Hamstring injuries account for approximately 50% of all muscular injuries in sprinters, and approximately 40% of all muscular injuries in soccer and rugby union. With the big games being held this year, it is likely we will be seeing a few hamstring injuries on the field and on the track as the athletes push themselves to their limits.
The hamstrings are a group of three muscles that are bi-articular (they cross two joints), so have a role in both knee flexion and hip extension. A hamstring injury is characterised by acute pain in the posterior thigh with disruption of the hamstring muscle fibres.
As physiotherapy practitioners, we will usually grade an injury depending on its severity.
- Grade 1: Damage to individual muscle fibres (less than 5% of fibres)
- Usually takes approximately 2-4 weeks to fully heal
- Grade 2: There is more extensive muscle damage, with more fibres involved, but there is not a complete rupture
- Usually takes approximately 3-6 weeks to heal
- Grade 3: This is full rupture of a muscle, can require surgery depending on the size of the rupture and individual external factors
- Can take anywhere from 3-6 months to recover
During sprinting, hamstring injuries will most likely occur at the end of the swing phase of the running cycle. At this time, the hamstring muscle is at its maximum stretch, and is experiencing a high force eccentric contraction in order to slow the knee extension and hip flexion that occur at this time. An eccentric contraction is an activation of the muscle while it is lengthening, and is thought to be a necessary component for a hamstring injury to occur – as we don’t see many hamstring injuries in concentrically based sports, such as swimming or cycling.
|Non-modifiable risk factors||Modifiable risk factors|
– Previous injury
|– Strength imbalances|
· Bilateral Asymmetry
· Hamstrings: Quadriceps ratio
Sometimes, no matter how careful we are, conditions combine and a hamstring injury occurs. The most important thing is to stop doing aggravating activities. But remember that this rest is relative, not absolute, and you should not stop all movement as that can delay healing. Every case is different, so it is important to consult with a health care professional in regards to the level of activity that you are capable of. Light resistance exercises, walking, and even light jogging can be beneficial to a hamstring strain in these early stages. Just remember to stay within tolerable levels otherwise more damage to the tissue can occur.
It is important to note that although we have grown up hearing that ice is the best thing for a muscular injury, this is not always the case. The inflammation that results from acute trauma to muscle fibres contains cells that promote healing of the tissue. By putting ice on the site of injury, blood flow is decreased, which in turn will decrease the inflammation and may delay the healing. Sometimes, ice may be beneficial to provide a bit of pain relief, but most of the time the body will know how much inflammation is needed.
It is important to start exercise early on in the rehabilitation process with some resistance. To start with, isometric exercises – muscle contraction without movement – are best. This allows the muscle to be stimulated with load, without forcing it through range of motion.
A good exercise to start is the static hamstring. To do this exercise, sit with your knee slightly bent, pull your heel toward your glutes, allowing the ground to stop the heel from actually moving. Hold the contraction for about 5 seconds at a time.
After a few days of this, you should be ready to move onto a double and then single leg bridge with approximately 5-10 second holds. As it continues to improve, make your leg straighter in the bridge to allow more load through the hamstring and less through the glutes.
Once you get past the acute phase of the injury, and the strength and function improves, exercise through movement can be introduced. To increase the strength of the hamstring muscle, most of the evidence points toward eccentric exercise. This is especially true for sprinters, as the most likely time for injury to occur would be during the eccentric phase of the hamstring contraction.
One of the most universally known eccentric hamstring exercises is the Nordic Hamstring drop. To perform this exercise, you will either need a partner or a solid object to hook your feet under. You will probably want to start with very low range and repetitions, it is unlikely to damage the muscle further, but it is a very taxing exercise and you may find yourself pulling up stiff for a few days!
Hamstring strains are a common injury involved in sprinting and high speed running sports. There are multiple factors that may predispose certain people towards this, some of them modifiable, and some of them not. If a hamstring injury does occur, the most important thing is to get the correct management plan in accordance to the severity of the strain guided by a skilled practitioner. If you currently have a problem with your hamstrings, or have had recurring problems in the past, be sure to come down to Absolute Health & Performance to get it checked out with one of our highly qualified practitioners!
Written by Physiotherapist Kristin Cameron | Absolute Health & Performance- Physiotherapy Services Melbourne CBD.