the works. Figuring out how each individual tactical athlete deals with stress is the first step. Do they act out in anger, do they drink, do they exercise? Understanding your outlet is huge in being able to manage these actions, ideas, etc. Out of these, healthy exercise to increase chemicals in the brain that improve mood and that benefits their entire system is the best. But only if it’s healthy, structured, and safe; one of the biggest thing involved in this is adequate rest. Without enough sleep, the body can’t recover. Without recovery, it’s just added stress to the body.
Strong back, posterior chain, pelvic floor
Here we are! The strength in the system! Without adequate strength, feeding somewhat back into load tolerance, your system will not be ready to take on the challenge of power-based movements and actions. The specified areas here – the pelvic floor, posterior chain, and back; all of these are areas we typically see needing increased activation patterns in the general public. But the tactical athletes use these systems much more often. With a strong back, meaning one that’s resilient to load tolerances, you can move more efficiently and you reduce your risk of injury to this system. The posterior chain (hamstrings, glutes, calves) is important in all lower extremity and trunk movements. When this system is firing adequately, it will reduce your risk of injury to the back and lower extremity. And finally, the pelvic floor – the one we leave out so often. This system is important in support of your internal organs and to the stability of your overall system. Making sure you know how this area works, and how to properly activate it – will also save you from injury in the future. Notice I never actually said weakness. Many of our systems aren’t “weak.” They have the adequate strength; they just need to be called to action correctly.
If you’re a tactical athlete that has any questions about these areas – in how to implement these principles into your workout routines, in how to find a workout routine, how to eat well, or how to deal with stress better. Please do not hesitate to reach out to me. If I’m not the person, I will find the resources to help. If you’re interested in becoming a tactical athlete or working with tactical athletes, also contact me. I’m always here to help.
tristan@vertexpt.com
