22nd January 20

Hamstring Injuries – Jonathan Wride ESP Physiotherapist

Last week in clinic an elite level sprinter visited me for advice on suspected
hamstring injury. This is a very common injury I see in footballers and track athletes so I will use this case study to discuss the best management for hamstring tears.

Where are the Hamstring muscles and why are they important?
The hamstrings are a highly complex system of large muscles positioned at the back of the thigh. There are actually 4 separate areas of the hamstring muscles as shown in diagram below.

They are very important for any sports that involve fast explosive sprinting
activities. The most important function of the hamstrings is actually to slow
down the leg as it is accelerates forward by the strong quadriceps muscles, not just bend the knee as commonly described in rehabilitation videos. This has very important implications when it comes to rehabilitation exercises as described later.

The most common scenario I see in clinic is the patient describes instant severe pain, often combined with an audible popping sound during a sprint movement. The most common areas to develop pain are one of 3 regions as shown by the arrows below:

What to do in the initial stages?
If there is a lot of bruising within 72 hours then it is advisable to get a scan on the injury in order to accurately diagnose the grade of tear and predict the likely time out of sport. Ultrasound scans are excellent for detecting muscle tears and can help predict return to play times.

Below is the image of a grade 2 hamstring tear as was seen in this case study.

Stage 1 (7-10 days):
The first 7 days are very important in order to recover optimally. The best
management if you suspect you have a hamstring muscle tear is to apply ice regularly along with a compression bandage around the area of pain. It is recommended to apply ice to the hamstring for 10-15 minutes 3-4 times a day (do not to apply ice directly to skin to avoid nasty ice burns!).

Or if you really want to nail it, we have a machine in the clinic known as a PhysioLab – this is what all professional athletes use when recovering from soft tissue injuries. It involves controlled temperature icing, with heavy compression. If in doubt, you can always give us a call and find out more!

Stage 2 (10-21 days):
Once the initial pain has settled and you can walk without a limp (the time for this varies depending on how severe the initial tear was) the rehabilitation exercises can begin.

All the exercises below must be pain free:

Exercise bikes and rowing machines can be a great way to keep up
cardiovascular fitness and general leg strength without putting too much stress on the hamstring muscles.

It is possible to start light slow jogging at this stage as long as pain free, but
certainly no moderate or high speed running.

Some pain free gentle active range of motion exercises for the hamstrings can also be useful. See video for an example exercise.


Stage 3 (21 days +):
If you can perform all the above exercises pain free and you have full range of movement during the hamstring stretch then it is time to start performing some eccentric strengthening. Eccentric muscle contractions are important, as this is the main way in which the hamstrings work during sprinting. Eccentric means slow and braking type muscle contractions as if you were lowering a weight slowly from a biceps curl for example.

Some examples of good eccentric exercises are linked below:

In the case example shown above I expect this elite sprinter to return to sport in 6-8 weeks. We will be closely monitoring the muscle recovery with ultrasound imaging to determine when it is safe to return to sport.

Avoid these common mistakes:
 Returning to sport without any eccentric hamstring muscle training. If
you have torn a hamstring muscle it needs to be strong whilst it is on a
stretch otherwise it will likely tear again.

 The biggest mistake I see with Hamstring injuries is athletes returning to
play TOO EARLY. When this happens they regularly re-tear an area that
was not yet fully healed. It is important to understand that the pain from a
hamstring muscle tear can settle much quicker than the actual tear can
fully heal, this means athletes feel better than they should and return to
play too early.

 Not getting the tear properly diagnosed. Muscle injuries can be effectively diagnosed and monitored with ultrasound scans and are much more cost effective than MRI scans. Ultrasound scans can also be used to determine when an athlete can safely return to play.

If you are struggling with a hamstring injury then it is advisable to get some
advice from a professional for the quickest recovery. If you would like some
advice then please get in contact to organise a scan or to discuss the best way forward.