Are you or have you been ‘HamStrung’?
‘Hamstrung’ – a figurative verbal expression from the noun hamstring (the muscle and tendon on the back of the thigh), originating in the 1500’s where soldiers would slay their enemy across the back of their thighs rendering them disabled, crippled, lame, or useless. If you have ever strained or torn a hamstring muscle (albeit in a less violent manner!), you probably felt the same.
Hamstring strains are the most significant injury in football, rugby, running (more commonly sprinting), and basketball. Apart from being debilitating at the time of injury, hamstring strains can be frustratingly slow to heal. Often taking an average of 3-4 weeks to recover, even up to 6 months to return to full sporting ability. What’s worse, is that there is a 20 to 50% chance that you will re-injure your hamstring in the same season!
The hamstring is a powerful group of muscles that arise in the hip and pelvis and insert as a strong tendon at the back of the leg, just below the knee joint. It is a two-joint muscle in that it works over two joints, both bending the knee and extending the hip. Most commonly injuries to the hamstring happen with sudden changes in running direction, sudden acceleration, explosive speed, or when trying to contract the muscle whilst it is being stretched, for example a soccer player with an outstretched leg, attempting a high kick all at the same time.
Social athletes or sportspersons of any level are at risk of straining their hamstrings. However, people who sit for long periods of time during work or at home are also at risk of injury. They most likely have weak and tight hamstrings, due to the static nature of their day, and shortened position of the hamstring whilst sitting. Whether this is you, the office worker who is convinced to play a quick friendly game with mates after work; or get roped into the parents 100m dash at the school sports day; or a weekend warrior; ‘tearing’ your hamstring can happen.
When the hamstrings contract, the quadriceps relax. And vice-versa. It’s a not-so-delicate game of tug-of-war. When they are out of sync, injury can happen that can extend beyond the muscle groups themselves. Several factors, often in play at the same time, can cause a strained hamstring, however many of these factors are modifiable, suggesting one can prevent a hamstring strain to a certain degree. Strength imbalances, muscle fitness and endurance, warming up, underlying back problems, technique, conditioning of the muscle to acceleration and deceleration – these risk factors can all be addressed. Sadly, a previous hamstring injury and age are two risk factors that can’t be altered. Increasing age increases injury risk. It’s something to be aware of and possibly take extra caution to prevent a hamstring strain!
Your symptoms may vary depending on how severely you strain your hamstring. They may include pain behind the leg and into the buttock immediately at the time of injury or afterwards, with difficulty walking. Muscle spasm and tightness in the muscle, bruising (which can spread down into the calf area) and tenderness, swelling, an audible popping or snapping sensation. With a complete (Grade 3) tear, you may feel a ‘ball’ of muscle in the back of your thigh.
Management may include early treatment with the RICE protocol, ask your physiotherapist for advice about this for the first 48-72 hours. You may want to rest the leg and use a crutch to reduce loading on your injured leg. Once this acute phase has passed treatment can progress to:
- Manual therapy techniques, including gentle pain free massage. Soft tissue mobilisation of the hamstring and surrounding muscles including the lower back, glutes (buttocks), calf and quadriceps (front of the thigh).
- Treatment of any underlying back problems and normalising neurodynamics.
- Correcting muscle strength and flexibility imbalances
- Exercise therapy to improve eccentric strength of the hamstring
- Correction of sports technique and functional problems
- Rehabilitation of endurance, agility, proprioception and sports specific drills.
Keep this in mind:
- Cross-train in sports that don’t place a heavy demand on the hamstrings (upper body strength training, easy lap swimming, low resistance stationary cycling or elliptical trainer).
- Observe the 10 percent rule: Do not increase exercise intensity, frequency or duration more than 10 percent a week.
- Regular massage may form part of a prevention strategy, keeping the hamstring muscle flexible and aiding in muscle recovery.
For optimal recovery and prevention of a recurrent hamstring strain it is essential you work through a treatment and rehabilitation program with your physio.
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