It’s the season to be Hammy!
So it’s that time of the year again when the weekend warriors dust of the old football boots and get back onto the sporting field. Unfortunately for most of us, we have been a little bit too inactive over the festive season and lack a bit of conditioning. Enter the recipe for a hamstring strain!
Hamstring injuries are among the most common lower limb injuries in sports, accounting for up to 29% of all injuries in sport (Ahmad et al., 2013). Injuries to these muscles can result in prolonged impairment and an increased risk of re-injury of between 12-31 % (Ahmad, et al., 2013).
A little bit about the hamstring
The hamstring comprises of three muscles, the biceps femoris, semitendinosus, and semimembranosus. As a group, the hamstrings encompass both the hip and knee joint, and are responsible for both hip extension and knee flexion.
How does injury occur? Am I at risk and what are the symptoms?
There are two different types of acute hamstring strains (type I and II). Type I occurs in sports requiring high speed running, and type II occur during movements leading to excessive stretching of the hamstrings such as high kicking, front splits or a sliding tackle, type II strains are most commonly seen in gymnasts or ballet dancers (Brukner & Kahn, 2012).
There are 3 grades which represent the severity of hamstring strains/tears. They are:
· Grade 1- Small tear in muscle fibre causing generalised pain but no strength loss
· Grade 2- Significant tear to muscle fibres and associated pain and swelling
· Grade 3- Complete tear of the muscle
Risk factors (Ahmad, et al., 2013)
· Inadequate warm-up/training
· Poor muscle strength or muscle strength imbalance
· Poor lower limb flexibility
· Poor core stability
· Previous history of lower limb injuries
· Increasing age
Signs and symptoms (Brukner & Kahn, 2012)
· Moderate to severe pain and tenderness
· Difficulty walking or inability to walk
· Reduced flexibility
· Reduced strength
What can I do to prevent this?
Pre-season training is key!!! Yes that’s right, putting in the hard yards (or metres for the non-Americans) before the season kicks off can have a huge effect on reducing injury rates and preparing you for the season ahead.
Oh no I’ve pulled a hammy! What can I do?
The recovery of hamstring injuries is heavily dependent on the grading of the injury and how each individual responds to initial treatment. For instance, if you are able to jog pain free within 1-2 days following an injury, research shows that you may be able to return to sport within 2 weeks. However, a delay in returning to jogging can increase the timeframe to recovery (Brukner & Kahn, 2012).
First 48 hours of injury-
· RICE (rest, ice, compression, elevation)
· Short range pain free muscle contractions
Following 48 hours
Stretching is an important component in the recovery from hamstring strains. Research suggests that stretching the hamstring allows recovery times to be decreased, helps with restoring correct fibre alignment and decrease the risk of reinjuring the hamstrings (Brukner & Kahn, 2012).
Soft tissue massage
Following a hamstring injury the muscles can develop adhesions (i.e. scar tissue) which limit the functionality of the muscles. There is some evidence to suggest that soft tissue massage of both the hamstring and gluteal regions can assist with scar reorganisation, reduce reoccurring hamstring strains, and improve function (Brukner & Kahn, 2012).
Strengthening not only the hamstrings but the surrounding muscles is crucial in the prevention and rehabilitation of hamstring injuries (Brukner & Kahn, 2012). Evidence suggests that eccentric training (lengthening the muscle), such as Nordic drops are beneficial in preventing the recurrence of hamstring injuries and also aids in the realignment of muscle fibres that have been disorganised (Brukner & Kahn, 2012; Petersen, Thorborg, Nielsen, Budtz-Jørgensen, & Hölmich, 2011).
Once adequate strength is obtained, functional training is encouraged. This phase includes sprint technique, agility and sport specific training drills. Research shows that functional training such as a running program where a gradual increase in activity is implemented and monitored can assist in return to sport and decrease the reoccurrence of hamstring injuries (Brukner & Kahn, 2012)
Take home message
Be kind to your hamstrings and they will be kind to you. Stretching, strengthening and building the fitness foundation before you get back into sport can lead to improved physical function and decrease the risk of hamstring injury.
There are several sport specific injury prevention programs that we utilize at the clinic, depending on the sport you play. If you have any questions, or would like advice on which one is best for you, shoot us an email or give us a call.
When it comes to sorting your sports injuries, come in to see one of our highly skilled physiotherapists. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advice on the best course of action for your condition to get you back in action sooner than you could’ve imagined. We have an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. So give us a call on (02) 8411 2050 to get started on a journey to a better you.
Ahmad, C. S., Redler, L. H., Ciccotti, M. G., Maffulli, N., Longo, U. G., & Bradley, J. (2013). Evaluation and Management of Hamstring Injuries. The American Journal of Sports Medicine, 41(12), 2933-2947. doi: 10.1177/0363546513487063
Brukner, P., & Kahn, K. (2012). Clinical Sports Medicine (4th ed. ed.). North Ryde, N.S.W.: North Ryde, N.S.W. : McGraw-Hill Australia.
Petersen, J., Thorborg, K., Nielsen, M. B., Budtz-Jørgensen, E., & Hölmich, P. (2011). Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. The American Journal of Sports Medicine, 39(11), 2296. doi: 10.1177/0363546511419277