My Grade 2 Hamstring Tear and the Five Phases of Recovery

This is session number 68 of the Performance Place Sports Care Podcast. Hey, Brad. Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, everybody. Happy New Year. I hope everyone is warm from their polar bear plunge. And more power, too, if you did it. I don't do polar bear plunges. It's too cold for me. Guy from Southern California. And, yeah, it's probably going to be 90 degrees all January, for all we know.

Especially this year into October, it was like, gosh, all the way to the end of October, it was like 80, 90 degrees on the weekends. It was amazing. So, yeah, Happy New Year. So, the A-bra thing, actually, this came from, I want to say, about two, three years ago, maybe. So, one of my best friends, actually, he's half Pakistani, half Canadian. And so, he's great at impersonations of his dad. His dad's Pakistani. So, then he would give impersonations, also, too, of Canada. And he just threw a lot of A's in there. So, for a while, we started A, A, A, A, A, kind of back and forth and, you know, aboots and so on.

And, by the way, I love Canadians. So, in case anyone thinks I'm not bashing on Canadians. I promise. So, we just threw the A's in there and just kind of came out. And so, eventually, I started living next to a couple dudes who, they, so they called me OC Rich Folk. And so, one guy was from Mississippi. One guy was from Alabama. So, they had some great stories when they were growing up. So, their impersonation of me was brah or bro, you know, because OC, surfer culture over here, although I don't really surf. So, anyways, they would say bro, brah. It turned into brah. And then, one day, it turned into Canadian plus brah.

So, A, brah. So, then, eventually, what we did is, like, since we saw each other, like, nearly every day, you just kind of look out on your patio and see the other person. A, brah. You just kind of, you know, talking to each other. So, it's the, so that's our high or our excitement. So, if you ever give me a couple beers in, we'll probably throw down some A, brahs. So, that's the story on that. Now, one of my, I don't believe in New Year's resolutions, but one thing that I thought would be a great start for the New Year is going to be to do a YouTube video every day. So, if you have not found my YouTube channel yet, I'm trying to correlate the podcast topics to the YouTube channel.

And every day, you're getting these very short. Actually, every Wednesday, they're going to be a little longer. And we switch from Friday to Wednesday for long ones. But every other day, you get, I mean, every day, every day but Wednesday, you're getting about two to five-minute videos. And the ones on Wednesday are, you know, 15 to 30 minutes because they're a little bit more comprehensive. But I thought I would put that out in there. So, that's my goal for this year. So, if you've not been on there already and you've thought, well, what are the stuff that I like to use for rehab? What are the tests that I like?

What are some of my thoughts on other topics and drawings and so on because I can't do everything over the auditory part of podcasts? Then go on there and check it out because I put a lot of work into it. I mean, I was working ahead of time. I mean, most of my editorial calendar is done about two months ahead of time. So, I'm trying to keep up on things for you guys as well. So, if you haven't done it as well, go on to iTunes and please review this podcast for me, okay? We are going to start this year doing a monthly drawing as well. So, if you go on there, take a screenshot of your review. And by the way, it doesn't have to be five stars.

It could be less. All I want to know is what you think about the podcast, what you'd improve, what have you liked, if it's had an impact on your life or on your patients. That's what I want to hear. I want to make sure that everyone is getting the right content they want. So, if you go on there, take a screenshot of your review. Send it to info at p2sportscare.com. And we're going to put you in a monthly drawing. And so, just put your email. We'll contact you for an address if you do win. We're going to do a drawing at the end of the month. So, it is for a Performance Place Sports Care t-shirt.

It's the one I wear to work. It's the softest dang thing you've ever worn in your life. And I just bought a bunch of them. And I wear it every day now as well as a couple other ones that I had custom made. But they're so soft. Like, there's no reason to wear 100% cotton anymore. So, the entry last, or it goes the last day of the month. Okay? And then we're going to do a drawing after that. And I'm going to redo it a couple times. I don't know how long I'll do it. But, in case you're listening to this podcast, you know, two years down the line, you probably missed the boat on that. So, here we go into the actual podcast.

So, on the note of this being a new month, I thought I would start out by telling you first, the month is all about hamstrings. Hamstring stuff. Oh, man. Hamstrings. I can't tell you enough about hamstrings and my experience with them. So, the reasons why you're going to want to stick tuned, stay tuned, I guess, to this podcast over the next five weeks is because I'm going to go over quite a few things with hamstrings. We'll go a little bit into anatomy, which is probably not the most interesting. We're going to have an interview with a running coach on as well. We're going to have a sports doc on.

We're going to go over some stretches, some corrective exercise, some rehab, some return to play, some personal stories, a bunch of stuff. Now, first thing I want to make sure that everyone realizes is that you can change what I speak about based upon if you email me or not. Hamstrings are something that's personally important to me, and I do have a lot of people who comment about hamstrings. So, I thought this would be a really good topic to talk about with you guys. So, if you haven't been to the P2 Sports Care site already, that is my site. I spend a lot of time on it. I check my emails. I go to the YouTube channel as well, which you can find if you go through the main part.

Go to I'm a patient, and there's going to be all the resources there for you. If you want to find any of the podcasts, it's going to be right there. There's a whole player on the page. You can find the YouTube channel. You can find articles. You can find a bunch of stuff. Now, today, I'd really start with, I want to tell you about my personal experience with hamstrings. And I had my first hamstring injury from baseball. Actually, it was around, gosh, so I'm 35 now. It was probably about six years ago, I think. And I remember exactly how it happened. And it's funny, going through school, you read all these, you know, textbook common descriptions of how these injuries occur.

And the hamstring is one where you kind of feel like, apparently, the person feels like a pop in the back, feels like they got shot, things of that nature, you know. So, what I was doing, actually, I was playing baseball. This is adult league baseball. I was around 28, I think. So, that was, how long ago was that? Seven years ago, I guess, as of now. So, anyways, so I was playing center field. And a ball was hitting the gap. And it was into the left center gap, really close to the wall. It was a little bit out of my reach. It was right by the warning track. And I thought, I'm going to dive for this ball.

I'm going to try to get this ball. It's going to be a really cool, badass, Jim Edmonds, Willie Mays type of catch. Okay. The left fielder wasn't really that close yet. So, I'm like, I had a lot of time. And let's just give it a go. So, I dove. I think I dove, anyways. So, I couldn't really tell, honestly, because I felt, right at that moment, I felt a pop. And actually, what I thought, when I, so I ended up on the ground. I missed the ball, actually. And I felt my hamstring just feel like it was just throbbing, right? I tried to stand up. I couldn't really stand up. And the first thing I did was, I mean, I got the ball in at first.

And the second thing I did was, look around for a second ball. Because I, honest to God, thought that someone threw a ball at me. And that's what happened at my leg. So, this was kind of like a textbook thing to me, anyways. It was an all-out sprint. I actually fell. I don't even think I dove. I mean, it was that close where I was just about to. But I'm pretty sure I just fell because of what happened. And the first thing that the left fielder said, he said, are you all right? And I said, well, I think I tore my hamstring, you know? And I'll never forget what he said. And it was, well, you're getting a little older.

And I thought, I know he's trying to help. But at the same time, that is the last thing I want to hear right now. The last thing I want to hear after I get an injury, and the first injury I've gotten in a long time, is that I'm getting older and this is just the way it is. Okay? And I actually had a friend who said this recently. We went to a baseball game, and we were out tailgating, and this guy from our high school actually showed up. And he was wearing flip-flops, and you can see his foot was, or his ankle was a little messed up. And we started talking about his ankle. And he's like, yeah, you know, I turned it a couple years ago, and just not the same, and da-da-da-da.

And so my friend said, just to console him a little bit, because I talked to him later about it. And he's like, yeah, man, we're getting older. And I thought, you know, after that, I told him, I was like, don't ever say it around me again, man. Like, I think it's a very weak-minded way to think. And he's like, I know, I was just trying to console him. I'm like, okay, I'm just giving you shit. You know, but at the same time, none of us, none of us, at least in my circle of friends, I think should ever think that. I think we can out-beat our genetics. You can out-work your genetics. There is no, we're getting too old for this.

Okay? Maybe you might not sprint all out anymore when you're 80. But there's still people, if you look at the master track meets, I mean, some of those dudes, I think the guy that actually has the record time for the 100 still does it faster than I ever would. I mean, those people aren't just always freaks of nature. They work hard for it. So, back to the hamstring thing. So, I actually could not finish the game. And I got in my car. I had a stick shift car at the time. And I had to drive about 20 minutes or so. And I know that's probably California talk. So, I guess it was probably close to 10 miles, maybe.

I don't know. But it was far enough to where I was in bumper-to-bumper traffic. And it was on a Sunday, which is ridiculous around here. I don't know why. It was, oh, it's probably because it was sunny out. People were going to the beach. So, anyways, I had to stop and go a couple times. And I think the worst part of it was letting my foot up off the gas. And this is how I remember what side it was, actually. It was the right leg. And it's because every time the traffic eased, it wasn't enough to hit the brake. And it wasn't enough to pull the clutch. Or it wasn't enough to... Now, I'm forgetting how to drive stick shift.

But, anyway, so you push the clutch down, let off a little bit. And, holy crap, that lit me up. So, it was really hard. So, I stayed a really far following distance behind all these cars. Because I didn't want to let up anymore. I just wanted to add a little bit of pressure on the gas. So, I wouldn't have to do that again. And, you know, I guess before I get too far into the story, I should just let you guys know that I am going to provide what my story was and some of the things that I did. So, it's more of a service that you guys that have hamstring injuries know that all this stuff is common, how I managed it, and so on.

Because it's a very disabling type of condition. I know that when playing fantasy football, which I did years ago, I don't really need more. I remember there was Andre Johnson that we would always want to get. In the Houston Texans. But, you always had these hamstring injuries. And, it was kind of like, you don't want to get someone with a hamstring injury because it's always going to maybe flare up. And, you kind of expect them to miss two, three games a year. And, that's just kind of what it is. And, it usually happens with people who are faster, you know. So, it really takes their game away.

So, I'm going to go through all that stuff with you here and just kind of give you some insight into ways to think about this injury because it is a common one. Okay, I've met people and there's been guys on my team. There is one guy on my team right now that he had a hamstring injury years ago. Years ago. And, he's much older now, but he doesn't really run that much anymore. He plays second base. And, he just chooses not to use it anymore because he doesn't want to flare it up. And, we call this fear avoidance. And, I know that with this injury that I had, there was definitely a period of time where I was afraid it was going to happen again.

And, this was even when I started playing again. And, not until months and months later did I finally feel like, holy crap, my legs feel like springs again. This feels amazing. And, I was talking to one of my friends that I play with. And, he's an older guy and, as you can tell, I don't play with a bunch of younger guys. But, he's probably pushing about 50 now. And, he's been really conditioning himself over the last year. And, he said, you know, I feel really good. My legs feel like springs, you know. And, he actually had a hamstring injury too. I remember working on him behind the dugout at one of the games about five years ago as well.

So, it happens to a lot of people, but it doesn't have to be the death of you. Now, this is actually one of those injuries that I wish I would have written a blog post on. I didn't yet. I probably should based upon remembering this whole thing for the podcast. But, I did do one for an oblique strain that I had a couple years ago. And, I look back on that and I see, wow, I was, that hurt? That was better? I had no idea, you know. But, I do remember a couple things that I wrote it out. And, I was diligent about it along the process of healing. And, that's been able to help a lot of people out. If you look at the video on that, actually, there's a lot of people that can resonate the same thing.

You know, it's, it's, I think it's comforting knowing that other people have experienced the same thing as well. So, with the hamstring one, I do remember that one of the most exciting things was going to get the mail every morning. And, I live in an area where we're not on the bottom story. So, I had to run down the stairs to go over to the side of the mailbox. So, it was maybe about 50 yards, okay. And, I wouldn't run far. But, I'd walk down the stairs from my, from my bedroom. I'd kind of lightly jog down the stairs and over to the mailbox to get the mail. And, really, what I was looking for was for that one morning where I didn't feel any pain or tugging at the one spot where it felt like I got shot, okay.

So, it was more of exploratory for me. So, it, and honestly, it took, I'd say, two, two and a half months to really feel like that was not painful. It was really surprising, actually, because I'd never experienced anything like it. I did go back and play sooner than probably what I should have because I remember I was, I put myself in right field. And, actually, I, actually, I take that back. Eventually, I put myself in right field. And, I first started with just hitting. And, I said, look, I'm going to hit. But, I'm just going to run down the first base. If it's not a legit double, then, obviously, I'm, or if it is a legit double, then I'll probably make a single, right.

But, if I have a leg out and run hard for a single, I'll just let it go, okay. And, the team was okay with that. So, but I remember there was, there was times when I first batted that there was a ground ball into the hole at shortstop. And, I had to run fast to try to get to first. And, I didn't refrain at all. But, I remember, and if I, I hope you guys can hear this, that my leg cadence was like this. Okay. It wasn't like, so I was really not equal on either side. And, I was using my stronger leg, or the leg that wasn't injured, to drive me forward. And, looking back, that's really not a great thing to do because we develop all these muscular imbalances.

But, it was what I wanted to do at the time. And, after that, actually, during the first, it was the first game still that I had gotten back. And, actually, before I go into where I, the right field story, was that it was interesting that it didn't really hurt to actually run forward. But, it hurt to slow down once I passed first base. So, what I resorted to, actually, was I would run to first base. And, rather than running through the base, I would dive to first base head first. Okay. I thought this was a good remedy. It didn't hurt at all. But, obviously, I had that odd cadence with my steps as well.

So, I thought, you know what? Let's just try to play the outfield. Because, they asked, hey, like, someone wants a break. Play a couple innings out there. Okay, cool. Let's do it. Right field, there's not much that happens. Let's just try it out, right? So, lo and behold, people hit these little bloopers to right field. So, I tried to dive, you know? But, I had to sprint to get there. So, I think, here's the reason why I'm saying this part of the story is that, so, I put myself in way too early. And, I think that I could have been a lot more responsible with testing things out during the week.

And, I think this happens with a lot of people. Is they get an injury. They avoid stuff during the week. They're like, I'm going to save myself to the weekend when I want to play. And, they go and they get disappointed. Like, why did it hurt again? Why did it feel different? How come I wasn't able to perform the way I wanted to? And, the reason is because we're not conditioning ourselves during the week. I don't think it's a very responsible way to treat an injury. And, I did the same exact thing. So, on that note as well, I always like to think of, because I've had a fair amount of injuries myself, I think about the psychology of the person, of the patient.

And, I think I've talked about this on some other podcasts before. But, it's interesting to see that when you're the patient, and I've had people like this when they've had balls right into the face, right? Their nose is bloody. They were checking them for a concussion. And, we say, hey man, let's just, can you answer these questions? And, they're like, hey, I don't have a concussion. Let me back in the game. And, you know, if they were to really sit there and think about it, you know what, please evaluate me. Because, my life depends on it, you know. For all we know, they could have had a bleed as well.

And, so, when I have an injury, just like everybody else, I think, well, maybe we'll make this exception, you know. And, I know with back injuries, hamstring injuries are kind of the same, you know. Where there's certain type of activities that will aggravate it. There's other ones which will be more therapeutic to it. There's ways to rehab it. There's certain amounts of time during the week that, or during the day, that you could be rehabbing, doing productive things for it's healing. But, a lot of times we don't follow those. And, it doesn't make any logical sense. And, I've said this a lot of times throughout my life so far, and I'm sure I'll say it a lot more, is that it's hard to present logic to someone who's being illogical.

And, at that point, with this injury, I was being illogical. And, now a word from our sponsor, Health IQ. Did you know that higher levels of physical activity, like running, is actually associated with reducing risk of seven, seven different types of cancer? And, it's actually around 20% roughly. This is a big drop. Health IQ knows this, and they know that you're an overall healthy person, so why not pay less for life insurance? Contact them and take their lifestyle quiz to see if you qualify for special rates on life insurance. Health IQ is an insurance company that helps health-conscious people like runners, cyclists, weightlifters, and vegetarians get lower rates on their life insurance.

To see if you qualify, get a free quote today at healthiq.com slash performance, or mention the promo code performance when you talk to a Health IQ agent. Now, back to the show. Now, some of you might wonder how bad was this tear. You know, was it grade one, grade two, grade three, blah, blah, blah, right? All I can tell you was that we didn't have it imaged, okay? It did produce a bruise, which was interesting, actually, because I actually went for a massage about, I want to say, less than a week after. And, looking back, I might not have done that based upon what I know now, anyways. Not that there's anything wrong with massage, but I don't think it was going to be right for me with my injury at the time.

And so, the massage therapist actually found a bruise. It was, like, way, way up, almost into the groin on the backside, and I would never have seen it myself because I'm not that flexible. But that insinuates there was a fair amount of tissue damage in there, okay? So, the old grading system of muscle tears, which, by the way, there's a new one, which I do have a whole podcast on that I did last year. That one is session 46 for you guys that want to listen to it. By the way, if you do want to see any of my podcasts, I will put them in the show notes. But you go to p2sportscare.com slash podcast pound, like the number sign, or I guess, as you young kids know now, is hashtag.

So, it's going to be p2sportscare.com slash podcast slash pound 46, okay? So, that one's all muscle classification or classifications of muscle injuries. But, at the time, this would be classified as a grade 2 because we have a partial tear. It's not completely torn off, but also it's not a quote-unquote strain, which would be a grade 1. So, a lot of times, I look at the significance of a bruise there as being it's a good measurement for the grade of an injury. Because when you see someone with a complete rupture, I mean, you'll see bruising all the way down their leg to their calf to the bottom of their foot because the blood goes down with gravity, okay?

And it kind of goes amongst all the other interstitial fluids in there. It's not just held at the area where the injury was at, but it's interesting. So, if you have a hamstring injury and you look at the bottom of your foot, if it was a big enough one, you might have a blood clot, not blood clot, but you'll have like a redness down there. It'll look like just a bruise under the skin, but nothing really happened there. So, what did I do with my injury here, okay? So, honestly, what I did for probably the first two weeks is I sat on the couch and ate Cheetos. Probably Doritos. I remember I was feeling really bad for myself anyways, like, because I couldn't do anything.

I was just in disbelief that it happened. You know, maybe I am getting too old for this thing. You know, I would have liked to play baseball until, I mean, I still play now. I'm 35. You know, I probably play, I keep thinking I'll play until my performance goes down, but realistically, it wasn't that great last year. And instead, I went to the cages and got better, you know? You can work harder and harder and harder, and I guess until that becomes something I don't want to do, then I won't stop. But I didn't want an injury to stop me. So, for the first couple weeks, I was just kind of feeling sorry for myself.

And finally, I realized that, you know what? I've been through, I've been through school. I work with sports injuries. I need to know how to deal with this, okay? And I was very early on in practice, and actually, I would probably date it right there. It's because I think I graduated school in about when I was 28. So, it was around around the same time as about the first year I was out. And so, I thought I knew a lot, but, you know, this really, this injury really opened my eyes to things. And even now, like, when I ride on injuries and I put them on the side or do videos on them, I kind of wish I had them for a day, you know?

Just so I can tinker with it, just so I can see the things that aggravate it, so I can know the things that improve it, how to rehab it, and so on. Because until then, it's all based upon theory. There's no personal experience. But this is one where I thought, you know, I can make this useful for people. And it was. It was really useful. And from that, I actually created quite a few other pieces of content. One of them is I call the five phases of muscle repair. So, these five phases are actually ones that I looked at quite a few studies just to kind of give myself a timeline. Because at the time, there wasn't really a lot out there to give me a good guidance on what I could be doing during each phase of the injury.

And what I found mostly was I was looking at grade two tears because that's what I had. But obviously, there's different grades of grade two as well. So, I like to say small to medium-sized tears. And the timeline that I'm going to go through a little bit here is it's very dependent upon the tear. Okay? So, that's one condition there. But it's also based upon the person, the age. I mean, heck, even if you smoke or you don't have enough protein intake, I mean, those are things that can affect your healing process as well. But if you do want to find this article, by the way, you can go onto my site, go onto injury articles, scroll down past all those little pictures with the dots on it.

And there'll be a icon that says five phases of healing. Or you can go straight to it and just do p2sportscare.com slash five phases muscle strain. And then I'll find it or you can find it in the search bar. But either way, it's a great read. It took me a very long time to write and I did five videos on it. So, in case you're not a reader, you can watch the videos too. So, the first phase was called the vulnerability period, which I called it. And these are not coined terms unless you want to say that I coined them because I just kind of put it together. I thought it would make better sense to people.

Second phase was the mobilization period. The third phase was the early strength period. The fourth is the mid-strength period. The fifth is the late strength period. So, I guess I wasn't too creative on those. But those are what I tell patients in here when they get a hamstring strain. I tell them these are the time frames roughly that we can think about and how you should kind of gauge the things that you're going to do on your hamstring. So, the first five days, again, is what we call the vulnerability period. So, it's very vulnerable. So, at the time, think about it. We have this tear, this split in the muscle.

So, we have this gelatinous type of spider web connective tissue which is in the area and it's really not too advisable to mobilize it a lot. So, think about excessive stretching. And I know the muscle is going to feel tight. Okay. It's going to feel painful. It's going to feel like you're going to want to do some rubbing and stretching and massaging of it. But based upon what we're seeing here, I don't know if you want to because you want that gap to fill. You want that gap to have some scar tissue to develop in it. I know everyone says scar tissue is a bad thing but it's good. It's needed at some point, you know.

There's a whole difference between scar tissue and adhesion. But either way, if you have an area that's split, you need to get it to heal itself back up. So, on that note too, I did know that part and I actually opted to not take any pain medication. Okay. Because it was uncomfortable. But at the same time, I knew that it would decrease the amount of repair that I desperately needed. Okay. So, the second phase was the mobilization phase and this is kind of where things get a little bit more fun. Because the first phase, the vulnerability phase, is just kind of like let's just ice, rest, heat, compress, elevate.

Which I don't believe in all of them anymore. I know that there's been arguments back and forth on icing and all this other types of stuff. But I do think the elevation and compression were of use or protection, the P part of price. Because protecting it and not letting it get overstretched, overstrained again, are things that we want to do to allow that gelatinous material to start healing up. Then when we get into the mobilization period, we're now into about 7 to 21 days. And you're going to notice that I said, the last one I said, first 5 days, this time frame is not an exact science. But it's a rough time frame.

Okay. So, I'm not making these things up. These are based upon things that I saw in research. So, I'm going off of what I saw. I'm not trying to fabricate any of this stuff beyond just naming the areas. So, in this first, so in about a week to about 3 weeks, we're looking at now to mobilize the joints and the scar tissue that's forming. And I call it conditioning the scar. Okay. We don't want the scar to mat down and go crazy everywhere and stick to surrounding tissues. But we want it to do its job to create some type of cross-bridge formation. So, things that I did in this phase, and I was really late on the first phase, and I was probably here.

Actually, I was a little late here. I think around 14 days is when I started doing stuff. And I started realizing when I was reading, I was like, holy crap, I'm missing these windows. And it's funny, actually, because a lot of people that I see that come in, they've waited 3 months, 6 months. They've missed almost all these windows. And as we go to the very end of this podcast, you're going to see that, holy crap, like, after 6 months, it's hard. It's hard to get definitive changes. And not that it can't be done, but it's just the body isn't doing the same stuff anymore. Okay. This inflammatory process or the healing process is a great time to remodel and condition the area to make sure that it's not going to be a problem long term.

And I could say, honestly, today that my right leg functions completely fine. Okay. I did have another hamstring strain or I guess a grade one or another type of hamstring injury because I didn't completely classify based upon the new classification yet because it was years ago as well. That one was on the other leg. Now, I can honestly say today both of them feel completely fine and I feel like my legs are spring. So, you can improve it for sure. Okay. So, during this mobilization period, again, things that you can possibly do are active stretching or reciprocal and abyssin stretching, light tissue work.

So, I mean light, not aggressive, or manual therapies or passive modalities. Okay. So, one of the first things I like to do is you start with some active stretching. And what I mean by this is that it's not forced passive stretching. Okay. You're basically just going and putting the leg through ranges of motion. An example is leg swings. Okay. You stand up, you swing the leg back and forth, keep the torso tight and tensioned, and you're basically just bringing the hip as well as the knee through ranges of motion lightly. Okay. We're gently, gently kind of moving the scar back and forth amongst the tissues around it.

Okay. Light manual therapy. I do mean light. Okay. I want to make sure that we're not breaking what is forming in there. I'll say that again because a lot of people say, well, let's just do a deep tissue work to it during this time period. And if this is a fresh injury, a fresh one, okay, where there's actually gelatinous material in there, it'll separate them. Okay. Now, some people might say, well, it works for me. And true, it could. But also, we have to consider the actual age of the injury. Now, if this is a chronic injury, are we really dealing with, and say there's not any blood that is pulled to the surface of the skin, then yeah.

Like, maybe this is just that there's a soft tissue problem in there. You know, maybe it's just a minor strain. But either way, if it works for you there, and if it's a chronic injury, it's not the same type of inflammatory process that's going on. So, it's a little bit different. That's why everyone's injury is a little bit different. But I can tell in all honesty that this injury on me was much fresher than the injuries that are longstanding on people. Next, I didn't use these, but you could have used them, or I could have used them, is some of the other passive modalities. TENS units, ultrasounds, e-stems, heat, things of that nature.

I'm not a big fan of those, not to say there's anything extremely wrong with them, because they do make you feel better. But at the same time, it's just not something I use in my clinic. I think about things that I can, how can I make it so my body can improve how this thing is feeling without having other things that I would have to pay thousands of dollars to buy. I think the most expensive thing in my office is, huh, should I let this information go or not? I guess it's the tables, okay? Don't steal my tables. I believe that's mainly because I keep myself safe when I'm working with people. I can't help them if I can't help myself either.

But a lot of the other things, I mean, I don't have fancy laser units. I don't have ultrasound machines. I mean, I did have a TENS unit that, or a, sorry, an electrical stimulation unit that I bought when I first got out of school. But even that was like $400. It wasn't that much. So, I believe that I would rather do the other stuff personally. Now, the next phase is, I think, where it gets really fun. But I think it's honestly mismanaged quite often. This one is called the early strength period. And this is where we start to actually load the tissues. And I've had a lot of people ask, well, what does load mean?

Well, load could be walking. Load could be bands. Load could be squatting. Load could be, on the extreme end, it could be squatting 300 pounds. And I'm not saying squat 300 pounds during this early strength period, but that's what load is, okay? So, the reason why we have to do that is because we have to restrengthen this area. And the reason why we want to do that here, or at least this rough time frame of 21 days to six weeks, is because right around this time period is where we start to have that bridge, that gelatinous material, solidify. So, it is now able to transfer load from one end of the muscle to the other.

We can transfer load through the scar. And that's what you want because that's what a healthy functioning muscle does. But if you do it too early, like in those other phases, then we're going to tear the thing apart. Now, the body really starts to, it's adaptable, okay? It is an adaptable machine. It is amazing by the things it can actually do if we tell it to do it. Now, muscles abide by a type of principle called the said principle, okay? You can look that up, go on your Google, go on your Yahoo, and put up S-A-I-D, principle, muscle tear. And I'm sure you'll find something similar to what I'm talking about.

And it's a, it means a specific adaptive force to implied demand. And actually, funny, I've actually heard someone change a word in there. But either way, it means the same thing to me. You make the muscles start to work, and they'll start to respond and accommodate and start to adapt, okay? Now, if we put load upon it, if we make you walk, then we're going to put a light load upon it. And the muscle says, hey, let's remodel. Let's, let's, this is happening to us all the time. This guy's making us walk. Let's start to rebuild a little bit. Because over the past three weeks, we haven't really been doing that, right?

So, it doesn't take long for the body to start decondition, and the body is pretty smart, okay? Like I said before, if you're not using an area, it starts kind of moving the use of its proteins and resources in that area to somewhere else, okay? So, I think I've heard the rough estimate of, for every day of bed rest we have, and that's complete bed rest. It takes four days to recover that same amount of strength, okay? And I'd have to find the reference on that, but I remember it was at a seminar, I thought, holy crap, that's quick. And I remember it was on rats that they, it was on their back legs, I remember.

It's kind of sad the way they examined them, actually. They hung up, they kind of, they let their front legs be, but they kind of pulled them up by their tail, so their back legs couldn't really go anywhere. So, we didn't have the load of gravity either, so it was, it was a really true test of that. So, it's kind of, you can't really bed rest a rat unless you knock them out or something like that, right? Now, you might wonder, what can I actually do during this time period? Like, what exercises are safe? And, I mean, all I can tell you is what I've read and researched and, you know, things that I did or that I would do now with patients.

And, I kind of start adding a little bit of, I add four-range emotion, mainly. And, so we're getting three types of contractions in there. We're getting eccentric, isometric, and concentric. So, it's basically the majority of them that the body can do. And, eccentrics, people call it the negative and, or the negatives. And, there's been some good research, at least over the years, that has showed that eccentric loading is effective for reducing the risk of further hamstring strains or having them again. And, they've done them on a lot of Norwegian soccer teams, it seems like. And, there was one in 2004 that I've referenced on my articles, as well as one in 2005 on jumper's knee.

And, it was interesting to see that these things work so well. But, if you start into them too quickly, actually, there's a fair amount of muscle damage that happens because that eccentric or lengthening contraction is what first causes the injury, really. It's that ripping and tearing apart while the muscle's trying to contract as well. So, I tend to have people just go as deep as they can into squatting or hip hinging, which would be more like a Romanian deadlift, okay? If they start to shift weight to one side or another, I try to keep their weight upon that area and just kind of do a risk-reward with them as well.

If it hurts really bad, then maybe this is too soon. But, if they're just shying off of it because they're scared, but it really doesn't hurt them, we need to get them back into a normal squat or a hip hinging pattern. So, the deeper you go into a squat or a hip hinge, the more it'll start to pull on the hamstring as well as the adductors. So, there are, although it seems like some people think, well, we're only working the quads, we're not. We're working a lot of things. Also, too, which I didn't mention before, is a lot of times hamstring injuries come from issues of the core and trunk, okay?

So, early on, and this is the window that I missed, and I didn't write it right in this article here, is that I could have been doing a ton of isometric core stuff. I could have been doing standing, non-moving things like suitcase marches would have been great. I could have been doing wall wedges, front wedges, pall-off press, front planks, side bridge, bird dogs, dead bugs. I could have been doing a ton of stuff, and I wasn't doing any of it, okay? I was sitting there eating Cheetos. And so, there's a lot of those things you can do, and if you wonder where to find those things, I will have an article up really soon.

Hopefully, by the time this podcast hits, this is the New Year's podcast. So, my New Year's resolution is to, for the end of this year, is to finish a core, not necessarily the course yet, but I have a bunch of videos that I'm going to put on this article, which is extremely comprehensive. The article is going to, it's actually pretty much all written right now. It's just being proofread. It is on the history of core training and what we used to think it was, which was the six-pack. Then we thought it was just the hoop of the core, which is the belly and back. Then we started to realize it was actually much more than that.

We started thinking the pillar system, which is a term coined by core performance. And if you read Stuart McGill's stuff, he starts to tell you about the guy wire system as well as internal abdominal pressure. And there's a lot of different parts, such as breathing, which I could have been working on during this time frame, which I do address in that whole article. So, if you don't understand what I'm talking about, I go through all of it in there and I give a bunch of video examples of the exercises that we use here at Performance Place. Now, the fourth period is now getting into the mid-strength period.

And this is around week six to eight. And you can see that's a huge window. Huge window, okay? It's very dependent upon the type of injury they had and the grade of it. And so, now we're starting to use a little bit more aggressive tissue work because now scar tissue is a little bit more advanced in there and it's not as vulnerable. But also, too, we're starting to load the entire lower limb, not just the one muscle, okay? And I want you to realize that is that when we rehab an area, we can choose to do a local muscle-specific rehab program or exercise. Or we can choose to rehab a movement, okay?

Because the movements are the things which often create this and movements are the things that suffer after we have an injury, okay? I can't tell you how many times I've had people ask. And one of my good friends is the same way. He came with a shoulder condition and we did what I had him do. I had him do a suitcase carry and it made his shoulder feel better, right? He was able to raise his arm above his head. It was great. I had him do a kettlebell arm bar. And actually, that's the one he looked at or he asked about. So he's doing this arm bar and he's turning around on the ground. If you don't know what it is, it basically looks like a log rolling with a kettlebell above your head.

And he says, what muscle does this work? And I said, a lot, you know? And when we went into the suitcase carry and then I told him to do a deadlift as well, he's like, well, what muscles does this work? I'm like, okay, from now on, you're not allowed to ask that, okay? This doesn't work one muscle, nor do we even care about working one muscle. We're working a movement, okay? I'm going to say it again. I'm going to pause, okay? We're conditioning movements. We need to make sure our body can do certain movements well. Whether we can have the most jacked, strong hamstring in the world, but we might not know how to sprint.

We might not know how to squat, okay? We might not know how to lunge or even push a car. I mean, those are things that people got to do, you know? So, these are movements that we're improving into this mid-strength period. So, a lot of people go through a variety of movements. And obviously, there is the concept of fear avoidance here. Like, people get scared. They say, I don't want to squat that deep. I don't want to deadlift. It feels like there's a little pull. Well, let's work into it, you know? Let's see what a safe load is for you. Do you have proper core stabilization? Do you have everything else working for you to decrease your risk?

If you don't, then you're being reckless, okay? I can't say that enough. Is that we need to have all of our ducks in a row before we actually start to test these muscles. And that's kind of back on that same thing where I was being a little reckless where I just decided I'm going to sit and eat Cheetos and wait until Sunday. And then I'm going to play. No, I should have been doing a ton of stuff to condition this thing. And I have to think about this stuff every single time I have an injury. And it usually takes me a couple days. Sometimes it takes me going to somebody else. I actually, funny, I actually, when we did that back injury month in December, my first post was how I defeated back pain.

And then, funny, before it actually aired, I had a little bit of back pain. And it was the first back pain that I've actually had in a long time. More than like, you know, maybe a day or so or just tenderness or something like that. So, at that point, I was thinking, holy shit, what is this thing? You know, like, am I flexion intolerant, am I extension intolerant? Like, am I going through all the checklists that I typically do with patients? Am I writing down the things that hurt, the things that don't hurt, how to sleep? You know, what movements can I do safely? You know, should I stop exercising?

Should I keep exercising? What should I do? You know, and I wasn't doing any of that stuff. And this is the stuff that sometimes needs to be balanced. Sorry. Excuse me. They need to be balanced off somebody else, which I did, which is extremely helpful. And sometimes it's even that productive to have someone look at your case and say, look, this is going to be fine. Okay. A lot of people have had this. I've had this. It gets better. Do the work. Like the work that you do. Do the, like the rehab that you do. And educate yourself about your injury. And write on a whiteboard if it takes it. Get some of that.

Like, I have some of this stuff. I have some of this chalkboard that it sticks right on the wall or on the glass or on a mirror at the office. And I write stuff on there. Okay. I have one in the private room where I'm doing podcasting right now, the podcasting room, that gives me my podcasting goals. Okay. So get some of that. Write it up. Write all the things that you should be doing every day. And get an accountability partner. I can't say that enough. I guess there's a lot of things I can't say enough. But we actually have now, when people come into my facility, I actually tell them, like, what the biggest barrier for someone getting better, hamstring injuries or any injury, is accountability.

Okay. I can give them all the videos for free. I can tell them exactly which ones I want them to do and educate them about their injury. But until they actually want to do it and actually do it, they're not going to get better. And so what I have them do now is I have them, there's a couple things they have to do. They have to tell someone what their injury is, tell them what types of rehab, exactly which exercise they're supposed to be doing, and they're supposed to agree to give the partner $5 every day they don't do it. Okay. And the reason I do this is because I want someone to have skin in the game.

Okay. People didn't get this way in accident. You know, for most injuries, not traumatic. Most injuries are overuse-based. Or actually, I don't want to say overuse-based. It's mechanical-based. Like, we had poor mechanics. It happened. It happened over time. Just kind of like the housing crisis back in, was it, 2018 or in 2008? Where the stock market, like, dropped down. It went way down. You know, it was not, it did happen overnight or a couple days, but all of the, everything was in place for it to happen. The signs were there. They made a whole movie about it. It was the big short, wasn't it?

So the same thing happens with injuries as well. Do the homework, and that's the most important part. Now back into, I guess I should, you know, talk about the mid-strength period again. So I typically have people do their rehab if it's not too extensive. If it's not something that's like heavy squats or deadlifts or things of that nature, I typically have them do, like, say, core work or suitcase carries or pal-off press. I have them do this type of stuff about four days a week. And it might sound like a lot, but realistically, I think I'm underestimating the things they need to do. I mean, I could tell them seven, they'll probably do it four.

Squatting, though, they might do it twice a week. An exercise which you probably all have heard of now, if you've watched, if you looked at Runner's World and looked up other injury sites for hamstrings, as you've seen the Nordic hamstring exercise, that one's supposed to be only two to three days a week. And three is a lot because that is a very hard exercise, extremely hard, extremely hard exercise. And even that is something that is hard for people to do because they need a partner, okay? So, during this mid-strength period, like, I found it extremely useful to have people work on deep tissue-wise the spot.

And the type of deep tissue work that I do, active release or ART, is what I chose to get. And I was actually, during the time, like, I was doing an expo. We were doing an expo at an Ironman event at the time. So, there was a lot of other providers around me. And I said, hey, look, man, like, I'm going to be here for three days. Can you treat me today and the last day? And I would love for you to get right on that spot. And the funny thing, here's the funny thing with one of the guys. We're like, we're good friends. And we're sort of just shooting the shit on it. I mean, I guess he was because I was hurting pretty bad.

So, he dug his thumb into there, and he was working on it for about 10 minutes. And he said, at the end, he said, did I get the spot? And I said, no, you missed it the whole time. And finally, when we just kind of stuck our thumb a little bit around the hamstring and just pulled up around it, because a lot of hamstring injuries seem to happen on the inner part, which is not just on the outside. It's just more towards the center of the body or the center of the thigh. Then he finally lit me up. And even spending less than five minutes on that was extremely helpful. I was able to move better. My pain was decreased.

I felt like I could do my rehab better. So, there was a lot of benefit to that. But what my takeaway message was on that is that the quality of a person that you see is extremely important, okay? Now, what I do with hamstring injuries now is I fish around in there a little bit. I don't just start digging. And I tell the person, look, this is a two-way street here. You know exactly where you feel that little nub at. I can feel part of it, but at the same time, this is a big area. And I'm going through a lot of skin, a lot of fat, and in and around a muscle to try to find it. Now, obviously, the stuff on the very front side of the muscle, you can't really get, okay?

And that is the bummer with the body is that some of it's guarded by other tissues, okay? I can say we can go through the muscle, but realistically, it's better if you just sit around on top of it. That's why I love working on some of the Achilles, is you can almost reach around the whole darn thing. But it's a two-way street on it, and I tell them, look, man, like we have to find the exact spot. I'm going to fish around until we exactly find it. If we can't find it, maybe this is something else, you know? Maybe this is a radiculopathy or a pinched nerve. What's the slang term of it? Does your back hurt too?

Well, a little bit, yeah. Do you have any numbness in the foot? Yeah, I do. Well, maybe this is a nerve-related condition. Maybe this is a back-related condition. Maybe it's not even a muscle-related condition, okay? A lot of times when you have the actual scar tissue, your provider can find it with you, okay? And like I said, I'm not saying you have to go to someone who does active release. I learned a lot by going through the seminars there, and I tend to think I'm pretty good at finding stuff. And a lot of people I know who do the same thing are pretty good at it as well. Other people choose to use tool-assisted types of deep tissue work.

ASTEM is one of them. Grassen is one of them. But now that I think Grassen lost their trademark, which brought to the attention a lot of other tools. But still, I think how to use the tools are important. So you've got to find someone who's actually gone through courses to learn that as well. Now, the last one is phase five, which is the late strength period. And this is past 10 weeks, roughly, and all the way to a year. And you're going to notice when you talk to people with hamstring injuries, even if they're rehabbing it well, they still kind of feel it for months and months after and sometimes a year.

And the healing does take a lot of time. And this, the focus of this phase is really to re-educate your body in movements, okay? It's not always to throw load upon it. So if you move poorly, then you need to improve the way you move first and then start to increase load and speed, okay? An example is jumping and sprinting. If I still have this, but I don't have any pain, I need to re-get this and then start increasing speed, okay? We need to improve and just realize that our body is a compensating, adapting machine. It just does it. It knows for the past, apparently, if we're in a late strength period or phase five, we're into eight weeks or, sorry, 10 weeks in or more.

So we've had that long to develop the bad habits. So I think it's a good idea still to incorporate deep tissue work, I think, on a weekly basis. And, you know, I have people come in one time a week for it a lot of times. Two times a week, it does help. Three times, borderline, you're bruising them. So I've only had a couple people over the years come three times a week, and I did try to discourage them because I feel like I was getting enough work in those first one or two days. But this is where your rehab really starts to look like a normal weight training session. And it's funny, when you walk into my office here, you'd see that we have Olympic bars, we have kettlebells, we have weightlifting platforms, we have TRX, we have rowing machines, we have a lot of stuff.

And when people come in the first time, and actually, I remember this one guy, he came in on a Saturday, and I was rehabbing somebody. And he walked in, and he thought it was a gym. And then he walked out, and he walked in. And he said, I don't think I'm in the right place. I'm like, what are you looking for? You know, and he was a first-time patient. And he's like, well, I'm looking for a performance place. And I'm like, well, you're here. And he's like, no, I think I'm in the wrong place. He left and never came back. Who knows why? But either way, it starts looking like typical weight training.

But it's specific weight training. It's for a purpose. We're not looking for hypertrophy. We're not looking for muscle growth. We're looking for improving movements. We're then going to increase speed, increase load, increase functional capacity. If you did not listen to the podcast number 62, it is Gold, Gold by Dr. Richard Ulm. You should listen to that one. So that's podcast pound or hashtag 62, and you'll see it there. So that is the whole phase of healing there. And, you know, I think a lot of times what people run into first is uncertainty of knowing if they have the right diagnosis, okay?

So it's hard to know if you're going the right direction if you don't have the right diagnosis. And I can tell you, in all honesty, a lot of hamstring injuries, a lot of IT band ones that we see, quote unquote, are not actually that. A lot of times it's referred pain from something else. It could be a pinched nerve. It could be a SI joint dysfunction. It could be core stuff. There could be a lot of things that are not working that create referred pain. Think about a heart attack. No one ever chases the arm pain down the arm. They just realize your face is numb. Your arm is numb. It feels like there's an elephant on your chest on the left side.

I think we better take this person to the hospital so no one chases it. But the funny thing, when it goes into the leg, people tend to chase that thing down. So next, make sure you're taking enough rest, okay? Don't take too much, but take just enough, okay? So you've seen the healing times on this thing. You've seen the timelines. Know what you're supposed to be doing during the relative timelines. And if you don't know what to do or if you don't know if you're not really sure because you don't trust me and you don't know me, ask your healthcare provider. Go on to my article. Check out all the other resources and research that I have on this.

I put everything out there for you guys to really learn. And, you know, it's not that I'm trying to be cocky about any of this stuff. I just put it out there and I try to make these things the articles that I don't want to change again. They're the ones that I really want to be the classics, okay? I want people to keep coming back for years and years and years and realize that nothing changed yet and they keep learning more every time they come. And the last thing I see usually when people are not successful is they have not found the right healthcare provider for them. And just like every other profession, there's people who are great with geriatrics.

There's people who are good with post-concussion. There's other ones who are great with sports injuries. There's other ones who are really good at ankles, knees, hips, shoulders, and so on. You know, we can't all be the jack of all trades. So really find someone who understands your injury and understands your goals especially because if this was a hamstring injury on someone who just wanted to eat Cheetos the rest of their life, then that's fine. You know, like we don't have to put you through all the different phases of recovery. We can just tell you not to use it. You know, you'll probably be fine.

Shoot, we can put you in a wheelchair and you'll probably be fine as well. You might not be fine over the long term because your legs and hips and core won't be working anymore, but it'll get you to your short-term goals. So your goals are important to us, okay? So if you don't know who to find, just reach out to me. I don't have a provider list of people yet. I do have a couple people I like around different parts of the country who I think will do a great job. A lot of the people who are on my podcast as well. So if you look back and find their names and where they're at, if you like what they have to say, they probably know people around there too.

So we all kind of know people who practice like ourselves and realistically, I would not refer any concussion patients to me, okay? I'm not good at them. I don't like having them. I'm not really good at working with people who are extremely obese and it's not a job against them, but it's just there's different goals in place. And I like working with people who already have their goals in mind. They have ambitions to be athletic. They have ambitions to play weekend softball or distance running or sprinting or masters or any of this stuff because there is now a strong drive to get better. Installing that drive is a whole different thing and a lot of times we need someone to kind of psychologically go down the ropes of those to deal with those people and work with those people who need to set their life goals.

All right, I'm going to stop myself right there because that was a lot of content. So if you're looking for the show notes on this, you can go to p2sportscare.com slash podcast slash pound, whatever session number it is. And I think this is 68 here. So remember, you can get any of these show notes in that same exact fashion. I have all the URLs formatted the same. So any videos, studies, articles, references that I made, or if you're looking for links for people that I've had on, those are all on there as well. So if you haven't found it already, again, YouTube. YouTube is the thing this year.

Okay, so I'm going to put a video on every single day this year. Okay, I started at the beginning of the year. And since this is hamstring month, you're going to get a lot of hamstring stuff this month. So go ahead and go on there and subscribe. If you don't know how to find it, just go to my site, p2sportscare.slum. Whoa, whoa, whoa. I need to slow down here, huh? Slum. p2sportscare.com slash, or actually no slash, just going through I'm a patient. And then you'll see all these links. They will say, well, there's the YouTube channel. They'll shoot you all the way down the page there, and it'll put you right on the YouTube channel after you click through that button at the bottom.

All right, I'm trying to make this easy for you guys. So lastly, I want you to remember to be good to each other, all right? The golden rule, I believe in it. Yeah, that's an Eagle Scout thing, I think. Eagle Scout's honor, man. So just remember to leave everyone better than what you found them. It's not what you take, it's what you leave, and let's leave them all better. So I'll talk to you guys soon. I'll talk to you next week. Don't forget to check out those YouTube videos and share them with your friends.