Hamstrung - Rehab for hamstring injuries

 

Hamstrings injuries everywhere

Pogba facing six weeks in one of those race car seats at Manchester United.

Matt Moylan from the Penrith Panthers sidelined. Darius Boyd and Tevita Pangai at the Brisbane Broncos unavailable for last nights elimination final. Bevan French from the Parramatta Eels hamstrung aswell!

Hamstring muscle injuries are a common injury in sports that involve high-speed running and kicking. 

In the English Premier League (EPL) hamstring injuries make up around 12% of all injuries.

Some suggested pre-disposing factors include:

  • Age
  • Previous injury
  • Flexibility
  • Neural tension
  • Lumbopelvic stability
  • Joint dysfunction 
  • Inadequate warm-up
  • Fatigue
  • Fitness level
  • Poor training and workload management 

 

The biomechanics of it all

 

During maximal sprinting (Think Usain Bolt's last race), the hamstrings work to decelerate the swinging shin bone and control the straightening of the knee. 

They then work as the foot hits the ground to help extend the hip.

Most hamstring injuries occur at the end of the swing phase when sprinting. The injury usually occurs at the muscle-tendon junction of the outside hamstring muscle.

Hang on, there's more than one? You betcha! There's 3.

  • Biceps femoris (long head and short head)
  • Semimembranosus
  • Semitendinosus

 

Rehabilitation principles

Time. Sleep. Hydration. Nutrition. Mobility. Motor control. Strength. Function.

Put all the pieces of the puzzle together.

Like any injury, time plays a critical role.

All injuries and acute trauma will take time for the body to repair and regenerate.

A few key things to keep in mind. 

Hamstring injuries usually occur in an eccentric fashion - no, not their behaviour, their contraction type.

Like we mentioned before, the hamstrings help to slow down the swinging of your shin while sprinting. They absorb the kinetic energy created to make you run fast, and stop you from kicking your lower leg into the stratosphere.

Think of slowly lowering a weight to the floor. The muscles have to allow you to get the weight to the floor by lengthening, but also have to stop you from falling on your face by contracting.

 

They can be so eccentric these muscles

What this means is that rehab should progress to include specific eccentric strength of the hamstrings.

I like nordic hamstring curls, deadlifts, single-leg deadlifts. 

 

But lets not forget about helping the hammies out

Due to where they attach anatomically, the hamstrings assist hip extension, but your big ass gluteal muscles should be doing most of the work. Throw adductor magnus in there as well.

Here's a great quote from Mike Boyle...

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Motor Control 

I'm sure you've heard a lot of people say the words core strength when you've injured your hamstring. I like to say core stability. Maybe just stability, with good timing, and pattern. You know what, lets just call it motor control.

If you can control the position, particularly in this case the pelvic posture, you allow the hamstring muscles to be at an optimal length to create tension. If your motor control isn't up to scratch, look out.

 

When will I return?

It depends. You'll hear a lot of people throw out 4-6 weeks for hamstring injuries.

But it really depends on the individual, the severity of the injury, your health and recovery ability, your nutrition, the specific rehab program implemented, and what you need to get back to.

Return to running with progressions to maximal sprint are ideally implemented. 

A few clinical tests we look for include:

  • Full mobility
  • Comparable eccentric strength to uninjured limb
  • Pain-free maximal contraction
  • Completion of progressive return to run program
  • Full training
  • Agility tests

 

The Take-home

  • Hamstring injuries are common
  • Usually eccentric mechanism of injury
  • Rehab should include a graded mobility, strength and functional program that targets eccentric -specific movements
  • Rehab should also look beyond the hamstrings - hip extension patterns, gluteal and adductor strength, motor control
  • Graded stimulus and adaptation, time to recover
  • Nutrition to allow optimal cellular function, repair, regeneration, tissue-building etc
  • Complete rehabilitation including return to running programs and agility
  • Optimise performance by continuing an injury reduction program

 

This week we'll be putting out some of our favourite hamstring exercises. Look out for it on our social pages.