Hamstring strains are the most common injury in soccer and football. Strains can range from a small tweak or pull, to a much more severe high grade tear.
Unfortunately smaller strains are often inadequately rehabilitated, with people often resting and returning to sport after that.
In clinic, we rarely see the small injuries, people often come to us for severe injuries or when there are recurring strains!
A small tweak can often lead to a large tear or ongoing issues, let me explain how!
The hamstring muscle group is made up of 4 muscles: the semimembranosus and semitendinosus are on the inside (medial) of the thigh. The biceps femoris long head and biceps femoris short head are on the outside (lateral) of the thigh.
The hamstring muscles have 2 roles. They bend the knee, and extend the hip (straighten the hip when it is bent).
The medial hamstring muscles have a stronger role in knee flexion, the lateral hamstrings have a stronger role in hip extension.
Almost all hamstring injuries from running are to the biceps femoris long head.
How Bad is My Hamstring Injury?
Hamstring strains are referred to many names: pull, tweak, niggle, strain, tear, torn, grab, spasm. When there is a disruption of the muscle fibres, this is a muscle strain. Strains can be small or severe. So all strains are tears, and all tears are strains - the terminology is interchangeable.
Hamstring strains range from grade 1 to grade 3, majority are grade 1-2
Grade 1 (mild) – a small number of torn hamstring muscle fibres, resulting in some pain, but allowing full function. These may feel like bad tigthness
Grade 2 (moderate) – a significant number of hamstring muscle fibres, with moderate loss of function. Walking may be sore.
Grade 3 (severe)– all muscle fibres are ruptured resulting in major loss of function
Will Stretching Help?
Believe it or not, stretching and hamstring flexibility have been shown to offer no benefits in hamstring injury occurrence.
An American study used hundreds of NCAA college athletes for an entire season. The researchers measured the sit and reach test of the athletes then followed the athletes forthe following season to see if lower back and hamstring flexibility correlated with hamstring injuries. Being more flexible did not decrease your chance of a hamstring strain!
Reference: (van Doormaal MC, van der Horst N, Backx FJ, Smits DW, Huisstede BM. No Relationship Between Hamstring Flexibility and Hamstring Injuries in Male Amateur Soccer Players: A Prospective Study. Am J Sports Med. 2017 Jan;45(1):121-126.)
So if you’re stretching or believe in flexibility it’s time to throw that out and try something else!
We often see patients who feel defeated with their hamstring injury. They feel dejected because they have recurrence and ongoing issues. They often feel their hamstring strains are due to old age and that there is nothing that can be done. Well that’s absolutely WRONG! There are heaps of things you can do to bulletproof your hamstrings!
When your pain has settled after the acute phase, there are 5 components of ongoing management to stop reinjury
Eccentric strength is when the muscle contracts whilst lengthening. Think of holding a heavy dumbell in a bicep curl, then lowering the weight by straightening your elbow.
Eccentric strength has been consistently shown to improve hamstring health and reduce future strain. Hamstrings that are eccentrically weaker have a higher chance of strain injury.
The Nordic Hamstring Curl is a supramaximal eccentric exercise. It is easy to do with a partner and significantly improves eccentric strength. Sports medicine research is showing low doses (2 sets of 4, once or twice a week) can be enough to maintain hamstring benefits.
A fascicle is a single unit of muscle fibre (thousands of fascicle bundles make up a muscle). Longer fascicles have a greater ability to absorb load, and have been proven to decrease hamstring strain risk
Fascicle length does not improve with stretching, it improves with a heavy eccentric exercise
Once again add the Noridc Hamstring Curl into your program as it can improve on Fascicle Length (2 sets of 4, once or twice a week)
Adequate Lower Limb Strength
If there is a deficit in the lower limb biomechanical chain, there will be extra stress on the hamstrings and increase your risk of injury. Rehab may involve improving the chain.
Previous calf strain, ACL, knee surgery and lower back injury have all been shown to be risk factors for hamstring strains.
High Speed Running Exposure
The hamstrings are a high speed muscle group. They are hardly used at a jogging pace (and do not even work that hard at moderate speeds), however they exponentially increase in their work rate during sprinting. In elite and professional sport, athletes will start jogging within the first 3 days to help rehab and stop deconditioning.
There is no gym and strength exercise that mimics the work rate of the hamstring during running, except for running! So if you are only in the gym for your rehab you will be not doing the best thing for your hamstring strain. You need to gradually exposure the hamstrings to sprinting so they get used to those demands.
5. Load Management
Avoid massive spikes in sprint and change of direction volume
If you have had a period off sport, you MUST gradually wean yourself back in. This means slowly building up your training and running intensity, frequency and duration.
1. Add the Nordic Hamstring Curl to your rehab (it improves eccentric strength and fascicle length, and is a quick and easy exercise to administer)
2. Add Sprinting/High Speed Running to your program, and continue to do this once a week.
3. Load Management - consistency is key!
The Nordic Hamstring Curl
How can we help you?
At Melbourne Sports Physiotherapy our goal is to get you moving pain free as soon as possible.
But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
If you are showing some signs of this condition or simply want help prevent this from happening in the future then book in with one of our highly experienced Remedial Massage Therapists today!