We are at the point in the sporting season where we are seeing an increased amount of soft tissue injuries in the clinic. Hamstring strains are a common soft tissue injury that we see in sports like football and soccer.
Firstly, a quick orientation to the hamstring;
There are three hamstring muscles: the bicepsfemoris, semimembranosus and semitendinosus. The adductor magnus can also act as a hamstring with some movements. A hamstring injury happens in a few different ways in sports like football, in a really big kick where the hamstring is at maximal length, or similarly when sprinting.
Hamstring strains, like other soft tissue injuries, can be graded in terms of their severity. The severity will then help us predict how long rehabilitation is likely to be. There are other factors to consider, like what part of the hamstring was actually strained, but generally we are looking at anywhere from 3-12 weeks before return to sport, depending on the severity.
So, what is the latest in evidence-based management of hamstring strains?
Early mobilisation and early eccentric exercises!
Early mobilisation and early eccentric exercises help to influence positive re-modelling and neural re-organisation of the muscle fibres from early on post injury. They help to stop muscles shortening, and stop excess scar tissue developing.
Eccentric exercises refer to exercises where the muscle is lengthening. For a hamstring injury, at an early stage of rehabilitation, this might look like a resisted prone hamstring curl (the eccentric part is on the way down).
By mid-stage rehab, this could be hamstring curls on a fit ball or a rower.
At a late stage of rehabilitation, eccentrics should include Nordics.
But these exercises are not restricted to these early, mid and late stage time frames. Some athletes will progress more quickly, and what we know from the evidence is that the earlier progression can occur, the better it is for muscle recovery!
Stay tuned for Part 2 – Return to Running After Hamstring Injury!