Hamstring strains are common injuries in many popular sports, including football, rugby, track and field, and hockey. In football, hamstring strains make up 12% of all injuries, with an incidence rate averaging 5 injuries per club per season. Additionally, hamstring strains have the highest recurrence rate of any injury, 12% in football. These hamstring stains mainly occur during high speed running, more specifically the terminal swing phase (just before your front leg makes contact with the ground) and causes an immediate acute decline in function. The terminal swing phase of the running gait is the point in which the hamstrings are most highly eccentrically activated so the hamstrings must be strong enough to control this contraction to prevent any form of strain.
A hamstring strain typically results in an acute sudden onset of pain/tightness usually high on the hamstring which often is still able to walk on. Contraction and palpation can also produce pain when examining the area. Hamstring strains can be graded as shown below.
|Grade||Symptoms||Signs||Average time to return to sport|
|I||Sharp pain at time of activity, may be able to continue||A feeling of tightness and discomfort to continue.||10-14 days|
|II||Unable to continue activity||Pain on resisted contraction, stretch, and palpation. Bruising may be present after a few days.||21-28 days|
|III||Immediate sever pain at musculotendinous junction||Tear is palpable||6 month after surgery|
Treatment & Rehabilitation
Initial treatment of hamstring strains aim to reduce pain and swelling. Treatment usually consists of RICE, TENS, pain killers, and early pain free muscle contractions. Although RICE is the recommended initial approach, recent research in cell therapy and tissue engineering shows an additional role for controlled and monitored exercise regimens. Muscle contraction promotes angiogenesis (formation of new blood vessels and the expansion of existing vascularity) and in doing so increases the likelihood of delivering muscle-derived stem cells to the injured region. These muscle contractions can commence immediately and can be performed 3-4 times per day.
Following the initially stages of treatment, daily stretching can be commenced alongside regular soft tissue treatment including: lumbar mobilisations, neural mobilisations, gluteal and hamstring trigger point therapy and deep frictions to encourage correct scar tissue formation. This can be accompanied by strengthening of hamstrings, glutes and quadriceps. This is an essential component of the rehabilitation and prevention of further hamstring injuries. Strengthening should emphasise eccentric exercises and control as they provide the best outcomes for reduced re-injury rates. Nordic drops are seen as the gold standard exercise for eccentric hamstring strengthening but other specific hamstring exercises can be found on one of my previous blogs (refer to News page).
Early commencement of a progressive running program is an important part of the rehabilitation program following a hamstring strain. Once the following criteria are met, the rehabilitation can progress to the return to competition phase.
It is extremely difficult to decide when the sports person is ready to return to sport after hamstring strain. This difficulty may be the reason that there is a conspicuously high injury recurrence rate, particularly within a few weeks after the return. A practical tip to reduce the incidence of recurrence is to restrict game time when first returning from hamstring strain to minimise fatigue. In this way, return to sport can be progressed.
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