Hamstring Strains & Tears: How to prevent hamstring injuries?

With winter sports kicking back into gear, it’s important to address the common hammy injury. Whilst this is one of the most common sporting injuries, the principles of prevention and rehab are not common knowledge.

Mechanism of injury

The main mechanism for a hamstring injury or strain is when a muscle is stretched beyond its capabilities. It is often during running when our leg is preparing for contact with the ground where this can be seen. It is in this phase that the hamstrings are fully stretched and on maximum tension in an attempt to decelerate the leg. There are two hamstring muscles that side on the inside of the leg and one that sits on the outside. It is the outside muscle that is most frequently injured.

Risk factors

• Previous hamstring injuries
• Older populations
• Fatigue
• Reduced core and lower limb strength
• Lower limb muscle tightness
• The rapid increase in training load/volume
• Reduced muscle endurance

“Tore it off the bone”

This phrase gets thrown around a lot when it comes to hamstrings but only concerns very severe hamstring injuries where the tendon tears away from the bone it attaches to and may pull some bone away with it.

Most commonly, hamstring injuries occur in the thick middle section of the muscle or where the muscle and tendon fibres meet. The rehab process for more muscular injuries is much simpler, as muscle tissue heals much easier due to its superior blood supply in comparison to tendon pathology. If your injury is more towards your hip or knee there may be some tendon involvement which is commonly a longer recovery. This is because tendons do not respond as well as muscles to changes in load and do not have the same healing capacity. Therefore, a more prolonged, gradual and conservative approach is required.

Grades of injury and prognosis

Grades of muscle tears:

• Grade 1 (up to 3 weeks): Only a few fibres of the muscle are damaged
• Grade 2 (anywhere from 3-8 weeks): Approximately half of the muscle fibres are torn.
• Grade 3 (~12 weeks): Over half of all muscle fibres are ruptured. There may also be some tendon involvement.

How to prevent hamstring injuries?

1. Warm-up: It is crucial to complete a warm-up consisting of dynamic stretches, sport-specific running drills, agility and incremental stride efforts to ensure the risk of injury to the hamstrings is minimised during training or game day.
2. Strengthening: Not only is it important we strengthen specific muscle groups, but it is also vital to complete specific exercises tailored to the demands of your chosen activity or lifestyle. Strength programs need to be tailored for each individual due to factors such as:- Body composition
   – Fitness
   – Previous or concurrent training schedules/programs
   – Recent time off sport/activity
   – Other co-existing injuries
   – Baseline strength
3. Gradual loading when returning to sport or activity: Following an extended period of time off, there is a lack of muscle conditioning which needs to be made up for. If progressions are made too quickly, then the muscles are not going to be to cope with the demands of the task. Similarly, as we begin to fatigue, the capabilities of our muscles to perform under fatigue are reduced. Thus, the risk of injury increases.

If not properly assessed or prescribed by a health professional, there is the risk of developing hamstring injuries. If you have recovered from a hamstring injury, there is large importance placed on continuing to maintain strength training and ongoing rehab beyond return to sport. This is due to the major risk factor for hamstring injuries being prior hamstring tears/strains.

What do I do if I tear my hamstring?

• Initially manage hamstring injuries with the RICER protocol
  ◦ Rest
  ◦ Ice – 10 mins on, 10 mins off for up to 1 hour. Use a layer of towel between the ice pack and the skin to prevent ice burns.
  ◦ Compression
  ◦ Elevation
• Avoid passive or static stretching – if there has already been a tear, we do not want to further contribute to tissue damage
• Avoid heat – this will increase blood flow to the injury site where there is already swelling and inflammation occurring
• Early access to Health Practitioner

How will Osteopathy and Physiotherapy help?

• We can provide you with a thorough assessment, and an accurate diagnosis and provide you with relevant education and a clear management plan going forward.
• Understanding of how to tailor a specific rehab program including both gym, running and cross-training programs
• Provide education about what you can and can’t do during the management of hamstring injuries
• Effectively monitor the progression of strength, through the use of a strength dynamometer
• Provide quality hands-on treatment to facilitate your rehab program
• Identify and treat clinical findings such as strength deficits, motor control, muscle tightness or joint stiffness which may contribute to the occurrence of your injury.

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