Hamstring injuries are one of the most common injuries that occurs in football. This may be due to the combination of the demands of acceleration, agility, endurance, kicking and bending over to pick up the ball. While hamstring injuries are not unique to football and have a high prevalence in other sports (eg. soccer, rugby, athletics and cricket) they do have a high prevalence among AFL footballers of all levels. This makes them the most common injury in sports with high speeds running and acceleration.
Information from the 2016 AFL Injury Survey shows that hamstring strains continue to be the cause of most matches missed per year. The incidence (5.2 new injuries per club), prevalence (19.7 matches missed per club) and recurrence rate (15%) remain relatively stable, despite better understanding of the various pathologies and increased focus on prevention strategies. Click HERE to read full report.
Signs and Symptoms:
Local pain/tenderness over point of strain
Decreased strength, flexibility
The prognosis for hamstring strains varies depending on the severity and location of the injury with a minor strain taking up to 4-6 weeks to fully heal while a complete rupture has a much longer timeline for return to sport.
Grading a strain:
Grade 1: small amount of muscle fibers, localized pain and no loss of strength
Grade 2: strain of significant amount of muscle fibers, with pain and swelling. Pain is reproduced with contraction and movement is limited by pain.
Grade 3: a complete tear of muscle. This occurs most frequently at the musculotendinous junction. This injury normally requires surgical repair.
Mechanism of injury:
Both actions of running and kicking encounter mechanics that put the hamstring at risk of injury. Hamstring injuries that occur during sprinting are at the end of the swing phase when the muscles are active, lengthening, and decelerating the limb to prepare for landing. Kicking injuries can occur during either fast or slow movements as you get hip flexion and knee extension occurring at the same time placing the hamstring in a position of tremendous stretch.
It has been found that a combination of factors like muscle weakness, lack of warm up, decreased flexibility, poor lumbar and pelvic posture (anterior pelvic tilt), history of injury and muscle fatigue all play a part in the mechanism of the injury. However, recurrence and having a current injury are the most significant factors leading to an injury.
Back related hamstring injury:
Hamstring injuries can be mimicked by lumbar neural structures and gluteal muscles. The injury will present with positive hamstring strain signs with strength testing, but localized palpable pain may be absent. This will affect the prognosis as well as the treatment, with many people being able to recover within a week with appropriate treatment.
Acute management (72 hour period post injury):
Ice (at time of injury and every couple of hours post injury - 20 minutes on/2 hour off)
compression (at time of injury and throughout)
Immobilisation (at time of injury)
start gentle pain free movement of hamstring as soon as possible
Sub-Acute Management (after first 72 hours)
Increase gentle range of motion exercises, this helps realign damaged muscle fibers (within pain free range, 3-7 days post injury)
How can we help?
Hamstrings, hip flexors, and the gluteal and lumbar regions are areas we will generally focus on, however, treatments are subject to the presentation of each injury. We aim to treat injuries with a range of various techniques, including soft tissue, active release and dry needling. In addition, we will construct a rehabilitation program to manage and maintain the recovery process. This program will aim to restore range of motion and rebuild strength. The program will generally include:
Eccentric hamstring exercises
Eccentric exercise has been found to help prevent initial occurrence and recurrence of the injury. It is the most effective way to regain tensile strength and realign muscle fibers in a injured muscle. Examples of eccentric hamstring exercises include glute bridge walk outs, Nordic hamstring exercises and an arabesque/diver position.
The stretching and strength work will focus on regaining strength without compromising flexibility, and focus on pelvic stability. It is important to incorporate glute strengthening into the program as weakness or deficiencies in this area can result in hamstring overload and cause fatigue leaving it susceptible to injury.
Interval training (conditioned to demands of sport)
Stretching whilst the muscle is fatigued
Sport specific drill training
Pelvic stability, lumbar mobility, hamstring eccentrics