Recently, to keep the ballooning effects of the all you can eat buffet at bay whilst on my Cricket Australia Indian tour, I increased my high intensity running load. All was going splendidly with 4 days of high intensity running under my belt until on the 5th day and 90% the way through my very high intensity interval running session I tore my hamstring. I felt the tell-tale sensation that all my patients describe of a tearing and retraction sensation in my outer leg whilst running. I had to stop my running session and iced immediately. You’ll be happy to know that I have since fully recovered. No longer ‘gun shy’ of my max speeds (which is not that quick!), my strength has vastly improved.
I’ve treated my fair share of hamstrings given my long-term involvement in recreational, semi-elite and elite sports, particularly with the Aspley Hornets NEAFL team. Hamstring tears are a frequent concern among running athletes, often resulting in significant downtime and compromised performance. Hamstrings have remained the most prevalent injury the professional AFL over the past 21 consecutive seasons [1]. A more astonishing was that the average in 2012 was estimated to be over $40,000 per hamstring injury!
Understanding the Mechanisms
Danielsson et al. (2020) identified several key mechanisms that underpin hamstring injuries in running athletes. Most hamstring tears occur during the late-swing phase of the running gait, when the hamstring muscles are undergoing rapid lengthening. Factors such as eccentric muscle actions, high muscle forces, inadequate muscle coordination, and reduced neuromuscular control were identified as contributing to the vulnerability of the hamstrings during this phase. However, as evidenced in my above example, fatigue plays a large role in hamstring strains too!
Prevention Strategies
Preventive measures can significantly reduce the incidence of hamstring tears. Strengthening exercises targeting the hamstrings, such as eccentric exercises and Nordic hamstring curls or single leg romanian deadlifts (see video), have demonstrated effectiveness in reducing injury rates among athletes (Al Attar et al 2017). These exercises enhance muscle function and improve the ability to withstand the demands of high-speed activities. Additionally, addressing muscle imbalances, particularly between the hamstrings and quadriceps, is crucial for injury prevention. A balanced strength ratio between these muscle groups promotes optimal biomechanics and reduces strain on the hamstrings.
Adequate warm-up routines, including dynamic stretching and activation exercises, play a pivotal role in preparing the muscles for intense activity. Incorporating neuromuscular training, such as balance and proprioceptive exercises, can also enhance muscle control and reduce the risk of hamstring tears.
The scientific and physio consensus suggests that an appropriate exposure to high-speed running can actually reduce the risk of hamstring injuries! Studies repeatedly demonstrate that a higher volume of high-speed running during training and matches was associated with a reduced risk of hamstring injuries. Like all dose-response relationships in strength and conditioning, exposure to high-speed running may improve hamstring muscle capacity, enhance tissue adaptation, and contribute to better resistance against injury. However, the dose makes the poison – just like my 5 consecutive days of high speed running work!
Rehabilitation
In the event of a hamstring tear, a tailored rehabilitation program is vital for optimal recovery. Early rehabilitation interventions focusing on reducing pain and inflammation, such as relative rest, ice, compression, and elevation (RICE), are essential in the first 48 hours. As healing progresses, a gradual return to activity is recommended, emphasizing exercises that target strength, range of motion, and neuromuscular control.
Isometric exercises, progressive resistance training, and proprioceptive exercises are commonly prescribed during this phase. Furthermore, functional movements, sport-specific drills, and agility exercises should be incorporated as the athlete progresses. These exercises help restore coordination and muscle function required for running and minimise the risk of reinjury. Close collaboration between the athlete and physiotherapist is essential throughout the rehabilitation process to monitor progress, make necessary adjustments, and ensure a safe and successful return to sport.
Rehabilitation of a hamstring injury like most injuries is a gradual process that requires patience, commitment, and professional guidance. By following a well-structured program, athletes can regain strength, function, and confidently return to their sport. So if you have pulled your hammy, don’t worry! Come and chat to one our physios today so we can get you running back your chosen sport (or buffet).
References:
[1] Orchard JW, Seward H, Orchard JJ. Results of 2 decades of injury surveillance and public release of data in the Australian Football League. Am J Sports Med 2013; 41(4):734-41
[2] Danielsson, A., Horvath, A., Senorski, C., Alentorn-Geli, E., Garrett, W. E., Cugat, R., … & Hamrin Senorski, E. (2020). The mechanism of hamstring injuries–a systematic review. BMC musculoskeletal disorders, 21, 1-21.
[3] Al Attar, W. S. A., Soomro, N., Sinclair, P. J., Pappas, E., & Sanders, R. H. (2017). Effect of injury prevention programs that include the Nordic hamstring exercise on hamstring injury rates in soccer players: a systematic review and meta-analysis. Sports Medicine, 47, 907-916