How to Prevent and Recover from Acute Hamstring Injuries

Hamstring injuries are common with sports, particularly with sprinting (from 80% to 100% sprint effort), changing direction and movements that involve stretching the muscle such as kicking and tackling. With sprinting, often overload in training which can be increase speed, distance or fatigue can increase the risk of injury.

Studies have found that increase in load over a week, compared to loads that are built over 4 weeks are associated with a greater risk of hamstring. So it’s critical to have your training loads monitored and progressed appropriately to minimise the risk of hamstring injury.

Hamstrings are made up of 3 muscles: biceps femoris, semimembranosus and semitendinosus. Not all hamstring injuries are equal and some may take longer to recover than others. Hamstrings injuries can be divided into the muscle belly tears, tendon tears; or tendinopathy.

Research has found that slow stretch type injuries such as kicking ball, central tendon injuries, and injuries close to the pelvis ( where the hamstring attaches to the bone) take longer to recover. Biceps femoris injuries also have a higher recurrence rate.

Risk Factors for Hamstring Injuries

There are a number of risk factors for increasing the risk of an initial hamstring injury including:

• Previous injury – major knee injury i.e. ACL reconstruction, history of osteitis pubis
• Increasing age
• Ethnicity – Black African or Caribbean and Australian aboriginal
• Higher level of competition
• Later stages of football matches
• Hamstring muscle strength imbalance profile

Recurrent injury risk factors include:

• History of hamstring muscle injury
• Larger volume size of injury as measured on MRI
• Grade 1 injury

Timeframes for recovery are based on your presence of risk factors, the type of injury, age, load, previous strength and biomechanics. IT is important to have assessment and diagnosis done by your physiotherapist to determine timeframes of recovery for your individual injury.

Rehabilitation for Hamstring Injuries

Correctly rehabilitating your hamstring is essential to successful return to sport and minimising the risk of recurrent hamstring injury. Your rehabilitation program needs to be tailored to the type of injury, sport and previous strength and biomechanics. After an injury, pain can cause inhibition of your muscles, leading to decreased strength, particularly eccentric strength, which refers to strength when the hamstring is stretched or lengthened. There are a series of exercises and progressions that need to be prescribed by your physiotherapist to safely guide you through your rehab without risk of re-injury.

Progressive agility and trunk stabilisation, including a running technique programme improves neuromuscular control, which studies have shown to decrease the rate of re-injury. Your programme needs to include exercises and movements that are sport specific to mimic the load your hamstrings undergo during training and games.

Hamstring strengthening is key and is progressed based on resistance, volume, muscle length and velocity. There are a number of exercises available, we have videos of an example of hamstring exercises, but it is crucial you get a diagnosis and prescription of exercises based on your injury and risk factors.

Four common hamstring strengthening exercises are demonstrated in our Hamstring Rehab Series videos:

There are ways to decrease the risk of hamstring injury including:

• Adequate warm up
• Hamstring strength and conditioning, which takes time and effort
• Managing load appropriately
• Preparing your strength and load prior to your season of sport
• Avoiding large rapid increases in high speed running volumes.
• Trunk and agility training

References:

Duhig, S., Shield, A.J., Opar, D. et al. (2016) Effect of high-speed running on hamstring strain injury risk. Be J Sports Med, 50, 1536 – 40.

Brukner, P., Nealon, A., Morgan, C., et al. (2014) Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven – point programme. Br J Sports med, 48, 929-38.

Bourne, M.N., Opar, D.A., Williams, M.D. et al. (2015) Eccentric knee flexor strength and risk of hamstring injuries in rugby union a prospective study. Am J Sports Med, 43, 2663-70.

Petersen, K., Thorborg, K., Nielsen, M.B. et al. (2011). Preventative effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster – randomized controlled trail. Am J Sports Med, 39, 2296-303.

Brukner, P. (2015) Hamstring injuries: prevention and treatment – an update. Br J Sports Med. doi: 10.1136/bjsports-2014-094427

De Visser, H., Reijman, M., Heijboer, M. et al. (2012) Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med, 46, 124-130