Hamstring Injuries: Why they happen and how to deal

At all levels of sport, hamstring injuries remain one of the most challenging injuries to deal with. Most commonly seen in track, football, and soccer¹, hamstring strains present a challenge to all athletic trainers and physical therapists, as evidenced by the high rate of reoccurrence: almost 1/3 of athletes with hamstring injuries are reinjured within a year².  With how difficult these injuries are to treat, what’s the best way to attack rehab and return athletes to their prior level of sport?

              Having worked track and field as an athletic trainer for 5 years now, this remains one of the toughest and persistent injuries I deal with every year. There are many risk factors that need to be evaluated and addressed, from the core and pelvis all the way down to the foot and ankle¹. The majority of initial hamstring injuries I evaluate are not caused by insufficiency at the hamstring itself; rather, this seems to be where weaknesses elsewhere in the kinetic chain manifest themselves and cause injury. On the other hand, eccentric weakness in the hamstring muscle after injury has been consistently identified as a risk factor for re-injury^1,3.

Rehabilitation of hamstring strains needs to target all these deficits. In my rehab, I initially target the glute muscle in all 3 planes of motion while the hamstring itself begins to heal, as I’ve found that the vast majority of athletes do not effectively use the glutes. I’ll also use functional core exercises in the initial phase. As the hamstring heals and we are able to begin rehabilitating the muscle itself, I’ll begin more complex motions involving the core, glutes, and hamstrings together in a more functional manner, re-evaluating frequently to determine when to best let the athlete return to jogging, running, and finally, sprinting and return to sport. In every case, I discuss with the athletes the importance of continuing a maintenance rehab program to minimize the risk of agonizing re-injury.

             

-Chip Wintringham

1.     Heiderscheit BC, Sherry MA, Silder A, Chumanov ES, Thelen DG. J Orthop Sports Phys Ther. 2010 Feb;40(2):67-81

2.     Foreman TK, Addy T, Baker S, Burns J, Hill N, Madden T. Prospective studies into the causation of hamstring injuries in sport: a systematic review. Physical Therapy in Sport 2006;7:101–109.

3.     Orchard J, Best TM. The management of muscle strain injuries: an early return versus the risk of recurrence. Clin J Sport Med 2002;12:3–5. [PubMed: 11854581]