Hamstring strains are common in sprinters, hurdlers and long jumpers. Moreover, they make up approximately 12% of all English Premier League injuries, with an average of 5 per club per season, resulting in 15 matches and 90 days missed (Credit, Brukner and Khan).
But this injury affects more than just professional athletes. At Ultra Sports Clinic, we see hamstring injuries in people of all different ages from a variety of different sports. Many individuals report that it will be their 2nd, 3rd, 4th or even 5th strain they have had to their hamstring over the years. “Why does this keep happening to me?” they all ask. Well, it’s time we talked about managing your hamstring strain to make sure that this injury is your last.
Most hamstring injuries affect the biceps femoris muscle, most commonly in the musculotendinous junction. Studies have shown that you are most likely to strain your hamstring at terminal swing phase, just before your foot strikes the ground. This is because your hamstrings are maximally activated and are near maximal length.
Figure 1
If watching Mo Farrah effortlessly run 5km inspired you to take up running, and your first run around Hyde Park resulted in a sudden onset of sharp pain in the back of your thigh, Ultra Sports Clinic is here to help.
Step 1: Diagnose Properly
Did you know Ultra Sports Clinic has a Consultant Radiologist who specialises in Musculoskeletal imaging? Dr Rob Katz can Ultrasound your hamstring right here in the Ultra Sports Clinic without the need for referral. It is important to determine the cause of the pain, as other pathologies can cause symptoms in the back of the thigh, such as spinal pathologies. So make sure you call Ultra Sports Clinic as soon as possible to have your injury properly evaluated by a professional.
Step 2: Acute Management
For the first 48 hours post injury, your management should consist of:
RICE Principles
o Rest – Avoid aggravating activities
o Ice – 10 minutes every hour
o Compress – Use a bandage and wrap the thigh bottom to top (ie from knee towards hip)
o Elevate – Elevate leg as able, keeping in mind elevating the leg can stretch the hamstring. Elevate without causing further strain to the hamstring
Mobilize
o From a seated position, straighten the knee a pain-free amount. Best to do it after icing the hamstring.
o Work on this exercise for 5 minutes every hour
Step 3: Physiotherapy
The next step is to commence physiotherapy guided rehabilitation. After assessing the severity of your hamstring injury, an Ultra Sports Clinic physiotherapist will employ a number of evidence-based techniques to help you recover quicker. This may include: Massage to restore length to the hamstrings, releasing of gluteal trigger points and spinal mobilization.
Moreover, your physiotherapist may prescribe you an individualized home exercise program consisting of stretches and strengthening exercises. Stretches often target the hamstring as well as the antagonist muscles of quadriceps and iliopsoas.
The strength component consists of hamstring specific exercise (concentric and eccentric contraction) as well as strengthening of adjacent musculature with gluteals and the adductor magnus.
Step 4: Return to Sport
Your Ultra Sports Clinic physiotherapist and Ultra Sports Clinic sport rehabilitation specialist will work together to put together a progressive running program for you to safely allow you to return to activity. This will consist of runs of increasing distance, duration and speed to allow a graduated return to full running.
Once you have reached the appropriate milestones, such as completing the aforementioned running program and achieving 90-95% of eccentric strength of the uninjured leg, your physiotherapist will clear you for a return to sport.
Step 5: Injury Prevention
There are a number of factors that increase the likelihood of you sustaining a hamstring injury.
Intrinsic (personal factors):
Strength
o Decreased hamstring strength is a significant predictor of hamstring injury
Age
o 4x more likely to re-injury over the age of 23. Increase in age is met with reduction in muscle fibres and size which means there is a reduction in overall strength
Previous injury
o Previous injury results in a loss of strength meaning the hamstring is susceptible to re-injury
Race/Ethnicity
o Black athletes are significantly more at risk of sustaining a hamstring injury. Aboriginal Australian Rules Footballers were 11.2 times more likely to suffer a hamstring injury than non-Aboriginals. A study of the English Premier League (EPL) and League 2 suggests that this is not specific to any one nationality, but to all players of black racial background.
Flexibility
o Studies have shown a link between hamstring tightness and subsequent hamstring injury
Lumbopelvic stability
o Changes in the position of your pelvis can affect the length-tension relationship of muscles, such as the hamstring, which can increase the risk of injury
Joint dysfunction
o Degeneration of the spine can lead to decrease nerve innervation which reduces muscle strength
Extrinsic (Environmental) Factors:
Inadequate warm up
o Warm up increases the amount of force and length of stretch that the hamstrings can absorb.
Fatigue
o Fatigued muscles have less ability to absorb force which is why so many hamstring injuries happen late in the game.
Many of these factors can be improved with physiotherapy, chiropractic, sports massage and strength and conditioning training.
So call Ultra Sports Clinic today so we can make sure this hamstring injury is your last.
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