Hamstring Injury Prevention & Return to Sport

The hamstrings are utilised heavily in sports and even in our daily lives. Hamstring strength directly relates to an individual’s ability to jump, land, change direction, sprint and stop from sprinting as it generates a majority of the force and control needed. The hamstring muscles can also be responsible for protecting the knee and hip from a number of injuries such as knee ligament tears caused by muscle imbalances.

Anatomy of the Hamstrings

Why is it so important?

Footy season is just around the corner and starting up training again after a long break and getting deep into your routine may bring back old niggles or bring on some new ones. It’s essential to get on top of these early to keep you functioning at your best from the start of the season right through to the end, especially considering most hamstring injuries occur in the first few weeks of returning to sport.

Hamstring injuries are extremely common, accounting for about 12% of all football injuries in Australia. On top of this statistic, the likelihood of it becoming a recurring injury is over 30%. Therefore it is very important to get on top of your injuries and go through a complete rehab program to prevent you from being sidelined for longer than you need to be. 

Even if you’ve never had a hamstring issue or injury before, pre-season is the best time to get your hamstrings in top form and get yourself started on an injury prevention program to reduce the chance of injury and get you performing at your peak. Completing a bout of ‘prehab’ for your hamstrings is scientifically shown to decrease the rate of hamstring injuries by up to 70% as well as get you performing at a higher level on the field.

Am I at risk?

• Previous hamstring injury.

• Increasing age

• Sudden change in direction (acceleration or deceleration).

• Inadequate warm up

• Dehydration

• Muscle imbalances

• Lack of flexibility

Should I keep stretching my tight hamstrings? 

The feeling of hamstring tightness doesn't always mean that the hamstrings need to be stretched. In many cases, the tightness is a response to over-stretching and it is actually the body’s protective mechanism from further stretch/stress on the muscle.

Hamstring “awareness”, alternative to tightness, is used to indicate a feeling of less than an injury in the hamstring but can also feel like one is about to happen. This pain is generally referred from the lumbar spine and can often indicate an over stretch of the tissues around the area. Hamstring tightness and that feeling of hamstring awareness can have a negative effect on the way we walk, run, change direction, bend over and overall performance in sport.

This is because the hamstring is a two joint muscle that crosses the knee and the hip and tight hamstrings reduce our ability to fully extend the knee and bend at the hips. This generally leads to the body finding other, potentially harmful ways of completing certain tasks. For example, over utilising the lower back to bend forward instead of the hips and knees. 

If I just strengthen my hamstrings, I’ll get better, right?

Unfortunately, it’s not that simple. Hamstring injuries and deconditioned hamstrings can be caused by imbalances in the body from your lower spine, to your hips, knees and even ankles. Because hamstrings are such a heavily used muscle group in our daily lives, poorly managed hamstring deficits can cause surrounding joints and muscles to over compensate which can lead to further injury and pain . It’s important that we find and tackle the root cause of the problem to reduce these risks.

How can I prevent injuries to my hamstrings?

The current scientific research is geared towards completing exercises to improve the strength through different ranges and using different methods of muscle contraction to improve the durability of the hamstrings. It is also important to maintain good strength and mobility in the lower back and hips to ensure better movement patterns and evenly distribute the forces of movement. Here are a few exercises that can be used to target the hamstring muscles. 

Disclaimer: The exercises demonstrated may not be suitable for all individuals of and may not have the desired effects if completed incorrectly. It is advised to consult your treating medical professional before completing these exercises, especially if an injury is suspected.

How are hamstring injuries treated?

1. Thorough assessment of the spine and lower limb

2. Soft tissue massage

3. Acupuncture / dry needling

4. Targeted stretching and range of movement progression

5. Strength exercises specific to deficits

6. Return to sport/activity exercises

What should I do if I’ve injured my hamstring?

1. Book in an assessment with one of our Physiotherapists.

2. Get started on a treatment and exercise program to help reduce your pain and improve your movement and function

3. Complete a period of progressive loading exercises to build resilience and strong stable hamstrings and surrounding muscles

4. In the majority of cases, this will be enough to abolish your symptoms and get you back to your goals.

Feel free to leave any questions or comments you may have below, or call us on (03) 9841 5777 to speak to our friendly Physiotherapists regarding any hamstring problems you may have.

James Birt Physiotherapist

References

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Buckthorpe, M., Wright, S., Bruce-Low, S., Nanni, G., Sturdy, T., Gross, A. S., Bowen, L., Styles, B., Della Villa, S., Davison, M., & Gimpel, M. (2018). Recommendations for hamstring injury prevention in elite football: translating research into practice. British Journal of Sports Medicine, 53(7), 449-456. https://doi.org/10.1136/bjsports-2018-099616

Chu, S. K., & Rho, M. E. (2016). Hamstring Injuries in the Athlete. Current Sports Medicine Reports, 15(3), 184-190. https://doi.org/10.1249/jsr.0000000000000264

Jandre Reis, F. J., & Macedo, A. R. (2015). Influence of Hamstring Tightness in Pelvic, Lumbar and Trunk Range of Motion in Low Back Pain and Asymptomatic Volunteers during Forward Bending. Asian Spine Journal, 9(4), 535. https://doi.org/10.4184/asj.2015.9.4.535

Mend Me Shop. (2020). Anatomy of the Hamstring & Upper Leg. Hamstring Injury Information and Treatments. https://www.aidyourhamstring.com/hamstring-anatomy/hamstring-anatomy.php

Physiopedia. (n.d.). Muscle Strain. Physiopedia. https://www.physio-pedia.com/Muscle_Strain

Physiopedia. (n.d.). Proximal Hamstring Tendinopathy. Physiopedia. https://www.physio-pedia.com/Proximal_Hamstring_Tendinopathy

Pizzari, T. (2015). Risk factors for hamstring injury: An updated systematic review and meta-analysis. Journal of Science and Medicine in Sport, 19, e9. https://doi.org/10.1016/j.jsams.2015.12.401

Schache, A. G., Crossley, K. M., Macindoe, I. G., Fahrner, B. B., & Pandy, M. G. (2010). Can a clinical test of hamstring strength identify football players at risk of hamstring strain? Knee Surgery, Sports Traumatology, Arthroscopy, 19(1), 38-41. https://doi.org/10.1007/s00167-010-1221-2

Sports Medicine Australia. (n.d.). Hamstring Strain. Sports Medicine Australia. https://sma.org.au/resources-advice/injury-fact-sheets/hamstring-strain/