With footy season starting this week, I thought it would be perfect timing to discuss footy’s most commonly injured body part… the hammy! In the AFL, each club will average six hamstring injuries per season. That’s the most games missed of any injury! And unfortunately, of these, 30% are likely to recur throughout the year. In today’s blog, we will have a look at the ins and outs of hamstring injuries – what they are, how are they are injured and what to do when things go wrong.

What are the “hammies”?

The hamstrings are a large muscle group located in the back of your thigh. They cross two joints: the hip and the knee (such muscles are termed biarthrodial). These muscles are at a higher risk of strain because of the forces exerted on them over two joints, especially when in a lengthened position.

Hamstring muscle

Image credit: OrthoInfo

The main actions of your hamstring are to assist with hip extension and knee flexion (bending the knee back). In sports, they are involved with the deceleration of your leg (eccentric contraction) when you are running (in late swing phase) or kicking.

Footy player kicking ball with extended hamstring

Image credit: News.com.au

They also help straighten your hips when you pick things up off the floor (concentric contraction) or doing a gym exercise like a hamstring curl.

Our hamstrings also work in conjunction with our gluteals, quads, calves and lower back muscles when performing these actions – never in isolation.

How do you injure your hamstring?

Sudden movement or force applied to your hamstrings are common ways to strain them, and often when in an overstretched or lengthened position. Common actions include running, sprinting, and kicking.

What are some of the risk factors?

  • previous hamstring injury
  • older age
  • sudden change in direction (acceleration or deceleration)
  • poor flexibility and poor strength
  • muscle fatigue
  • imbalance between the quads and hamstrings
  • inappropriate, inadequate, or no warm up

What’s the difference between a pull and a tear?

The answer is “nothing really” – they are both strains but often used colloquially to mean different things. Most people will describe their injury as a pull but really what they are talking about is a grade 1 strain. When people talk of a tear, they are most likely talking about a grade 2 injury, where some bruising and swelling will be evident.

Strains can vary in severity and are often graded:

  • Grade 1 = mild strain, overstretching of the muscle fibre
  • Grade 2 = moderate strain, some tearing of muscle fibres
  • Grade 3 = severe strain, complete rupture of muscle fibres

How are they diagnosed?

A physio or sports doctor will be able to diagnose your injury, and its severity, based on several well researched diagnostic tests for your hammy. The mechanism of injury is normally the first clue to what structure may be injured, with reports of the actions already mentioned above being the usual culprits.

From there, assessing the strength and flexibility of your hamstrings will also normally indicate if a strain has occurred. Your physio or sports doctor will be able to feel along the muscle belly for local tenderness over the site of the strain. Sometimes, when a tear has occurred, a palpable inconsistency or deformity is felt in the muscle belly, with a large lump just above the site of the tear.

Based on the loss of strength, loss of flexibility, amount of bruising, swelling and overall loss of function, a prognosis can be made, and a grade of injury determined. Rarely would an ultrasound or MRI be required to diagnose a hamstring strain. The exception to this would be seen in elite sport, where MRI are more commonly performed, not to diagnose the injury but to assist in the prognosis of the strain’s severity.

What treatment do I need?

Like all muscle strains, the RICER formula should be followed for the first 48-72 hours:

R = Rest

Ceasing activity to prevent further injury.

I = Ice

For pain relief and preventing excessive bruising and swelling.

C = Compression

To prevent excessive bruising and swelling.

E = Elevation

To prevent the bruising and swelling from running down the limb and pooling in distal structures.

R = Referral

Seek professional assistance as soon as possible to ensure optimal management and the quickest recovery possible – this doesn’t mean Dr Google!

Common treatments for grade 1 and 2 hamstring injuries include:

  • massage
  • ultrasound therapy
  • dry needling
  • stretching
  • hamstring strengthening
  • core strengthening
  • lumbar (lower back) mobilisations
  • gradual return to running program

If there are still deficits evident in your assessment and your training is restricted, you will increase the likelihood of a re-injury if you return to sport too soon. As a rule, once an athlete is able to complete two full training sessions, without any pain or restriction, they are then cleared to return to sport. On average, grade 1 strains will take up to three weeks and grade 2 strains between four to eight weeks before returning to normal activities.

Generally, management for grade 3 strains may involve surgical repair and take up to three months of rehab to fully recover.

How can I prevent doing a hammy again?

Like a lot of things, there are no guarantees in life… but we do know a few things that will give you the best chance of not becoming a statistic when it comes to recurring strains:

  • Complete your rehab program post injury. Don’t rush back too early!
  • Continue your rehab even once you have returned to sport as directed .
  • Complete a thorough body warm up pre-sport. Your physio will prescribe exercises that are suited to your body and injury.
  • Work on posterior chain strengthening and conditioning. Address any noted imbalances.
  • Maintain spinal health. Lower back stiffness affects your biomechanics and neural input into the hammies.
  • Stretching and cooling down after every training session.
  • Allowing adequate recovery time between workouts or training sessions.
  • Don’t ignore tightness or niggles. They can be a sign you are about to strain your muscle!

If you have had an acute hamstring injury or had issues with recurring hammies, the team at Revive Physiotherapy and Pilates have years of experience and up-to-date knowledge on the best, evidence-based treatments for hamstring injuries. They will have you back on the field, and hopefully staying on the field, in no time! Call today on 9391 2600 or make a booking online for a full assessment and treatment plan.