The problem hamstring
Hamstring strains can be more difficult to manage than other muscle strains as they have a high recurrence rate and a number of different contributing factors. Don’t let this worry you though, as there are effective rehabilitation strategies that minimise the risk of re-injury and facilitate a safe return to sport.
How do hamstring strains occur?
It’s a common misconception that hamstring strains occur due to the muscle being overstretched, however most hamstring strains occur during maximal sprinting at the end of the swing phase (when the swinging leg begins to slow down before the foot touches the ground).
Returning to sport safely and minimising the risk of re-injury
- Hamstring strengthening
After a hamstring strain it is very important to rebuild strength in the injured muscle. Eccentric exercise has been shown to be the best way to rebuild hamstring strength in a way that helps prevent re-injury. This can be done using the Nordic curl exercise as shown in the images below. There should always be at least one day of rest between performing these exercises and they should be continued even after you’ve returned to sport.
- Core stability
Improving stability of the pelvis and lumbar spine is also a very important part of the rehabilitation process and involves strengthening muscles such as gluteus medius and transversus abdominus. This includes exercises such as the single leg bridge catch and single leg squats.
- Progressive running program
Gradually building your speed, stride length and distance is important in returning from injury. A progressive running program is the best way to safely return to running and should start as early as day two post injury, if possible. Initially, running should involve slow-medium paced jogging from 500m to 2km, then progress to interval running over 100m when able. Once athletes have the ability to accelerate and decelerate fairly well they can sport specific tasks such as jumping, direction changes and kicking.
- Don’t go back too soon
Time taken to return to sport depends on the severity of injury and level of rehabilitation. Athletes with a mild strain can take 2-3 weeks, moderate strains can take 4-8 weeks and a complete rupture may require surgery, in which case rehabilitation can take three months.
To ensure athletes don’t return to sport too soon it can be useful to use a checklist of required tasks that must be completed before returning to sport such as the following:
- Completion of a progressive running program
- Full range of motion
- Near full strength (at least 90% compared to other side)
- Pain free maximal contraction
- Successfully completing a full week of training at full intensity