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Injuries

Hamstring Strains

What is a hamstring strain?

• The hamstrings form the group of muscles at the back of the thigh
• A hamstring strain is caused by an over-stretch, tear or complete rupture of one or more of the three hamstring muscles (e.g. when sprinting from either a jog or a standstill position)
• Hamstring strains are common in sports that require explosive stop-start running motions (e.g. rugby, netball and athletic sprinting events).
• How do Hamstring Strains occur?
• Hamstring strains frequently occur at the beginning of a game/training session due to inadequate warm-up, or near the end of the game/training session when fatigue is a contributing factor
• Poor rehabilitation can leave inflexible scar tissue making it prone to re-injury
• Hamstring injuries often recur and can become long-term injuries if rehabilitation is inadequate or the progression of rehabilitation is too fast.

What Should You Do if a hamstring strain occurs?

Apply the RICED procedure...

RICED procedure
	REST
	•  Rest reduces further damage •  Avoid as much movement as possible to limit further injury •  Don't put any weight through the injured part of the body.
•
	ICE
	•  Ice cools the tissue and reduces pain, swelling and bleeding •  Place ice wrapped in a towel onto the injured area •  Apply ice immediately for 20 minutes, then for 20 minutes every two hours for the first 48 hours.
•
	COMPRESSION
	•  Compression helps to reduce bleeding and swelling •  Hold the ice pack firmly in place with a bandage •  Between ice treatments maintain bandage compression.
•
	ELEVATION
	•  Elevate the injured area to reduce bleeding and swelling •  Place the injured area on a pillow for comfort and support.
•
	DIAGNOSIS
	•  If the injury has not improved significantly within 48 hours, have the player assessed by a medical professional (e.g. a doctor or physiotherapist) •  An accurate diagnosis is essential for proper rehabilitation of moderate to severe injuries.

ALWAYS seek the advice of a medical professional for an accurate diagnosis.

What Rehabilitation Should Follow a hamstring strain?

The following recommendations serve as a guideline only.  Always seek the advice of a medical professional for a rehabilitation program specific to you and your injury.

Range of motion

• Restoring normal range of motion will allow proper function of the hamstrings.

• Stretching the hamstrings will help to restore the length of the muscles. This will reduce the risk of further injury and assist performance

• Initial stretching should be limited by pain. Longer stretches (10 to 20 seconds) held at positions of greater stretch should be performed as comfort permits

• A level of flexibility equal to or greater than the opposite leg is desirable before return to competition

• Continued stretching during the season will help to maintain flexibility.

Cardiovascular fitness

• Keeping fit will ensure a more comfortable return to training and competition

• Over-exertion or continued activity while fatigued could lead to
  further injury

• Non-weight-bearing activities such as swimming, cycling and arm ergometry (grinding) are good options at the beginning of rehabilitation.

Strength

• Strengthening the hamstrings and other lower limb muscles is essential
  to restore proper function in the lower limb

• Pay particular attention to developing a good strength balance between the quadriceps (front thigh muscles) and the hamstrings

• Strengthening of the gluteus maximus (buttocks) and gastrocnemius
  (long calf muscle) is also important

• Holding the leg in a fixed position for 10 to 20 seconds (isometric exercise) is safe until the wound is significantly healed and also prevents muscle wasting

• As improvements allow, active (self-movement) and functional strength exercises should follow

• Some strength exercises also need to be performed as the muscle lengthens (eccentric work) and/or at fast speeds to gain improvements

• Strength can be measured by contracting against resistance provided by another person. Ask them to make a comparison of strength between legs.

Psychological status

• Reduced confidence following a hamstring injury may prevent an athlete from attempting movements that will assist in full recovery (e.g. striding
  at full speed or accelerating rapidly while running)

• Gradually attempting more difficult agility tasks and setting realistic
  goals and time frames may help to rebuild sporting confidence

• Return to competition is not advised until an individual has 100% confidence in their playing ability.

Sport-specific rehabilitation

• Speed training is the most important part of sport-specific hamstring rehabilitation as hamstring injuries usually occur during sudden explosive accelerations

• Backwards running should be introduced between jogging and speed training

• Gradually increasing straight line (forward) running speed (e.g. from 1/2 to 3/4 to full pace) and then introducing curves and bends work will help the scar become accustomed to rapid and multi-directional stresses

• Adding rapid accelerations and decelerations, changes of direction (cutting at 45° and 90°) and jumping will also make the training more specific to sporting activity.

Ensure you are completely rehabilitated before returning to competition to minimize the risk of re-injury.

NOTE: This is an approximate guide only. Timeframes for rehabilitation and return to play may vary depending on the nature and severity of the injury. Always seek the advice of a medical professional for a rehabilitation program specific to you and your injury.

		POST-INJURY   •  Have swelling and pain settled? •  Is stretching pain free? YES	NO	CONTINUE RICED TREATMENT   If swelling and pain persist, consult a medical professional for further assessment and treatment
		BEGIN RANGE OF MOTION EXERCISES •  Gradually increase stretching •  Weight-bear as comfort permits BEGIN STRENGTH EXERCISES •  Isometric contractions

CAN YOU   •  Contract hamstrings against resistance without pain? YES

NO

CONTINUE TO IMPROVE STRENGTH AND MOVEMENT

PROGRESSION •  Maintain stretching •  Gradually increase weight then speed as pain allows - focus on lowering the weight •  Balance on one leg •  Wobbleboard

MAINTAIN FITNESS Pain-free stationary cycling, swimming, pool running. Full weight-bearing

CAN YOU   •  Contract hamstrings against resistance without pain? •  Achieve a full stretch? •  Balance on injured foot for an equal amount of time as the other foot? •  Demonstrate reasonable strength? YES

NO

CONTINUE TO IMPROVE STRENGTH AND MOVEMENT

BEGIN FUNCTIONAL EXERCISES •  Jogging when pain-free •  Acceleration/deceleration drills •  Jumping, hopping, twisting, figure of eight running

MAINTAIN FITNESS Jogging when pain-free, stationary cycling, swimming, pool running. Full weight-bearing

CAN YOU   •  Run forwards and backwards? •  Slow down and stop suddenly? •  Jump and hop? •  Run up and down hills? •  Cut to the left and right at speed? •  Complete all exercises with 100% confidence? YES

NO

CONTINUE TO IMPROVE AGILITY AND SPORT-SPECIFIC SKILLS

RETURN TO TRAINING

MAINTAIN Fitness, range of motion, strength, proprioception

How Can You Reduce The Risk of Re-injury?

ALWAYS seek the advice of a medical professional before returning to sport. Inadequate rehabilitation and a premature return to sport will increase the risk of re-injury.