Rehabilitating a Hamstring Injury

Hamstring injuries are very common across all sports. They can be frustrating for athletes as they are associated with a long rehabilitation time, while also having a high re-occurrence rate, normally within the first 2 to 4 weeks after returning to sports 1, 2. The time away from sport and exercise can be long and frustrating depending on the severity of the injury.

 

Symptoms

Hamstring tears most commonly occur with a sudden incident/ movement. There is usually sharp pain and an inability to use the injured leg to its full capacity. After the Hamstring has been injured, the most common symptoms are:

  • Pain/ discomfort

    • on stretch or while contracting the muscle (through range)

    • decreased ability to perform large compound movements i.e. deadlift (picking something of the floor)

  • Decreased range of motion

  • Decreased strength

 

Common Causes of Hamstring injuries

Hamstring strains have been found to occur most commonly during specific movements as listed below

  • The end range during your running gait, meaning leg fully outstretched in front – usually associated with high running speeds

  • Rapid explosive movements – i.e. pushing through the leg during take for sprinting or jumping

  • When there is a large required force, to be applied through the muscle during extreme ranges of motion.

  • Inadequate rehabilitation program or returning to sport too early can be the common cause when re-injuring your hamstring.

 

Common Sports/ exercises for Hamstring injuries

Sports that require a rapid acceleration, high intensity running / sprinting, have a very high occurrence rate of hamstring injuries. Repeat bouts of the sprinting etc. leading to fatigue throughout the muscles, can compound the rate of injuries as well.

  • Sprinting = track and field athletes,

  • Team sports such as rugby, soccer, afl etc.

    • Much of the research looking into hamstrings are based around these team sports in particularly at a professional level. This is due to the high incident rates, lay off time of athletes and money spent/wasted by the clubs with injured players out of action.

 

Risk Factors for hamstring injuries

  • A Previous injury!! The biggest factor predicting a future hamstring injury

  • Muscle weakness/ fatigue

  • Flexibility

  • Strength through ROM (neuromuscular control)

  • Poor warm up

  • Muscle/ limb imbalances

  • Dehydration

  • An Existing lower limb injury

    • Also post operation such e. ACL

  • Age = increased

  • Ethnicity

  • Movement mechanics

 

Progression plan for rehabilitating a Hamstring injury

  1. Manual therapy to assist in forming healthy scare tissue, to help strengthen the muscles, and regaining passive full range of motion

  2. Hip mobility and regaining pain free ROM (range of motion)

    1. Stretches, both active and passive

    2. With particular focus on pain free active movement

  3. Muscle engagement

    1. Upper and lower hamstring engagement,

    2. glute and associated muscle engagement e.g. core and pelvic control

    3. Examples: glut bridges, hamstring curls, Nordic hamstring curls

  4. Strength through Full ROM and Neurological patterning

    1. Glute, hamstring, and core

    2. Examples: Pendulums, RDLS, Squats

  5. Adaptive strength

    1. Spilt squats, walking lunges

  6. Force / acceleration-based training

    1. drop squats, jump squats, plyometric lunges

  7. Sports specific training

    1. running, sled pushes, jump downs with lateral jump

 

As we progress through the phases of recovery, phases may start to inter link with each other and are not held separately to one another.

 

Considerations for when structuring and progressing Hamstring recovery and prevention plans

General consideration

  • Severity of injury

  • Glute mobility

  • Calf mobility

  • Glute/Hamstring patterning

  • Core strength

  • Pelvic control

  • Force transfer

  • Neurological hamstring development

  • Upper vs Lower hamstring engagement

  • Strength at end range

  • Eccentric strength

 

Specific and personal considerations

  • Exercises/ Sport being performed

  • Scar tissue

  • Range of motion

  • Mechanism of injury/ how the injury occurred (concentric/eccentric)

  • Training history

  • Injury history

  • Running mechanics

  • End Goal

The rehabilitation of hamstring are very important, and has many factors that can influence the rehabilitation intervention. This is why its important to see to qualified health professional when looking to return to sport, to help prevention further re-occurrences of the injury. Please don’t hesitate if you would like to book in and start your rehabilitation process today.

Written by Exercise Physiologist,
William Holland

 

  1. Ernlund L, Vieira LA. Hamstring injuries: update article. Rev Bras Ortop. 2017 Aug 1;52(4):373-382

  2. Opar DA1, Williams MD, Shield AJ. Hamstring strain injuries: factors that lead to injury and re-injury. Sports Med. 2012 Mar 1;42(3):209-26.

Case Study

30 yrs old Rugby player

  • Bending over in a ruck, mid game. Trying to maintain position, was producing force through hips and thighs, unfortunately in process tore hamstring. It was a high (proximal) Grade to 2 partial tear.

  • The tear due to high forces being put through the hamstring where too high for the hamstring to cope with.

 

Program outline

  1. Started with manual therapies.

  • Used to help promote healthy scar tissue healing and recovery

  • Incorporated hands on massage, dry needling

  • This was performed over the first month of rehab, more intensely to start, and progressed towards more movement base and just a release to keep the leg moving well.

  1. Started with ROM and contractions 4-6 weeks

  • moving into bigger gross movements, non complex, as the leg will allow. This wasn’t necessarily done as hamstring was completely pain free through all ranges and movements. But brought in as tolerated.

  • aimed at strengthening the scare tissue that is being developed.

  • Able to with stand the movements and building strength with pain free movements

    • Example of the work out throughout this period.

      • Hamstring curl – prone with band

      • Standing hamstring extension

      • Single glute bridge – bosu ball

      • Nordics – inner range

      • Squats

      • Rack Pull

      • RDL

      • Supported pendulums

  1. The next progression taken is incorporating isolative strength and more complex movements to the program.

  • Example of program

    • 1a) Single glute bridge – bosu ball

    • 1b) Standing hamstring extension – red band

    • 1c) Nordics – inner range

    • 2a) leg press

    • 2b) pistol

    • 2c) front squat

    • 3a) rack pull

    • 3b) supported sumo

    • 3c) RDL

  1. Sports specific movements with reactive movements where brought in, with increasing intensity.

  • There was some feeling through the hamstring as fatigue set in and with the more explosive movements. This disappeared after a few weeks

  • Program

    • Glute bridge – single leg bosu ball

    • Monsters

    • Nordics

    • Front squats

    • Pistols

    • Drop squats

    • RDL

    • Powerband sumo

    • Bulgarians

    • jump down with Horizontal jumps

  1. Running

  • Was initially slowly brought in as the hamstring was comfortable with the movement and continued contraction. Small distances to start. But brought in as early as possible to keep the movement as natural for when increasing intensity and speeds.

  • The isolative strength phase listed above was more about increasing the distance, to incorporate the endurance and increase the fatigue threshold, in conjunction with the resistance training.

  • As the client progressed to more sports specific movements, the speed of the runs where increased, progressing towards a sprint as hamstring allowed.

Following all the treatments, the client was assessed and discharged, returning to rugby and has had no complaints since.

EducationGuest UserWill Holland