The hamstring muscles consist of 4 muscles, with the long head of biceps femoris being the most commonly injured because of its long lever arm, involvement in multiple joint kinematics and muscle architecture.
Each AFL club can expect an average of 6 hamstring strains per season, with a recurrence rate of around 13.5% per strain. This recurrence rate has been as high as 40% at the elite level in the last 20 years. (Orchard et al., 2013).
At the local or amateur level, recurrence rates are likely higher due to:
- Lack of access to good rehabilitation
- Poorer monitoring of load by coaches / player
- Less time and emphasis spent on strength work / injury prevention
So why do we see so many recurrent hamstring strains? The answer can be summed up in this sentence:
“Hamstrings are dangerous for sport and sport is dangerous for hamstrings”
So what should your sports physiotherapist be watching with you for each hamstring injury? Especially if you have had a recurrent injury. We have summarised what to do in 6 key points:
- Accurate Diagnosis: Not all hamstring strains are the same. We need to nail down the location, size and contributing factors to the strain to appropriately plan out timeframes.
- Low Eccentric Hamstring Strength: Eccentric hamstring strength decreases with injury and is often severely impacted by a strain. This needs to be rehabilitated over time and exposed regularly. It is essential that exercise choice is pertinent to injury location and translate into specific sport performance.
- Overload Running Program: Running is an extremely effective rehabilitation tool however needs to be gradual and progressive, especially at high speed. GPS units are a great tool to assist with this however not essential as we can provide specific running protocols incorporating acceleration and sprint speeds.
- Neurodynamics / Flexibility: This includes both the nervous systems ability to mobilise and muscle flexibility
- Neuromuscular Control / Biomechanics: The way you sprint, accelerate, bend and jump can all be trained to optimise performance and limit hamstring stress. There can be specific biomechanical faults that have not been corrected and will affect hamstring firing capacity.
- Appropriate Time to Return to Play: This last point is essential. You should only return to play once you have appropriately reached objective markers and proven you can tolerate full game loads. It is important to take out the guess work and utilise objective markers like maximum speed, exposure to all sport specific activities and strength testing.
It is imperative all of these points are addressed! If one is missed it can be the downfall in your rehabilitation and leave you susceptible to a recurrent strain.
If you have had significant time off of sport because of recurrent hamstring injuries during this season or previous years the off season is the best time to focus on improving hamstring strength and preventing injury. See a qualified sports physiotherapist at WA SportsMed to take you through an individualised injury prevention program that keeps you on the park for the full season performing at your peak.
Or if you have just suffered a hamstring strain, see an expert at WA SportsMed Physiotherapy and get the right plan in place to get you back on the park!
References:
- Orchard JW, Seward H, Orchard JJ. Results of 2 decades of injury surveillance and public release of data in the Australian football league. Am J Sports Med 2013; 41:734-741.