JF: TFL, Deep Hip ER, and Proximal Hamstring Pain in a Runner along with Neck Related Symptoms: Week 4

The report from this past week included some considerable progress along with some lingering symptoms in the R proximal hamstring and R butt cheek. I am going to include in BOLD some updates to your warm up sequence along with some progressions in your strength routines. Specifically, I want to make sure you are gradually increasing the load on glute and hamstring along with another self myofascial release option for the hamstring. Just keep in mind, with the strength circuits, the goal is to feel fatigue in the muscle belly. As you progressively load the hamstring try to stay just short of feeling it in the tendon attachment if possible.
Organization of the week should look something like the list below
- Monday: Daily Sequence + Circuit 1 and 2
- Tuesday: Daily sequence
- Wednesday: Daily Sequence + Circuits 3 and 4
- Thursday: Daily Sequence
- Friday: Daily Sequence + Circuits 1,2,3, and 4 but only one set of each instead of 2 sets
- Saturday and Sunday: Daily Sequence
Daily Sequence
- Try for one set of each movement 10-15reps
- This sequence is meant to be a warm up prior to running or simply a sequence to do end of the day or first thing in the morning
- It should not take long
- It should be attempted when you have pain to possibly reduce symptoms
  - Number One: Self Myofascial Release
    - I know you mentioned you have done some of this already
    - I encourage you to try some of the techniques below, you do not need to hit every point but try to establish areas tht feel significantly different on your problematic side as points to focus on
    - Self MFR Quad/Hip Flexor VIDEO
    - Side Lying IT Band VIDEO
    - Self MFR Ball Glute/Piriformis VIDEO
    - Self MFR Hamstring VIDEO NEW OPTION
  - Number Two
    - Shoulder Extension/Internal Rotation Bridge VIDEO
      - This combines shoulder mobility, quad stretch, light glute activation
      - 8-20 reps slow and controlled
  - Number Three
    - Deep Neck Flexor with Thoracic Extension Seated and Foam Roll VIDEO
      - Can be done seated or lying on a foam roll as depicted
      - In place of a foam roll, a yoga mat or thick towel roll will work
      - 8-20 reps
      - The chin tuck can be awkward, see video below for more instruction
        
        Deep Neck Flexor Activation Head Supported Chin Tuck VIDEO
  - Number Four
    - Cross Leg Contract Relax Posterior Hip VIDEO OR Cross Leg Contract Relax Seated VIDEO
    - The feeling has to be in the butt and not the groin or anterior hip
  - Number Five
    - Try this position as an alternate to the ones below
      - 1/2 Kneel Post Isometric with Hip Flexor Stretch VIDEO
    - Hip Extension Options: Choose one or both
      - 21) Band Resisted Hip Extension Mobilization VIDEO
      - 22) 1/2 Kneel Anterior Lunge Single Arm Overhead Reach VIDEO
Strength Circuits: 3 days a week we will start to build a strengthening routine
- Goal is 8-20 reps or 30-90sec for each movement
- Go through the 3 movements to fatigue in the parameters above
- Go through a second set but half as many reps for each movement as the first set, EXCEPT FOR FRIDAY YOU WILL DO ONE SET OF EACH BECAUSE YOU ARE DOING ALL 4 CIRCUITS
- NOTICE BELOW MANY MOVEMENTS WILL HAVE A PHASE 2 OPTION IF YOU FEEL THE PREVIOUS OPTION HAS BECOME TOO EASY…..ONLY IF THE PREVIOUS OPTION IS TOO EASY
- Do this for each circuit listed below
- Circuit#1
  - Quadruped with Physio Ball Hip Extension VIDEO
    - May progress to straight leg lift, hold each for 5 sec and then lower back to toe touching floor
    - 8-20 reps slow, each leg
    - PHASE 2 OPTION:
      - Quadruped Hip Extension progression VIDEO
        
        SAME MOVEMENT WITHOUT BALL
        
        CAN ADD ARM LIFT AS DISCUSSED IN VIDEO
        
        8-20 REPS
  - Basics of Pelvic Control Pre- Bear Position VIDEO
    - Incorporate this concept in the bear with the leg lift, holding each leg lift 5 sec, alternating legs, 30-90sec, video below
      - Basics of Bear with Leg Lift VIDEO
  - Step Knee Flexion Intro VIDEO
    - Exaggerates the running stride
    - Make sure foot on the ground is straight and you maintain some lower abdominal tension
    - 8-20reps each leg
- Circuit#2
  - Laying on Back Weight Pull Over and Band Pull Over VIDEO
    - Start with light weight and a slow and controlled movement over head
    - Stick with the lying down version with dumbbells
    - Start light 3-5lbs each hand
  - Hip Thrust Progression
    - Double Leg VIDEO
      - can have back on a weight bench or edge of couch instead of ball
      - PHASE 2: CAN PLACE A WEIGHT ON YOUR PELVIS TO ADD SOME RESISTANCE OR TRANSITION TO SINGLE LEG
        
        IF YOU GO TO SINGLE LEG YOU MAY WANT TO START WITH 5 SINGLE LEG ON EACH AND THEN THE NEXT 10-15 DOUBLE LEG
  - Sidelying Leg Raise Progression to a Stretch VIDEO
    - Pay attention to the details on this one
    - Don’t lift the leg too high
    - Even if you are on the floor, keep it to a small amount of motion
    - PHASE 2:
      - Side Step Band Progression VIDEO
        
        DO THIS SLOW WITH A LIGHT RESISTANCE BAND
        
        SHOULD FEEL THIS MORE SO IN THE WEIGHT BEARING LEG
        
        8-20REPS
- Circuit #3
  - Counter Push Phase 1 VIDEO
    - Try sticking with one side at a time
    - Slowly bring one knee up towards counter or hands against wall and then straighten leg behind
    - Goal 30sec-2 min
    - make sure you keep shoulders down and don’t tense your neck as your arms get tired
    - You may want to do one leg, then do the movement below, then come back to do the other leg so your arms get a break
    - PHASE 2:
      - Wall Bird Dog VIDEO
        
        30SEC – 2 MIN EACH SIDE
  - Double Leg Bridge Phase 3 VIDEO
    - This can be done with feet up on the edge of chair or couch if you don’t have a ball
    - If this causes pain at the top of the hamstring, straighten the knees more and it will be less stress on the hamstring
    - Don’t worry about going up too high
    - Goal is to feel tension in the hamstring but not pain
    - 8-20 reps slow
    - PHASE 2
      - Single Leg Bridge Phase 5 VIDEO
        
        MAY WANT TO TRY 5 REPS SINGLE LEG AND THE REST DOUBLE LEG TO START
  - Squat Pulses In Short Range VIDEO
    - May use a light band around the knees of there is knee pain or significant grinding around the knee
    - Stay in the deepest range possible and do small pulses for 30sec-2 minutes
    - This should be pretty challenging, but make sure you have no joint pain
- CIRCUIT #4
  - Band Horizontal Abduction VIDEO
    - I just noticed I do this partially wrong in the video, make sure the hand holding the band…that leg is back…so if the band is in your right hand…your left leg is in front and your right leg is back
    - Try to keep you base of support narrow enough that you feel a little off balance
    - make sure to keep back foot straight
    - 8-20reps
  - Reverse Lunge Towel Slide VIDEO
    - This one will load the hamstring and hip flexor into a stretch
    - Be careful not to go too deep into the motion too fast
    - 8-20reps
  - Pre Run/Walk Single Leg Balance Drill VIDEO
    - Emphasis on balance and stability when moving through the gait/running cycle
    - PHASE2:
      - Pre Run/Walk Band Resisted Stride Drill VIDEO
        
        same movement with a band on the ankle
        
        8-20 reps slow