Hamstring injuries

Hamstring injuries are one of the most common sporting injuries, and are an injury which many people suffer reoccurrences from due to poor injury management. 

Anatomy 

 

The hamstrings comprise of three muscles:

  • Semitendinosus

  • Semimembranosus

  • Biceps Femoris

    • Short Head

    •  Long Head

Types of injury

 

There are two distinctly different types of hamstring injuries that can be distinguished by different mechanisms of injury – type I and type II strains.

 

Type 1 

Sprinting related hamstring injuryies - most likely to occur in the bicep femoris muscle. 

 

Type 2 

Stretch related injuries that are often seen in dancers or gymnasts.  These injuries may feel less intense to the athlete than a type 1 strain, but they may take longer to heal because of the location and type of injury to the muscle and tendon.  These injuries most likely occur in the semimembranosus muscle.
 

Risk factors 

  • Previous injury 

  • Age 

  • Height 

  • Ethnicity 

  • Flexibility 

  • Weight/BMI

  • Functional movement

  • Fascicle length 

  • Quads strength 

  • Hamstring eccentric strength 

  • Hamstring : Quads ratio 

  • Neuromuscular control 

 

What to do when you get injured? 

 

Show the injury some PEACE & LOVE

 

Protection – avoid activities & movements that increase pain during the first few days after injury. 

Elevation – Elevate the injured limb higher than the heart as often as possible. 

Avoid Anti-Inflammatories – Avoid taking anti-inflammatory medications as they reduce tissue healing. Avoid icing. 

Compression – Use elastic bandage or taping to reduce swelling.

Education – Your body knows best. Avoid unnecessary passive treatments and medical investigations, and let nature play its role. 

&

Load – Let the pain guide your gradual return to normal activities. Your body will tell you when it’s safe to increase load.

Optimism – Condition your brain for optimal recovery by being confident & positive.

Vascularisation – Choose pain-free cardiovascular activities to increase blood flow to repair tissues. 

Exercise – Restore mobility, strength & proprioception by adopting an active approach to recovery.

 

These are really good principles in managing your injury, however, it is vital you also see a physiotherapist for optimum injury management. The physio will complete an assessment & figure out where the source(s) of your pain are. 

Rehabilitation 

 

Hamstring rehab has gained a lot of attention in recent years among research, physiotherapy and strength and conditioning communities, Research on the best modes of exercise to rehabilitate the injury and indeed prevent it in the future is vital. 

 

It is best to adapt a multi-factorial criteria-based approach to rehabilitation, as we know that there is no singular reason why hamstring injuries occur. Factors such as muscle strength/capacity, muscle architecture, biomechanics and training load among others, can be involved. Therefore, rehab should address the most obvious contributory factor(s) to each individual case and whatever performance deficits the athlete is presented with.

 

Rehab principles 

 

All of the following must be addressed to insure a successful rehab:

  • Flexibility 

  • Glutes strength

  • Hamstring strength (Isometric, concentric, eccentric) 

  • Hip dominant 

  • Knee dominant 

  • Plyometrics

  • Ankle stabilisers

  • Lumbopelvic control 

  • Overall kinetic chain 

  • Running technique &sprinting 

 

Prevention, or should we say reduction? 

 

Hamstring injuries, or any injury, can’t be totally prevented, but we can reduce injury rates. The main area of research in hamstring injury around prevention has come with the Nordic hamstring curl. 

 

After an initial loading fortnight, research has showing that just 8 reps per week may be enough to act as a maintenance phase. This has been implemented most successfully through the FIFA 11+, which has shown up to 60% reduction in hamstring injuries. 

Hamstring injuries are very common in sports people and most likely always will be, but the number of incidents can be reduced by effective in-season warmups & training. Furthermore, the reoccurrence rate & rehabilitation time frame can be reduced by following a multi-factorial approach as discussed above. 

 

It is important to ensure that training load is effectively managed, and hamstring strengthening training and sprints is performed regularly. 

 The physiotherpistss at Active Motion Physiotherapy are equipped to complete an assessment, figure out where the source(s) of your pain are, and prescribe the correct treatment to manage your injury and pain.  Book your appointment today!

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