Hamstring Strains: The Athletes’ Dreaded Curse
It’s been fantastic seeing team sport return in recent weeks after a forced hiatus. We as a nation, have been craving the team comradery, mateship and endorphin rush that watching and playing sport gives us. The thrill of watching your beloved team kick a winning goal or chase down an opponent at maximal speed, ready to lay that almighty tackle… And then suddenly, the athlete pulls up short, hand grabbing the back of the thigh.
The dreaded feeling of a hamstring twinge…
We have noticed an increasing trend in the past few weeks, especially in sports that require sprinting, change of direction and kicking (AFL, football, rugby). Some of the most athletic and powerful athletes have succumbed to the hamstring strain this season, proving no one is immune to it.
So, why do hamstring strains happen and what can we do about it? Let’s look at the facts.
WHAT IS A HAMSTRING STRAIN?
During activities such as running, sprinting and kicking, the hamstring muscles act as a brake to rapidly decelerate the forces produced at the extending knee and flexing hip. During this deceleration phase, the hamstrings experience high levels of muscular strain and stress.
As the leg is at the end of it’s swing phase (just before it strikes the ground), the hamstrings are at their most lengthened state, generating maximum tension at this point. This also applies to the last phase of kicking a ball (just before the foot makes contact with the ball).
Repeated stress to the muscle and tendon at it’s limits, sudden bursts and changes in high velocity forces can cause the disruption of muscle fibres, causing the muscle strain.
AM I AT RISK?
Age:
In the AFL, athletes over the age of 25 years are 4 times more likely to sustain a hamstring injury than those who are under the age of 20 years. Similarly, in community football, athletes who are over the age of 23 years are 4 times more likely to injure than those who are under 23 years of age.
Previous history of hamstring injury:
If you’re no stranger to a hamstring strain, then your chances of injuring it again are relatively high. Studies in soccer and AFL have shown a recurrence rate of injury of up to 34%!
Muscle weakness:
We know that “stronger is better”, but how do we put a number to this?Measuring devices such as hand held dynamometers can give a reasonably accurate number (kg of force), which allows us to measure the symmetry between both sides and calculate a hamstring to quadriceps ratio. During a season, the strengh gap between the quadriceps and hamstring will commonly widen. For return to sport, we aim for the injured hamstring to be at least 90% of the uninjured side and a hamstring to quadriceps ratio of above 80-85%.
Neuromuscular fatigue:
Ever felt delayed muscle soreness (DOMS) a couple of days after a heavy match? You feel like your legs are very heavy at the next training session and feel like you’ve lost your zip. This neuromuscular fatigue is the temporary loss in capacity to produce force and velocity in the muscle. Increased likelihood of hamstring injuries has been linked with neuromuscular fatigue. The good thing is, it’s only temporary and recovers with rest. So, give yourself a well deserved ligher session when you feel particularly sore and fatigued.
Missed or shortened pre-season:
Any athlete will experience higher intensities and workloads during competitive match-play compared with training sessions. Lower cumulative workloads (total distance run) in a pre-season phase is a strong predictor of injury risk during in-season in the AFL and rugby codes.
A pre-season with high workloads allows the athlete to develop a sufficient chronic training load foundation to protect her/him from injury in-season. The interrupted sporting seasons due to Covid-19 has forced a stop-start mini-preseason and this may be why we are seeing a spike in soft tissue injuries. Only time will tell…
HOW LONG WILL I BE OUT OF ACTION FOR?
Hamstring injuries account for a huge amount of missed games in AFL, soccer and rugby. Minor strains might see a 2-3 week recovery, whilst more severe tears can see an athlete missing more than 12 weeks!
Indicators of a longer time away from competition include:
Needing to be assisted walking off the field
Having an extended period of an abnormal walking pattern or limp (>48 hours)
Location of injury closer to or part of the tendons that attach to the sit bone or back of the knee (high or low hamstring injury)
We can predict the recovery time depending on your grade of injury:
Grade 1: 2-3 weeks
Grade 2: 4-8 weeks
Grade 3: 8-12+ weeks, some requiring surgery.
HOW DO I PREVENT THIS FROM HAPPENING (AGAIN)?
Correct diagnosis:
Firstly, make sure your injury is a hamstring strain. Pain at the back of the thigh can be caused by a few structures that require different rehabilitation pathways. An experienced physiotherapist can rule out complete tendon ruptures, referred pain, sciatica and tendinopathy.
Quality rehab that is specific to your sport:
Different sports require different movement patterns such as kicking, sprinting, bending down to pick up the ball, tackling and landing. It is important to load and strengthen the hamstring in varying positions and tension that is required by your sport. A detailed assessment may also highlight asymmetries and address other areas that may be contributing to your hamstring injuries.
Return to sport guidelines:
There are simple evidence based objective measures that an experienced physiotherapist can measure to facilitate your safe return to sport. Such measures include muscle strength, hamstring to quadriceps ratio, single leg hamstring bridge test (aim for >25reps), muscle length tests and sprint times.
Pre-season matters!
Make sure you complete a pre-season to develop your chronic workload foundation. If you’re strapped for time, aim for 2 sessions down at the park per week, making sure you include sprint training, kicking and ball skills. AFL athletes have been aiming for >125km distance run over their 3-month pre-season. Use this as a guide only and reduce loading during the competitive season.
Run, run, as fast as you can!
Sprint training is a very effective and time efficient exercise for hamstring strengthening and injury prevention. Certain drills and techniques can condition the hamstrings during training. Try a mixture of 10, 20 and 50 metre sprints with a sufficient warm up.
Strengthening program for prevention:
Strengthening and prevention programs are recommended 2-3 times weekly for their desired effect. Studies have shown certain prevention programs, when performed regularly, can reduce lower limb injuries by 50%! See our list of evidence-based injury prevention programs for your sport HERE.
We have put together these helpful hamstring strengthening exercises that utilise all parts of the hamstring muscle and are easy to implement into your routine. They increase in difficulty with each exercise and we recommend selecting a few that are moderately challenging for you.
References:
Marcus J. Colby, Brian Dawson, Jarryd Heasman, Brent Rogalski, Michael Rosenberg, Leanne Lester and Peter Peeling (2017): Preseason Workload Volume and High Risk Periods for Non-Contact Injury Across Multiple Australian Football League Seasons; National Strength and Conditioning Association
Steven J. Duhig (2017): Hamstring Strain Injury: Effects of High-Speed Running, Kicking and Concentric Versus Eccentric Strength Training on Injury Risk and Running Recovery; Queensland University of Technology (Thesis)
