Hamstring Injury Management And Physiotherapy

Hamstring Strain Season Is Upon Us

For many of our Sydney based weekend warriors we have just seen the conclusion of the winter sports season with finals occurring last weekend across many of the netball and football codes. Leading up to these finals series I am sure like ours there where many Sydney based physio clinics with “athletes” on the treatment tables getting some work done on their hamstring injury in an attempt to be right for these crunch matches. It is suggested that 70% of hamstring injuries in football players occur during high-speed running with the other 30% of hamstring strains being the result of other movements including activities involving high kicking, sliding tackles, split motions, twisting, turning, passing, jumping and overuse.
Following hamstring injury there are certain prognostic predictors providing important information regarding return to play time frames. Strains typically associated with a poor prognostic recovery include; suffering a stretching type hamstring injury where such a hamstring strain has been suggested to have on average a 84% longer return to play times than a sprinting type hamstring injury.
Other poor prognostic predictors were:

• Location of the peak pain point on palpation and swelling proximity. The closer this was to the hamsting origin your ischial tuberosity (often referred to as your “sit bones”) the longer the projected recovery times.
• Longer swelling length visualized on MRI also indicates likely a longer return to play time frame.

This information was taken from the British Journal Of Sport and Exercise Medicine (BJSM) October 2013 volume. Specifically, Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. Written by: C M Askling, M Tengvar, A Thorstensson.

Return To Play Time Frames After Hamstring Injury

Arguably the cause of hamstring injuries and any research findings on professional footballers can be paralleled to weekend warriors. However, it is worth noting that the elite or professional footballer eager to return to play as soon as possible, may well have greater resources available enabling better guidance and adherence to any treatment protocols and as a result this may potentially lead to shorter recovery times than an amateur athlete. However there is also the added motivation that this is their career and may involve higher internal and external pressures to return to play sooner than desirable. Therefore exact recovery time frames may vary one individual to another depending not only on their injury but on their individual situation, standing within the team, internal and external pressures as well as any medical and therapeutic resources available.

Clearly as with any injury, there are always individual variations in an athletes pre-injury status, injury severity and the persons ability to adhere to return to play protocols among other things… So as always there are a myriad of factors influencing final outcome. With this in mind the BJSM study and their hamstring injury protocol achieved a return to sport 45% (23 days) shorter than the conventional protocol used. Regardless whether you are a professional footballer or social sportsman athlete reducing the number of days lost through injury is something that would be a significant boost to both groups of athletes. This significant reduction in the number of days “out of action” achieved by this study through their specific treatment protocol ultimately relates to 2-3 fewer games lost through injury. In a weekend warriors season there are often only around 18 matches so getting to play an extra 2-3 matches can make a substantial difference to someones season and given the resources available to an amateur athlete to assist them in reaching match fitness the less games missed the easier it will be for them the return to that level.

Hamstring Loading In Lengthened Positions Is Key

The key characteristics specific to the BJSM protocol in this paper focused on loading the hamstrings during maximal dynamic lengthening, involving movements at both the hip and knee. The rehabilitation protocol follows other research papers previously suggesting rehabilitation of acute hamstring injuries should build on attaining eccentric loading at as long muscle lengths as possible. The assumption here was that the loading exercises should look to mirror particular situations that lead to injury.
Ultimately a rehabilitation protocol consisting of mainly lengthening type of exercises was found to be more effective than a conventional protocol in promoting return to play in acute hamstring injuries. Strength and flexibility exercises for the hamstring that primarily involve exercises with high loads at long muscle-tendon lengths is the most effective at reducing time to return to play following hamstring injury.

Hamstring Injury Respond Well To Appropriate Physiotherapy Treatment

Following a hamstring injury, regardless of the cause, be it playing football, or another sporting activity, it is always a good idea to book in to see a physiotherapist who has an interest in sports injuries. Being assessed regarding the severity of injury and projected return to sport time frames can help reduce set backs by returning to sport too soon. Furthermore having a physiotherapist help create a rehabilitation program for you will help you both return to play quicker, and reduce any likelihood of hamstring injury recurrence.

Disclaimer: This information is provided as an educational service and is not intended to serve as a substitute for personalized medical advice. Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned in this post. Anyone seeking specific advice, or assistance regarding “hamstring injury” should consult his, or her physiotherapist, orthopaedic surgeon, general practitioner, sports medicine specialist, or otherwise appropriately skilled medical practitioner.