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Yoenis Cespedes is coming back from a hamstring injury. Here’s what that recovery looks like.

Mets outfielder Yoenis Cespedes is recovering from one as we speak.

MLB: Atlanta Braves at New York Mets Noah K. Murray-USA TODAY Sports

Hamstring injuries are one of the more difficult injuries to recover from due to a high injury recurrence rate. Yoenis Cespedes has been limited since late April with a hamstring strain that ultimately placed him on the disabled list.

Strains, in general, are difficult to treat as treatment options are quite limited until the tissue has fully healed. Muscle tissue healing can be facilitated through manual therapy and other techniques that promote blood flow to the injured area. As the hamstrings are recovering, it is important that the core and other muscles of the lower body remain strong. This way, once the hamstrings are healed, the body is ready to start transitioning towards full baseball related activities.

What are the hamstrings and why is it important in baseball?

The hamstrings are a group of three muscles that act to flex the knee and extend the hip. The muscles start at the ischial tuberosity (bony part of your butt) and attach to the top of your tibia (shin bone).

When running or walking, the hamstrings functionally act to control how quickly the knee straightens and braces the body for impact as the foot approaches the ground. Once the foot hits the ground, the hamstrings then act to help extend the hip as the other leg swings forward and repeats the process. Clearly the hamstrings play a huge role and it is important that the athlete has sound running mechanics given the cyclical nature of running. When agility (quick change of direction) and speed come into the equation, more demand is placed on the hamstrings, thus further stressing the importance of appropriate running mechanics.

As demonstrated by Cespedes, the most common way (nearly two-thirds of all hamstrings strains!) to strain your hamstrings while playing baseball is running to first base. The reason for this is because as the player is running, he has to read the field while coordinating his steps on whether to run faster (to reach safely) or slow down (to prepare to round the base and head to second). This split-second decision may cause poor running mechanics, especially if the player hesitates on the decision. The player may reach out and try to take a huge step forward or start shuffling his feet as he approaches the base; either choice causes further stress on the hamstrings, increasing the chance of straining the muscles. The muscle group may not be prepared to move the way the player desires, often resulting in a strain.

Given the demand placed on the hamstrings while running, setbacks can easily occur and it is very important that the muscle has healed completely before initiating a return to a running program.

What is the recovery process?

The cause for hamstrings can be a result of several factors (poor posture, strength, flexibility, mechanics). Based on the findings of an exam, the physical therapist or athletic trainer can provide a treatment plan that can fix the impairments and hopefully prevent a re-injury. Some of the key characteristics for a successful rehab are to correct pelvic posture (it is often rotated forward), assure an appropriate strength balance between the quads and hamstrings, and focus on balance training (static and dynamics) before starting a running and baseball-related program.

At first, rehab will consist of manual therapy to facilitate tissue healing and working the hamstrings in pain-free range of motion. In addition, exercises will be prescribed to loosen any tight muscle and strengthen all of the other muscle groups in the legs and core. As the hamstrings get healthier, balance activities will begin and will be working towards standing on one leg on varying surfaces. Single-leg strength is crucial because running is a series of single leg bounds, thus serving as the focus of the next phase in recovery. To add difficulty, balance training will transition from static (staying in one place) to dynamic (having the ability to stabilize the body after moving). Once the athlete’s dynamic stability and single-leg strength has improved, a return to run program can be initiated as well as baseball-related activities.

According to a 2014 study, the average MLB player missed 24 days due to a hamstring strain and approximately 25% of these players were out for more than a month. In addition, about 20% of these players have had a hamstring strain before; interestingly, May had the highest incidence rate of hamstring strains.