Not All Hamstring Strains Are Equal

Hamstring Strains Are Most Frequently A Sprinting Injury

The winter sports season is upon us, meaning physiotherapists all around Melbourne will be dealing with athletes having suffered hamstring strains. AFL and soccer are sports with notoriously high numbers of hamstring strains the majority of which occur during high speed running.

70% of hamstring injuries in elite football players occur during high-speed running (sprinting) and the rest with stretching, sliding, twisting, turning, passing, jumping and overuse.

Predictors Of Poor Recovery With Hamstring Strains

Poor prognostic predictors regarding hamstring strains and athletes returning to play following hamstring injury (referring to hamstring injuries that are likely to take longer than average to recover) include:

• Suffering a stretching type injury such as reaching for a ball with an outstretched leg or bending to pick up a ball whilst on the move are injuries that have on average 84% longer return to play times than contraction injuries (contraction injuries referring to hamstring strains occurring during regular sprinting motions).
• The area where the peak point of pain is to touch on the back of the thigh. The closer to your sit bones (the ischial tuberosity) the peak pain point is felt the longer the recover times.
• Location of swelling. Similar to the location of peak pain, the closer any swelling present is to the ischial tuberosity the poorer the prognosis.
• Most weekend warriors will not require an MRI for an acute hamstring strain but another predictor of poor prognosis found was the length of swelling upon MRI. The longer the area of swelling visualized on imaging likely indicates a longer return to play time frame.
• These findings although relating to the professional footballer (soccer player) can arguably be applied to the weekend warrior. Notably the professional athlete may have both more resources and motivation to aid their return to play but these can be considered useful guidelines for the armature sportsman to help with estimating a safe return to play.

Return To Play In 23 Days

45% of athletes return to play in 23 days following sustaining a hamstring strain. Individuals variations will always exist and many variables come in to play such as pre injury status, adherence to any physiotherapy guided protocols… But it is nice to have a bench mark to aim for and the realization that with the majority of hamstring strains the sportsperson is likely to miss 2-3 matches based on having weekly games.

It is easy to see improving recovery times by just a few days could be the difference between missing only two matches verses three or more. In a short season every game missed through injury is significant so adherence to physiotherapy advice and protocols can help you play more matches during the season which is what being a weekend warrior is all about, getting out there and having a run.

Loading Over Stretching With Hamstring Strains

With hamstring strains rehabilitation programs based on exercises primarily involving high loads at long muscle-tendon lengths were found by Askling CM, et al to be the most effective at reducing the time to return to play.

The idea is that rehabilitation in a controlled graduated fashion should attempt to mirror the particular situation that lead to the injury. Where rehabilitation of acute hamstring injuries should build on attaining eccentric loading at long muscle lengths (the phase of contraction that occurs as the muscle lengthens is considered an eccentric contraction).

Eccentric loading and loading muscles towards their end of range can put strain on healthy tissue let alone muscle tissue recovering from injury so guidance with such rehabilitation techniques is crucial for successful outcomes.

Professionally Guided Management Makes The Difference

If you have sustained a hamstring strain having a physiotherapist assess your injury to help gauge a working return to play time frame and set up a rehabilitation protocol. Can help you return to play quicker and reduce the likelihood of any recurrence.

Reference: 2013 Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Askling CM, et al Br J Sports Med 2013.

Written by Hayden Latimer. Hayden’s practice is based in Sydney, he is the owner of Sydney Physio Clinic. Prior to opening https://www.sydneyphysioclinic.com.au/ Hayden has worked as a physiotherapist around the world for over 15 years.