Recurrent Hamstring Strain

Hamstring strains are extremely common in sports with high demands on speed, power, rapid change in direction, acceleration/deceleration, jumping & kicking. Because the hamstrings cross two joints the muscle group is prone to injury & re-injury during the swing phase of sprint movements where the muscle bulk reaches maximal elongation & prepares the leg for heel strike.

There is another less known but very common hamstring injury, hamstring tendinopathy that often occurs at the origin of the muscle. This injury is more likely to occur in distance runners & has both an endurance or fatigue component & a stabilising role.

Hamstrings have the less known function of stabilizing the pelvis. During large arm movements the hamstrings are activated to stabilize even before the muscles of the arm start to work & similarly during trunk movements. So the hamstrings on your standing leg will work in a different way to the hamstrings on your swing leg. They also work in different ways affecting your hip & affecting your knee. All these roles of the hamstrings need to be addressed in your rehabilitation programme & therefore one of the benefits of treatment is that you should be able to increase the efficiency of your running style and hence improve times.

If you strain a muscle you have torn a number of the fibres you need to avoid stretching the muscle while it repairs. Due to the high recurrence rate of this injury, it is important to gain early diagnosis & management from your Physiotherapist to aid in return to sport, &
prevention. Research shows that early treatment is very important because if you are unable to walk at normal pace pain-free within 24hrs post- injury then you are very likely to take more than a month to return to your sport.

Hamstrings injuries have been associated with:

–       Previous hamstring injury

–       History of serious knee & groin injuries

–       Muscle imbalances in the same leg

–       Muscle fatigue

–       Hamstring tightness & weakness

–       Hip flexor & Quads tightness & over-activity contributing to long weak hamstrings

–       Poor lumbar posture/lower back stiffness

–       Degeneration of the lower lumbar spine – L5/S1

–       Poor activation & weakness of abdominal & gluteal muscles

–       Poor neuromuscular control contributing to poor coordination of muscle activation

–       Poor neural mobility in particular the sciatic nerve

–       Poor running technique, in particular overstriding

–       Inadequate warm up

–       Training error including overload or underload such as deconditioning between seasons

–       Increased Age

–       Systemic conditions such as Crohn’s disease that affect mineral absorption

–       Knee Reconstruction

–       Ankle stiffness, fibula bone function & foot control

Because it is usually a combination of a number of factors that may predispose you to further hamstring injury, your Physiotherapist can undergo an assessment of these issues to see which may apply to you. Some of these contributing factors are not modifiable for example, age, however many can be addressed by a comprehensive assessment & management by your Physiotherapist.