Andrea: Long Overdue Update

This is a long overdue update on my progress from Surgery #2 back in September of 2014. The last time I posted here I was only 6 weeks out from surgery - now I'm nearly 4.5 months out! It's been a while, but I really didn't feel like posting anything until I had finally made some progress.

The roller coaster of rehab that I talked about last time - "(I feel like I am on a never-ending cycle: pain ("I'm never going to get better") - some relief / not too bad ("I'm getting better!") - aggravated / pain ("this is never going to end")... repeat X a million times)" continued on for over two months (~4 weeks post-op to ~3 months post-op).  I didn't see any improvement for a long time. This was incredibly frustrating and disheartening. Danny became as much of a psychologist as he was a physical therapist, the poor guy had to deal with my breakdowns every week for quite a while. I tried to keep positive, but my hopes were definitely dwindling.

The corner turned (a little) in December. The swelling in my abdomen finally went away and I felt good enough to walk for 30 minutes every day. I was also able to bike with Jake on some of his runs. The bilateral was still there, but much more manageable. After the holidays, I was able to increase my activity level: longer walks, longer bike rides, a little elliptical, backcountry skiing / SkiMo, strength training, and yoga.

Jake made me an awesome chart of all my different activities :)

Right now, I would say I'm at about 60% of full health. That is a good amount of improvement, but it is definitely taking a lot longer than anticipated to get totally back to normal. Dr. Meyers gave me a 6-week recovery plan... that was completely unrealistic. For someone that discovers their core injury immediately or has a minor injury, maybe 6 weeks is possible... but for someone like me that has been injured for 2.5 years - there's no way that time frame is realistic. I have set my own goal of 6 months to feel "almost-normal".

Currently, I don't have much (if any pain) during rest... maybe 2/10 on average. After exercise I feel some discomfort/pulling on the right side between my right adductor and abdominal scars, and left pubic/adductor pain + abdominal tightness. Recently, my left side has been the limiting factor on activity.

I still have a long way to go. I don't know if I will keep getting better from here or if I will have another stall-out period of no improvement (I hope not). Ideally you'll see another update from me soon because that will mean things are looking up :)

Andrea: Athletic Pubalgia Surgery Post-Op Rehab Weeks 0-2

I am now two weeks out from surgery. I spent the first six days in Philadelphia, working with a physical therapist (Nicole) at Vincera Rehab and checking in with Dr. Meyers. My dad was nice enough to take a few days off from work and keep me company, as I would have gone crazy from boredom without him.

I traveled back to Salt Lake City after six days, and the traveling day was hard on me. Over eight hours of sitting in an airplane is not easy after abdominal surgery! I had increased swelling and pain the following day, but it returned to previous levels after another day.

Throughout the second week, my pain level remained about the same, if not slightly increased. I have been consistent with my physical therapy exercises and walking prescribed by Nicole. I started seeing PT Danny at Canyon Sports Therapy in Salt Lake City, and he has been great so far - he even contacted Nicole to discuss my surgery and the appropriate rehab program for me.

At 11 days post-op I noticed an accumulation of fluid in the lower right abdominal area. Dr. Meyers told me it was called a seroma and was related to the extensiveness of the tissue dissection on that side. Jake and I call it my "pooch" - let's just say it does not make my stomach look attractive!

Other things to note: I went back to work after 7 days but limited my time there to only a few hours and worked from home the rest of the second week post-op. I also lost 3 lbs since surgery (good-bye muscle) and needed 10 hours of sleep at night plus a 2 hour nap during the day!

Here are the PT exercises that I have been doing -

250m walking
4x25m side steps
4x25m backward walking
2x10 bird dog – arms only, lead with thumb - then progress to both arms and legs
3x10 posture shoulder exercise (arms at right angle and rotate out) with 3s hold
3x10 clams with 5s hold
1x30 transverse abdominis isometric contraction with 5s hold
2x10 bent knee adductor squeeze with 5s hold
2x10 bent knee abduction against resistance with 5s hold
3x10 bridges with 5s hold - then progress with both a band around knees and ball b/w knees
1x5 extended leg lift and resisted adduction with 3s hold
1x30 back flexion and extension
3x10 side leg lift at 120 degrees (targeting glute medius) with 3s hold
250m walking
2x25m side steps
2x25m backward walking
Heat and ice several times a day
Massage starting at 10 days.

Icing after a round of morning PT exercises

I feel like I've gotten better and worse at the same time. The exercises are becoming easier for me, but I'm also having more pain than I anticipated after how well the first week went. I'm also an emotional rollercoaster - super optimistic one minute and then convinced that I'm never going to be pain-free the next. Jake really enjoys dealing with the mood swings on a daily basis! :)

Recovery and Rehabilitation from Athletic Pubalgia (Sports Hernia) Surgery - Part 3: 3 - 4.5 months

The two previous post-surgery recovery blogs are located here and here. At three months post-surgery I really started seeing some results. I spent most of August running about 30 miles per week and then was able to increase my mileage up to 40 mpw for the month of September. What a huge relief to be able to run regularly again!

Here is a general summary -

August: The first week of August I got roped into the Corporate Games 5K for work. The grass was significantly harder for me to run on than the road because of the uneven terrain and my weakness with lifting my leg.

Corporate Games 5K

Throughout the rest of the month, I increased my longer runs from 5 to 7.5 miles. I was able to run outside of a one mile radius of home since I was gaining confidence in my ability to run further without pain. I did get overly excited and tried to do a few faster workouts, but it was too soon. My physical therapy was similar to what it had been but with a few adjustments/modifications.

- Psoas inhibition
- Psoas activate then heel slide
- Step downs (2x more on right side)
- Lateral step up/step down
- Clam shells
- Hip abduction (while laying and side step monster walks)
- Hip adduction
- Glute activations

The second week of August, I started having a lot of upper abdominal cramping when running. It would slowly build until it was a very painful cramp and would remain until I finished running. I was told that this is common for people whose psoas muscle is not functioning, so there was still a lot of work to do there.

September: Over Labor Day weekend, some friends and I went to Silverton, CO for fun in the San Juans Mountains. I was able to do some long hikes and felt great. I even went on a 9 mile (hard) trail run up at Molas Pass!

Hiking Highland Mary Lakes Loop

I jumped into two races the next couple weekends - the Alta Peruvian 8K as a fun run and then the Flat as a Pancake 5K, which I ran in 19:13. This was a 2.5 minute improvement over Draper Days 8 weeks before - a great indication that I am in fact coming back. I began running one mini-workout and one longer run a week while keeping my mileage steady. I started getting some compensation in my IT band/hamstring so I really need to work on strengthening my hips more before I try to increase my workload any more. I found that going to the hot tub every day really reduces the amount of discomfort I had in my groin the following day.

I think this graph of my weekly running mileage pretty much sums up the level of activity I was able to handle since surgery on May 8th.

I definitely am not completely healed yet and have a few more months of limitations, but I can see the end of the tunnel now. I WILL GET BETTER! I can only hope that I have enough time to train and get fit enough to go after that Olympic Trials time standard in 2014-2015! :-)

Recovery and Rehabilitation from Athletic Pubalgia (Sports Hernia) Surgery - Part 2: Weeks 7 - 12

The first six weeks post-surgery blog is located here. The next six weeks were slow but steady improvement. I was still very limited by groin and compensating pain, but those became a little less overwhelming by the week. Here is a weekly recap -

Week 7: Started running a little more. I went to Duluth with Jake for the Half Marathon Champs and I needed to run. I would stop as soon as I started to hurt (usually 1 mile or so). Lots of compensation still, adductor soreness, and groin discomfort. But better! Same PT exercises.

Week 8: Added some biking and got up to 2.5 miles of running about every other day. The biking and running added some stress on my groin area, so I started doing PT on the alternate days from running. My groin and adductor got quite sore and my right knee felt slightly unstable but had to start somewhere!

Week 9: 4th of July week. We went up to Hebgen Lake, MT with some friends. I was having sporadic periods of feeling terrible then feeling great. I ran my first race - Sawtelle Stampede 5K. I paced my friend to a sub-25 and felt great for 2.5 miles (it's amazing what the racing atmosphere can do!) before my groin got weak and achy.

Week 10: My psoas hurts. I focused a lot on the psoas inhibition exercise and relaxation pose (see previous blog post). I was working really long hours and had a lot of stress which definitely contributed to the pain. I was able to run a little more than the previous week and got up to a 4 mile run this week. I went to PT and he added back extension exercises and more glute isolation exercises to my routine. 

Week 11: Starting to feel like I am really running again with several 4 milers. I ran my second race post-surgery as a test to see where I am. I ran 21:28 at the Draper Days 5K, and it was tough! I also went on my first hike since surgery and did well for 3.5 miles before my right leg got tired.

Week 12: We went up to Jackson, WY for the week. I didn't run much but was able to do a lot of hiking! It was a huge accomplishment to hike for 9.5 miles up to Ampitheatre Lake and back. I put my legs in the cold lakes as often as possible and iced with my feet up the rest of the time. It was very exciting have some fun adventures again.

Recovery and Rehabilitation from Athletic Pubalgia (Sports Hernia) Surgery - Part 1: Weeks 1-6

I am now 4 months out from athletic pubalgia surgery and feeling much, much better. I decided to summarize the progression for those that may have questions about the post-op of this surgery. Keep in mind that the healing time varies significantly depending on how long you have had the injury and how significant the injury was. I had problems for 8 months leading up to the surgery (and could not even walk without significant pain) and therefore my recovery has been pretty slow. In contrast, my friend Bret only had the injury for about a month and was running 4 miles without pain a mere 15 days after surgery (August 27, 2013). Jerk! :) I would bet that most people are somewhere in between Bret's recovery and mine. My surgeon said that my injury was the worst of this type he's ever seen in a female, and he's been doing these procedures for three decades.

Although there have been a few setbacks, I am making overall progress week to week. I'm not going to lie, the past few months have been very hard. BUT I do (finally) have confidence that there is an end to this injury!

I have been posting every day about my recovery on my Fast Running Blog if you want to see the daily ups and downs. On this site, I am breaking up the recovery into 3 blogs - First 6 weeks, 6 weeks - 12 weeks, and 3 months - 4 months.

Week 1: HARD. I had a difficult time just sitting up by myself because of the pain from the surgery. (Note: do not schedule a flight home the day after surgery). I began "walking" the day after surgery, starting with only 20 ft and progressing to about a half mile by the end of the week. There was a lot of hunching over and A LOT of laying around. I had discomfort with every movement and occasionally shooting pains from my groin to my back. I was only able to sleep for a couple hours at a time and with tons of pillows under my knees and ice packs.

Rock bottom - riding the scooter at the grocery store.

Week 2: Still in a lot of pain. I went off narcotics after a week, although I never felt like the drugs helped much. After moving around for a couple hours at a time, I had to lay down for several hours to recover. Overall pelvic pain dominated the week and ice was my savior. I walked every day and got up to a distance of 1 mile. I was only waking up 1-2 times a night needing a new ice pack.

Week 3: Definitely doing better. I was able to keep the pain in check after activity by laying for 30 minutes and letting the injury site relax. We traveled to Oregon for our friends' wedding and I was able to do some short walks to waterfalls along the Columbia River Gorge. The pool seemed to help with range of motion and loosening up muscles. Sleeping through the night now.

Week 4: Back to feeling pretty normal with daily living with just a general achy-ness. We got a cute, old foster dog for healing powers and a friend to walk with. I started walking for several miles every day and felt about the same as pre-surgery - groin discomfort, TFL and glute pain. Although I felt a little better, overall I couldn't tell if the surgery did anything yet. I started physical therapy with these exercises: 

- 5 min, 10s holds of light pelvic tilt 
- 3 x 15 glute activation - make sure glute fires first (http://goo.gl/jv4c84)
- 3 x 15 oblique cable exercisee 
- 1 x 10 core stability hip rotation (http://goo.gl/BnycHq)
- 1 x 10 straight leg raise 
- Pelvic adjustment

Week 5: Lots more walking. I was still struggling with compensation patterns but am able to walk several miles a day. I tried running for a couple minutes and it caused my adductor and groin to be sore the following day. Continued the routine of physical therapy and made some progress. Increased the number of sets on other PT exercises and added these exercises as well:

- 90 second hold of strain-counterstrain position of iliopsoas
- 1 x 10s psoas inhibition exercise (patient lies supine in hook lying and is instructed to dorsiflex at the ankle and push through their quadriceps as if to gently slide up the mat. The challenge is to contract the quadriceps without activating the hamstrings. If done correctly, the tibialis anterior and quadriceps are activated, while the hamstrings and psoas are inhibited)

Week 6: I incorporated a tiny bit of running into my walks. I could only run for a minute or two before my right leg ran out of power or my groin started to hurt. I am still very diligent about the PT exercises every day.

Andrea's Athletic Pubalgia Surgery

[Update: Please read Andrea's Athletic Pubalgia Surgery #2. I highly recommend NOT seeing Dr. Brown as his surgery was unsuccessful and resulted in more complications.]

This could potentially be a long post, so I'm going to try and keep it as concise as possible, and summarize some of the information Andrea has been posting on her training log. I'll link to more detailed information when possible, and as always - if you have more questions, we are happy to answer whatever we can.

As most readers of this blog know, Andrea has been injured for a long time - she's basically been on the sidelines since the end of July 2012. Some of her updates on Wasatch and Beyond since that time:

September 2012 - Injury Pains
November 2012 - Still on the sidelines...
January 2013 - Injury Update

She was hurt (with no diagnosis) and unable to run from September through November, then made a bit of progress in December and January (even ran a 5K race), but then in February/March things fell apart again. If you read through those blog posts, you'll see that she was one of the most pro-active patients ever: she saw several MDs/PTs, went through multiple courses of physical therapy, tried no running, Alter-G running, backwards running, cross training, no exercise at all, etc etc etc. It was frustrating to say the least, especially with no diagnosis and no relief from the pain. Andrea did everything right for 9 months and nothing seemed to help. By April, the amount of walking needed to complete basic tasks (like going to the grocery store) were difficult and put her in a lot of pain. I felt awful for her and just wanted nothing more than for her to have some consistent relief.

Finally at the end of April she flew down to Nashville TN to see Dr. Thomas Byrd, who is one of the top hip surgeons in the world. He did a thorough evaluation, another MRI (#3!), and was able to rule out FAI and/or a labral tear as the source of her pain. This was good news, as those are difficult surgeries to recover from. I should note that about a month earlier, a local surgeon (Dr. Hickman, who I wouldn't let put a band-aid on me) told her that she definitely had FAI and needed surgery right away. Its SCARY how WRONG he was. Lesson is: don't settle for the first opinion, especially that of a junior surgeon. Dr. Byrd's feeling that FAI could be ruled out was also backed up by several expert radiologists that Andrea sent her imaging to.

A week after her appointment with Dr. Byrd, Andrea and I found ourselves in Fremont, CA for a consultation with Dr. William Brown, a "sports hernia" specialist. Dr. Brown diagnosed Andrea with this condition, and she decided to have surgery the following morning.

The injury turned out to be pretty substantial. Here's the quick rundown of specifically what was wrong and the surgical fix:

• external oblique aponeurosis tear, about 2 inches long, was sutured back together. 
• internal oblique underneath that spot was damaged and about to tear, thicker portions of the muscle were sutured together across the compromised area. It had also separated from the conjoint tendon, and needed to be sutured back to that. 
• 2 branches off the iloinguinal nerve were frayed; these were cut off. 
• adductor longus was partially torn off the pubic bone and was attached to the adductor brevis in order to relieve some pressure from the pubic bone. 

He said it was the worst injury of this type he has ever seen in a female. He said something along the lines of "I dont know what in the world you did to cause this!" 

Andrea's daily log for May provides the day to day details of how all of this played out.

In one of her posts, Andrea explains a little more about this injury and process of diagnosis:

The injury I had is what is considered a "sports hernia" although it really isn't a "hernia" at all (somehow it got that name a name a long time ago because it occurs in roughly the same area as a regular hernia and happens to athletes). A better term to describe it is Athletic Pubalgia. Diagnosis is very difficult, because it basically occurs through process of elimination of all other groin/hip injuries. It is also rare (very rare in females), and a lot of doctors don't even know about it (for example, I had one surgeon in Utah tell me such an injury didn't even exist!). Matt Poulsen actually suggested this could be the problem all the way back in September, but he also knew it would take some trial and error to accurately reach this conclusion. He was right all along. Typically, people with this injury are encouraged to try several courses of physical therapy (along with ruling out FAI, labral tears, etc). I did all of those things and as you will see by the size of the tear, there was no way this was ever going to heal with PT or conservative treatment alone. The amount of surgeons who work with higher-level athletes and repair this injury can be counted on one hand. Dr. Brown was the closest to SLC and had excellent reviews; I'm very glad I chose him as my surgeon.

We have been very impressed with Dr. Brown throughout this entire process. In the weeks leading up to her appointment, he talked to Andrea several times on the phones and answered all of her e-mails quickly. In the first 48 hours after we left the surgery center, he called at least 6 times to check in on her. His concern was real, and we would both highly recommend him in the unfortunate case you ever have to deal with an injury like this.

Andrea is almost a week out from surgery at this point. She will post more about the recovery process (not easy!) in another post.

Now, I'm going to post some images from the surgery. Don't keep reading if you are squeamish or don't like seeing this kind of stuff...

This is the location of the injury, for reference:

This first photo is of the primary tear of the external oblique aponeurosis. The tear is 2-3 inches long and separated by a full thumb's width. The arrows show where the tissue should be attached. That entire area between the arrows is torn...

The second photo is another layer down, now looking at the internal oblique. This area wasn't torn, but the area outlined by the yellow box was very thin and barely being held together. It was at risk of tearing at any point. The internal oblique was also torn from the conjoint tendon (but we don't have a photo of that)...

The third photo is showing how Dr. Brown is pulling thicker/stronger portions of the internal oblique together over the thin/compromised area.

The fourth photo is Dr. Brown pulling the external oblique together (essentially attaching the ends separated by the yellow arrows in photo #1 back together)...

We don't have good photos of the adductor repair or the damaged nerves. Maybe that is a good thing!

Injury Update (Andrea)

Well, I FINALLY have some good news! After 4.5 months of injury terribleness, I'm making some progress. I've been able to run 20-25 miles per week for the past three weeks. I haven't posted until now because I wanted to make sure this wasn't just a fluke :)

What made the difference? Honestly, I don't know... it had to be a combination of things. After 12 days of no running and another round of steroids in the beginning of December, I was feeling as bad as ever. The time off from running was not helping at all. I was mentally drained from hours of therapy, stretching, icing, etc... with no results.

It was time to just try to run through it. Running got me injured so maybe that's what I need to get better. I found a clinic near my work called Performance Rehab Clinic that has an Alter-G Treadmill. These treadmills are becoming more and more popular in the rehabilitation world because they allow you to exercise at a decreased bodyweight (through differential air pressure). This reduces the impact and stress on lower extremity joints, muscles, tendons, etc. and enables patients to gradually retrain. I am now running on the Alter-G 2-3 times a week at 75-85% bodyweight. I am able to run at a decent pace without any pain. I've been able to accompany that with some miles outside now too.

Here is a short video of me running on the Alter-G...



In addition to the Alter-G, I am working with physical therapist Daniel Mills at the same clinic. He is focusing a lot on deep stretching and strengthening. After a few sessions with him, my glute pain was completely relieved. I left for Tennessee over Christmas break and that pain came back, so I know the pain is being relieved by the stretching that I cannot do on my own.

I've come to believe that all the pain in my hip, glutes, abdominals, and hamstring are because the muscles have become overactive and protective in nature and therefore are not performing their jobs correctly. My rehab is focused on re-training and re-educating the muscles to recruit in the proper amounts and in the proper sequence.

Whew...what a mess! I'm still struggling with some pain throughout the day, but it's gradually getting better. One step at a time. I'm very excited to be running for 20-30 minutes every day, and I'm very motivated to be smart and do this rehab the right way.

Still on the Sidelines...

This post was written by Andrea...

I hate injuries. Especially the ones that put me on the sidelines for 3 months... with no end in sight. Without having a specific diagnosis, it's really hard to know how to treat my current issues. The short rundown is that my right iliopsoas and glutes are irritated constantly and sometimes my distal hamstring and IT band hurt.

-I've had two MRIs and two X-Rays.
-I've seen three physical therapists, two massage therapists, and one orthopedic surgeon.

-I've tried no running, only cross training, minimal running, backwards running, pool running, walking, yoga, strength training, and strengthening exercises. 

-I've taken two regimens of oral steroids and had an nerve-block injection into my back. 

-I now own an E-Stim machine, inversion table, and all kinds of rolling devices.

The living room is a PT clinic

You would think that something would work or give me a better indication for how to make some progress. Maybe I'm just not doing all the different combinations in the right order. I don't know, but it's very frustrating! This is definitely the longest I have ever been out of running. And its not just the lack of running that makes this injury a bummer - I can't do most "fun" things that I can think of - hiking, backpacking, skiing, cycling, walking, rollerblading, etc. 

I know it's not the end of the world. It's merely an injury, not some life-threatening disease or anything (I hope, at least! Luckily I didn't get meningitis from the spinal injection.).

I am super thankful that I have a great life with awesome friends and family. I just wish I could do something with them besides eat! :) 

Hopefully, there will be a light at the end of the tunnel soon...

Injury Pains

This post was written by Andrea...
2012 seems to be my year of injuries. As if right on cue to the new year, I developed forefoot pain that bothered me from January until the beginning of March. I was able to train successfully from then until April, but then I re-aggravated a distal hamstring strain during an interval workout. I decided to train through it until the Half Marathon Championships in June. After that, I slowly ramped my training back up. I finally got my mileage back up... only to begin experiencing hip pain in July. I decided to take more time off..

...and here we are now - its September and I've hardly run in the past month. The hip pain got worse over the next six weeks. In that time, I tried ART, physical therapy, and a round of oral corticosteroids with no relief from the hip pain. Just last week, I got MRIs of both my hip and my spine. Results = inconclusive. A little displacement in a nerve in the spine area, a little unusual labral characteristics, but nothing that couldn't show up as a false positive on someone that was 100% healthy and asymptomatic as well.

One of the most frustrating things about an injury is not knowing: 1) the root cause of the pain, and 2) how to recover from/fix it. I was given the go-ahead to exercise again as long as it didn't cause the pain to get worse.

So this week I started running/cross training a little more. The hip pain actually seems to be getting better with exercise... but at a cost. The biceps femoris muscle of the hamstrings, from the distal attachment to the short head, is painful when I run. So the million dollar questions - are the two injuries related? Is one causing the other? Are the problems I am experiencing coming from a completely different source? Could all this be related to the chronic back pain I had up until May of this year?

It is so hard for me to be injured. I like to be as active as possible, whether it be running, hiking, skiing, cycling, etc. I'm trying to stay positive with all of this, but I NEED my exercise to keep me sane, to relieve stress, to clear my mind, and to feel like I've accomplished something every day.

I'm at the point now where I just want to be healthy again. Forget about training for a specific race, forget about high mileage and tempo runs. I would be perfectly content to get up every morning and go for an easy 30 minute run and be able to have fun adventures. For a while, at least :-)

Quick Fix for a Hamstring Strain

This post was written by Andrea:

During the last 5 weeks, I have had three episodes where my hamstring has "acted up". The first time was on September 13th during a 7 mile tempo at marathon pace. I felt a twinge on every foot strike for about 3 miles, and it seemed to help if I kicked my leg back to my butt. The twinge went away at mile 5 and I was able to finish the run with no problem. Only a little residual soreness the next day (nothing to be too concerned about, these things happen during marathon training). Two weeks later we had the OktoberFAST 5K and one mile in I could feel that twinge on foot strike again. It only lasted for a couple laps and then I was fine; followed by another day of residual soreness. The Long Beach Half Marathon was the last time it happened, but resulted in much more damage. I only felt the hamstring from miles 3-5, and it went away after that. However, I have felt the effects from that race for a week now and have concluded that I have a mild strain.

I went to a physical therapist to make sure that I'm doing everything I can to get this better before the marathon in 5 weeks. He emphasized several points. Between those and other ideas I have found via the internet, I came up with a list that seems to be working so far:

1. DO NOT STRETCH. It will irritate the muscle and delay the healing process.
2. Ice immediately after running to prevent swelling.
3. Heat the hamstring before a run to loosen it up.
4. WEAR COMPRESSION SHORTS OR SLEEVES. This prevents muscle vibration and jarring of the hamstring.
5. Do not overstride and try to land midfoot. The lower leg should be at a 90 degree angle when the foot hits the ground. This prevents extra stress on the hamstring to pull the leg back.
6. Strengthen the hips and core - specific exercises like side planks, resistance band hip abduction, etc.
7. MASSAGE. It definitely isn't pleasant, but helps a lot.
8. Do the Swiss ball hamstring curl to work muscle in full range of motion, but make sure there is no pain (Youtube Video).
9. Ibuprofen if necessary. 
10. Cross training. The bike, pool running, and elliptical put much less stress and can help get the aerobic exercise without any pounding.
11. NO HARD, FAST INTERVALS. Marathon pace running could be okay, but anything faster should be done with caution, if not completely avoided.

I have done all the items on this list for the past week. I can still feel a slight burning/aching sensation every once in a while, but the strain has definitely gotten better. I was even able to run 22 miles on Saturday without a problem (besides being tired, of course). I hope this advice can help others if they start to feel a hamstring injury developing.

[Update 8/8/2012]: I have come across several articles that have VERY valuable information that I would highly suggest looking through - 

Preventative Effect of Eccentric Training on Acute Hamstring Injuries. This hamstring exercise training protocol proved to be a huge success - 

"For the entire group of players, the hamstring injury rate for the training group was 3.8, compared to 13.1 for the control group (normalized values based on the number of players and length of each team’s season). That is a 71% decrease in the rate of injury using a simple program of Nordic hamstring training. For new injuries, eccentric training reduced the injury rate by more than 60%. For recurrent injuries, the rate was lowered by about 85%!" From here.

Preventative Exercise Progression for Hamstring Strain. This is a great program to follow for strengthening the hamstrings. I would incorporate the Nordic Hamstring exercises as well!

Does anyone have other suggestions for recovering from a hamstring injury? 


Luckily Andrea has skinny legs, and was able to use a "calf" compression sleeve on her thigh, worn under compression shorts, to keep her muscles warm and stabilized on our long run over the weekend. Thanks to the guys at Salt Lake Running Company for thinking of this trick.


Calf sleeve on the thigh for compression


And some unrelated pictures... ready to attack breakfast post-Long Run... the only problem w/ long runs is sometimes they actually take away your appetite for a few hours... we couldn't even finish half of our breakfast and ended up bringing most of it home!


And that pretty much sums up how a 22 miler at 6500 feet feels