In AFL, hamstring strains account for 1 in 6 injuries, resulting in ~21 missed games per season for each club and 2-6 weeks sporting absence each injury1,2,3,4. In professional soccer, injury rates are closer to 20% and equate to ~80 days lost per club throughout the season5.
With the soccer and football seasons fast approaching, I thought we would discuss one of the most common injuries– the dreaded hamstring strain.
Literature suggests that recurrence rate of hamstring injuries can be up to 33% in athletes, with re-injury most commonly occurring in the first two weeks following return to sport6! This is staggering and suggests that many individuals return to sport prematurely.
How are they injured?
Before we discuss the mechanism of injury, it is first important to understand the anatomy. As you can see in figure 1., the hamstrings consist of three individual muscles working together; semimembranosus, semitendinosus and biceps femoris, which run from the ischial tuberosity on the pelvis and insert onto both the tibia and fibula below the knee. They act to both extend the hip and bend the knee and are active during both acceleration and deceleration activities.
The hamstrings often get injured during high speed running or in activities like kicking, as they are working at both the hip and knee joints and can become over-stretched7. These activities stretch the hamstring close to its maximal length, as well as simultaneously contracting to slow the leg down. As a result of this, it may reach a critical point where the muscle fibres can no longer tolerate the load and are injured. Hamstring injuries are unique to the individual; however, they most commonly occur at the musculotendinous junction (where muscle belly meets tendon) and the main muscle injured is the biceps femoris (on the outside of the leg). As a rule of thumb, the higher up the hamstring injury and pain, the longer the return to activity.
Grades of hamstring injury
It is important to correctly diagnose injury severity to design and implement an adequate rehabilitation program8.
Grade 1 – Over-stretch without tearing (2-3 weeks)
Harder to recognise Almost feels like a little niggle that you can run/work through and may settle once you stop exercising, (leading you to think you may not have injured anything) Generally, this will get worse and instances of discomfort will increase in frequency
Grade 2 – Moderate strain (4-8 weeks)
Often described as the feeling of something ‘going’ or tightening upMay be able to walk (with pain!) May be bruising and swelling
Grade 3 – Severe or complete rupture of the muscle (>3 months)
Easy to diagnose and spot – you will have felt something ‘pop’ or ‘snap’ and you may have ended up on the ground feeling as if somebody has hit you with an axe! Likely be unable to walkWill swell and bruise up significantly due to associated bleedingRequires surgical opinion and subsequent physiotherapy sessions to help you return to pre-injury level
Initial management
Prior to coming to see us, initial management (first 0-72 hours) is centred around the RICE principles;
Rest is important over the first 72 hours Ice it until you are an eskimoCompression bandages should be applied to limit bleeding and swelling Elevation is essential
In the initial 72 hours, avoid heat on the injury and refrain from stretching and massage as they will increase the bleeding.
At Bayside Sports Medicine Group we are well trained to deal with all types of sporting and musculoskeletal injuries. The latest research suggests that commencing a specific and targeted rehabilitation program early on yields the best results. So, if you have the unfortunate experience of injuring your hamstring, make sure to book in so we can get you back moving!
References
Cross, K. M., Gurka, K. K., Conaway, M., & Ingersoll, C. D. (2010). Hamstring Strain Incidence Between Genders and Sports in NCAA Athletics. Athletic Training & Sports Health Care: The Journal for the Practicing Clinician, 2(3), 124-130. Orchard, J. W., Kountouris, A., & Sims, K. (2017). Risk factors for hamstring injuries in Australian male professional cricket players. Journal of Sport and Health Science, 6(3), 271-274. Prior, M., Guerin, M., & Grimmer, K. (2009). An evidence-based approach to hamstring strain injury: a systematic review of the literature. Sports Health, 1(2), 154-164. Shield, A. J., & Bourne, M. N. (2018). Hamstring Injury Prevention Practices in Elite Sport: Evidence for Eccentric Strength vs. Lumbo-Pelvic Training. Sports Medicine, 48(3), 513-524.Acute hamstring injuries in Swedish elite football: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. (2013). British Journal of Sports Medicine, (15), 953.Erickson, L. N., & Sherry, M. A. (2017). Rehabilitation and return to sport after hamstring strain injury. Journal of Sport and Health Science.Liu, H., Garrett, W. E., Moorman, C. T., & Yu, B. (n.d.). Injury rate, mechanism, and risk factors of hamstring strain injuries in sports: A review of the literature. JOURNAL OF SPORT AND HEALTH SCIENCE, 1(2), 92–101. https://sma.org.au/resources-advice/injury-fact-sheets/hamstring-strain/