“Hamstring injuries account for 12–15% of the total injuries in different sports and mostly occur in high-speed running or activities requiring extremes in a range of motion. Moreover, the re-injury rate is 12–41% with the second hamstring injury usually more severe than the first, and the time away from sport generally twice as long” [1].
The hamstrings are the muscle group on the back of your thigh or upper leg; made up of the biceps femoris, semitendinosus and semimembranosus muscles.
Why did my hammy tear on the weekend? Risks for hamstring injury [1-3]
Decreased hamstring strength
Decreased hamstring flexibility
Imbalance between thigh muscles (Quadriceps vs Hamstrings ratio); imbalances left to right.
Previous hamstring, knee, ankle, and lower limb injuries
Fatigue
Age
How bad is it? how long until I can play again? [4]
Depending on the severity of the tear and grade differing characteristics of swelling, redness, tenderness on palpation, resting pain, bruising, restrictions in range, or weakness may occur.
Muscle strains are classified in 3 grades according to their severity (Grades 1,2,3):
(G1) Mild: a tear of a few muscle fibres; minor swelling and discomfort with no or only minimal loss of strength and restriction of the range of movements; pain/tenderness and or swelling may be delayed.
(G2) Moderate: greater damage of muscle with the tear affecting approximately half of the fibres in the muscle with a clear loss of strength; often associated with sharp acute pain, swelling, and bruising.
(G3) Severe: a tear extending across the whole muscle belly and complete rupture, resulting in a total loss of muscle function. This will cause significant pain, swelling and bruising.
Your recovery times will vary depending on the severity of grade and what level of function your rehabilitation and or return to sport will be required. Thus appropriate diagnosis and progression of your rehabilitation with your physiotherapist is important in return to sport timelines.
How do I rehab my injury?*
POLICE [see muscle tears/strains blog].
Massage to reduce swelling and muscle tension. To align and reduce scar tissue.
Restore range of motion/muscle flexibility
Isometric exercises/muscle activation
Concentric eccentric strengthening exercises; knee and hip dominant
Plyometric and sport specific exercises
Strapping
The Nordic hamstring curl exercise a magic preventative?
The Nordic hamstring exercise combined with sports-specific training in football players is shown to reduce both the incidence of hamstring injuries by 60% and recurrence rate or re-injury by 85%; following a 10-week program [5].
As mentioned, hamstring injuries frequently occur sprinting and high-speed efforts; thus making sure we’re training with high-speed efforts are just as important as a preventative. Make note, appropriate gradual progressions and avoiding large increases in high speed training volumes ensure your odds of hamstring strain or injury are reduced. Increased weekly sprint distances (90–120 m above 95% maximum effort) and 6–10 efforts per week in team-based running sports have been shown to have a protective effect on lower limb injuries [6,7].
*Assessment and diagnosis for each individual injury should always be conducted by your physio prior to developing a treatment plan with exercise prescription and appropriate progressions. Should you have any further questions or would like to discuss your hamstring injury with a physiotherapist, please contact Our Physio Central Coast (02) 4339 4475.
References
[1] De Visser, H. M., Reijman, M., Heijboer, M. P., & Bos, P. K. (2012). Risk factors of recurrent hamstring injuries: a systematic review. British Journal of sports medicine, 46(2), 124-130.
[2] Opar DA, Williams MD, Timmins RG, et al. Eccentric hamstring strength and hamstring injury risk
in Australian footballers. Med Sci Sports Exerc 2015;47:857–65.
[3] Clark, R. A. (2008). Hamstring injuries: risk assessment and injury prevention. Annals Academy of Medicine Singapore, 37(4), 341.
[4] Järvinen, T. A., Järvinen, T. L., Kääriäinen, M., Äärimaa, V., Vaittinen, S., Kalimo, H., & Järvinen, M. (2007). Muscle injuries: optimising recovery. Best practice & research Clinical rheumatology, 21(2), 317-331.
[5] Petersen J, Thorborg K, Nielsen MB, et al. Preventive effect of eccentric training on acute hamstring injuries in men's soccer: a cluster-randomized controlled trial. Am J Sports Med 2011;39:2296–303.
[6] Malone S, Roe M, Doran DA, et al. High chronic training loads and exposure to bouts of maximal velocity running reduce injury risk in elite Gaelic football. J Sci Med Sport 2017;20:250–4.]
[7] Oakley, A. J., Jennings, J., & Bishop, C. J. (2018). Holistic hamstring health: not just the Nordic hamstring
exercise. British journal of sports medicine, 52(13), 816-817.
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Joshua Cooper BExSc(Hons), MPhty P: (02) 43394475 F: (02) 43092350 www.ourphysiocentralcoast.com.au