The seasons of hockey and football are upon us. But whether your sport is hockey, football, basketball, soccer or rugby, you are more susceptible to getting a hamstring strain from these sports. Hamstring strains are the most common type of sport injury and can keep you out of your sport for a long time if not treated appropriately.  Let’s break it down a little further:

What are your Hamstrings?

The hamstring muscle is a group of muscles (3) crossing two joints, your hip and knee, and is located at the back of your thigh. It originates from the lower back portion of your pelvis and attaches to the back of your tibia (shinbone). This muscle allows you to mainly bend your knee and extend your hip. Hamstrings play a key role in many functional movements such as walking, running and jumping.  During walking, the hamstring is responsible for decelerating the shinbone to control how much the knee straightens just before the foot strikes the ground. This places an eccentric load on the muscle.

What is a Hamstring Strain?

A strain is when the fibres in a muscle are over-lengthened and can result in a tear if severe. There are three different grades to diagnose the severity of the strain:

Grade 1 (overstretch) – micro tears in the muscle, mild pain, minimal loss of strength.
Grades 2 (partial tear) – 50% of the muscle fibres are torn, significant pain and moderate loss of strength.
Grade 3 (complete tear)– Complete tear of the muscle, significant loss of strength.

How do hamstring strains happen?

Typically, hamstring strains occur when an eccentric load is placed on the muscle. An eccentric load is when the muscle is lengthening while it is contracting instead of shortening. Hamstring strains can occur in either two ways: sprint or stretch related.

During sprinting, the hamstring works extra hard to decelerate the shinbone at higher speeds. As the foot is nearing the ground, it is at this point that the tear can occur. A strain can especially occur with a sudden stop while sprinting. Sprinting-related hamstring tears usually happen lower down the thigh, in the long head of the biceps femoris muscle, at the point where the muscle joins the tendon.

Stretch-related hamstring tears occur higher up at the back of the thigh in the tendon of the semimembranosus muscle. Stretch-related injuries can result when the hip is bent while the knee is extended, such as when a football player performs a long kick.

What are predisposing factors?

Factors that can increase your risk of a hamstring strain include:

• Poor low back posture; can cause the hamstring to be taught, therefore putting it at risk for injury with any extra stretch on the muscle during play
• Previous injury to the area
• Lack of flexibility
• Poor strength
• Poor warm up prior to engaging in sport
• Strength imbalance between the quadriceps (front thigh muscle) and hamstring

What does a Hamstring Strain Feel like?

A Hamstring strain can produce one or more of the following symptoms:

• Sudden pain in the back of your thigh
• Tender and painful to touch
• Bruising in the area
• An audible pop
• Difficult to walk or run after the onset of pain

If you experience these symptoms, your doctor may refer you to get an ultrasound or MRI to confirm the severity of the strain and ask you to see a Physiotherapist. At this point your Physiotherapist will perform a thorough assessment to help diagnose and treat your symptoms.

Treatment of a Hamstring Strain

In the acute stages of treatment, rest, ice, compression and elevation are recommended in order to control inflammation and provide a good environment for continued repair. After the acute stage, your rehabilitation program should include the following:

Early mobilisation

Early mobilization and weight bearing as tolerated improve scar tissue formation and help to reduce future stiffness.

Gentle stretches

Gentle stretches within pain free ranges encourage appropriate scar tissue formation and help to reduce pain.

Strengthening

Strengthening is important to avoid future injury. Beginning with isometric exercises and progressing to concentric muscle strengthening within pain free range of motion (ROM).

Eccentric training

Because forceful eccentric contractions are what caused the injury in the first place, Eccentric muscle training will be performed later in your rehabilitation once the muscle has healed. Beginning with a low volume (3-5 sets of 3 repetitions) and high frequency (3-4x per week) program. Eccentric training is vital in order to help the muscle fibres re-align properly and re-organize the pathways that control the muscle at such a high speed.

Sport-specific rehabilitation

Sport specific rehabilitation to return to play once pain free ROM and strength is attained. For example, a football player may begin by doing running and stopping exercises at short distances and slower speeds, gradually increasing as tolerated until matched with sport level. This type of training can also help with improving proprioception. Proprioception helps your muscles recognize how tense or stretched out it is, in order to respond appropriate to protect against any injury.

Maintain functional fitness

It is also important to maintain functional fitness throughout your entire program without aggravating the injury. Example: cycling, swimming and upper body weights. This will help you stay as conditioned as much as possible to get you back to your sport sooner.

When can I get back to play?

The question you most likely asked the second you were taken off the field, court or arena.
The information your physiotherapist obtains at the initial assessment can provide a good indication of the time till recovery. Typically, how you presented after injury is a good basis: studies have shown athletes who took more than 40 days had a pain score of more than 6, heard a popping sound injury, had pain during everyday activities for more than 3 days, bruising, and a loss of range of motion more than 15 degrees. The pain after injury and during every day activities was more strongly associated with time to recovery.

It is important that you do not push yourself too quickly. Depending on the severity of your strain, your bodies own healing factors and your compliance to your rehabilitation program will determine how long it takes for your injury to heal. Pushing yourself can result in re-injuring the muscle leading to further complications.

Your Physiotherapist will provide you with a sport-specific rehabilitation program and will clear you once you are ready to go back to play.

What can I do to prevent a Hamstring Strain?

Hamstring strains may be the most common sport injury, but just as there are a number of reasons that can make you susceptible to getting a hamstring strain, there are ways to prevent it from happening. These include:

• Adequate warm up of the muscle to ensure good circulation and activation of the muscle
• A gradual increase in intensity of no more than 10% per week in any given new activity or work out
• Adequate flexibility
• A sport-specific work out program to train your muscles for the demands placed on it

Remember, preventing a hamstring strain is much easier than healing one!

How can a Physiotherapist help?

If you have experienced any of the symptoms listed above or know that you have a hamstring strain, a Physiotherapist can assess you to determine the severity and prognosis of your injury. As well as collaboratively develop goals for your individualized treatment.

If you don't have a hamstring strain, but are a current athlete or looking to begin playing a sport, a Physiotherapist can assess you for any predisposing factors and get you on an individualized prehab training program to prevent a hamstring strain injury from happening.

Here at Family Physiotherapy, we take pride in providing optimal patient care through a comprehensive assessment and creating individualized treatment plans. Please do not hesitate to contact us if you have any questions or concerns or would like to book an appointment about a new or chronic injury preventing you from attaining your fitness goals.

References:
Comfort, P., & Abrahmson, E. (Eds.). (2010). Pathophysiology of Skeletal Muscle Injuries. In Sports Rehabilitation and Injury Prevention (pp. 73-75). Hoboken, NJ: John Wiley & Sons.

Guillodo, Y., Here-Dorignac, C., Thoribe, B., Madouas, G., Dauty, M., Tassery, F., & Saraux, A. (2014). Clinical Predictors of time to return to competition following hamstring injuries. Muscle Ligaments Tendons Journal, 4(3), pages 386-90.

Valle, X., Tol, J., Hamilton, B., Rodas, G., Malliaras, P., Malliaropoulos, N… Jardi, J. (2015). Hamstring Muscle Injuries, a Rehabilitation Protocol Purpose. Asian Journal of Sports Medicine, 6(4).