Hamstring Strains- getting the rehab right.

 

Hamstring injuries are the most common non-contact injury in Rugby Union and the wider football codes. Unfortunately at the amateur level players often come back from injury too soon resulting in re-injury and further lost game time. Research shows that up to 1/3 of those who sustain an initial hamstring injury will re-injure it. Highest risk of recurrence is within the first 2 weeks of returning to sport. Our hamstring group is predisposed to injury due to several reasons. Firstly, two of the three muscles that make up the hamstrings cross two joints, the hip and knee, and secondly, the hamstring is subject to large forces in both directions as it has to lengthen and shorten under load while we run. It can also be affected by what is happening in the lumbar spine and pelvis. The biggest risk for hamstring injury is previous injury. 

 

 

A lot of factors need to be considered when assessing your hamstring injury.  Pelvic control, neural mobility, history of low back pain (disc bulges), weakness or loss of movement in other parts of the lower limb chain and hamstring strength all need to be considered. There is not a large correlation between hamstring flexibility and hamstring injury rates. Hence a rugby player who struggles to get his hands anywhere near the floor when he bends forward may play years of rugby with no hamstring injury. However there is a high correlation between hamstring injuries and hamstring weakness. If you have a weak hamstring it is likely that it will not tolerate the forces it is required to absorb when you are running and failure of some of the muscle fibres will occur. 

 

 

All factors that contribute to your risk of hamstring injury need to be addressed by your Physio on an individual basis. However unless this strength deficit is addressed you will have an elevated risk of re-injury. Increasing your hamstring strength, with a bias towards eccentric strength (lengthening the muscle under load) needs to be a key part of your rehab. Progression through a strengthening program that consists of exercises such as isometric hamstring bridges,  Romanian Deadlifts, Good Mornings, Arabesques and a graduated return to running program need to be considered. Your SquareOne Physio’s are experts in assessing the deficits that may be contributing to your hamstring problem and implementing a rehab program to address these. If you are having recurrent hamstring problems and play Rugby, or any other football code, then get an assessment and rehab program with your Physio. Similarly if you have suffered a hamstring injury in the past then a maintenance strength program completed once a week is essential to further reduce your risk of re-injury.

 

 

Lorenz and Reiman (2011). The Role and Implementation of Eccentric Training in Athletic Rehabilitation: Tendinopathy, Hamstring Strains and ACL reconstruction. The International Journal of Sports Physical Therapy; 6 (1): 27-44.

 

Opar, Williams and Shield (2012). Hamstring Strain Injuries-Factors that Lead to Injury and Re-Injury. Sports Med; 42 (3): 209-226.