Hamstring Strains: The Athletes’ Dreaded Curse
IIt has been fantastic seeing team sports return in recent weeks. As a nation, we have been craving the camaraderie, mateship, and endorphin rush that comes from both playing and watching sport. The excitement of a fast chase, a contested ball, or a last minute goal brings crowds to their feet.
Then suddenly, an athlete pulls up short, hand to the back of the thigh.
The dreaded hamstring twinge.
Over the past few weeks we have noticed an increasing trend in hamstring strains, particularly in sports requiring sprinting, rapid changes of direction, and kicking such as AFL, football, and rugby. Even the most powerful and athletic players are not immune.
So why do hamstring strains happen and what can we do about them?
What Is a Hamstring Strain?
During running, sprinting, and kicking, the hamstrings act like a braking system to control the forward movement of the leg. They rapidly decelerate the forces created at the extending knee and flexing hip.
At the end of the swing phase, just before the foot hits the ground, the hamstrings are at their longest length and working under the most tension. The same thing happens in the final stage of kicking, just before the foot contacts the ball.
Repeated stress at these limits or sudden bursts of high speed force can lead to the disruption of muscle fibres. This is what we commonly refer to as a hamstring strain.
Am I at Risk of Hamstring Issues?
Age
In the AFL, players over 25 years old are four times more likely to sustain a hamstring strain than players under 20. In community football, athletes over 23 are also at significantly higher risk.
Previous Hamstring Injury
A past hamstring strain dramatically increases the chance of re injury. Research in soccer and AFL shows recurrence rates of up to 34 percent.
Muscle Weakness
Strength matters.
Hand held dynamometers can measure force output and help identify differences between legs, as well as the hamstring to quadriceps strength ratio. During a season this ratio often becomes imbalanced.
Return to sport criteria generally include:
Injured hamstring at least 90 percent of the uninjured side
Hamstring to quadriceps ratio above 80 to 85 percent
Neuromuscular Fatigue
DOMS after a heavy match, heavy legs at training, or feeling slower than usual can all be signs of neuromuscular fatigue. This temporary loss of force and speed production increases the likelihood of hamstring injury. Fortunately, fatigue recovers with rest. When you feel particularly sore or flat, reduce training load to match it.
Missed or Shortened Pre-Season
Match intensity is significantly higher than training intensity. Lower cumulative workloads in pre season strongly predict injury risk in the AFL and rugby codes. A proper pre season builds the chronic workload foundation that protects athletes during the season.
Interruptions caused by recent disrupted sporting calendars have contributed to large spikes in soft tissue injuries. Time will tell how this plays out across competitions.
How Long Will I Be Out For With a Hamstring?
Hamstring injuries are one of the most significant contributors to missed games in AFL, soccer, and rugby.
Minor strains may take two to three weeks to recover. More severe tears can take more than twelve weeks.
Indicators of a longer recovery include:
Needing assistance to leave the field
A limp lasting more than forty eight hours
Injury location near the tendons at either the sit bone or the back of the knee
General guidelines are:
Grade 1: 2 to 3 weeks
Grade 2: 4 to 8 weeks
Grade 3: 8 to 12 plus weeks, with some requiring surgery
How Do I Prevent This From Happening Again?
1. Correct Diagnosis
Pain at the back of the thigh is not always a hamstring strain. Sciatica, referred pain, tendinopathy, or tendon rupture may present similarly. A thorough assessment with an experienced physiotherapist ensures the correct rehab pathway.
2. Quality Sport Specific Rehab
Different sports place different demands on the hamstrings including sprinting, kicking, tackling, bending, or landing. Effective rehabilitation strengthens the hamstring through the full range of tension and positions required for your sport. Good rehab also addresses asymmetries and contributing factors elsewhere in the body.
3. Clear Return to Sport Guidelines
Evidence based objective measures should guide your return. These include:
Muscle strength and symmetry
Hamstring to quadriceps ratio
Single leg hamstring bridge test (aim for more than 25 reps)
Muscle length tests
Sprint speed and performance measures
4. Pre Season Matters
A solid pre season builds resilience. If short on time, aim for two sessions per week at the park including sprint efforts, kicking, changes of direction, and ball skills. AFL players commonly aim for more than 125 kilometres of running over a three month pre season. Use this as a loose guide and adjust for your sport and level. Reduce overall loading once the competitive season begins.
5. Sprint Training
Sprint training is one of the most effective and time efficient ways to strengthen hamstrings and reduce injury risk. Include a mix of ten, twenty, and fifty metre efforts after a thorough warm up.
6. Strengthening for Prevention
Performing strengthening and prevention programs two to three times per week can reduce lower limb injuries by up to 50 percent. Choose exercises that target the entire hamstring group and progress gradually. Our recommended evidence based prevention programs for different sports can be found HERE.
We have put together a range of hamstring strengthening exercises that utilise different parts of the hamstring muscle and are straightforward to include in your routine. They progress in difficulty and we suggest choosing a few that feel moderately challenging for you.
If you would like help with hamstring assessment, sport specific rehab, or preventing future strains, our physiotherapists are here to guide you.
References:
Marcus J. Colby, Brian Dawson, Jarryd Heasman, Brent Rogalski, Michael Rosenberg, Leanne Lester and Peter Peeling (2017): Preseason Workload Volume and High Risk Periods for Non-Contact Injury Across Multiple Australian Football League Seasons; National Strength and Conditioning Association
Steven J. Duhig (2017): Hamstring Strain Injury: Effects of High-Speed Running, Kicking and Concentric Versus Eccentric Strength Training on Injury Risk and Running Recovery; Queensland University of Technology (Thesis)
