Have you suffered an acute hamstring injury? Here you will find information about possible causes and what a rehabilitation program looks like.
Causes of hamstring injury
Acute strains or tears of the hamstrings are common in many popular sports, such as football, hockey and track and field. It happened to me in track and field in a relay. You know right away something has happened! In the event of a muscle tear, the patient's story is important. People complain about a sudden and sharp pain, continueing sport is not possible. Testing shows pain on resistance and often on stretch. There is pressure pain on palpation.
Two types are described:
Type 1 hamstring injury happens when running at high speed. It often appears to occur near the end of the swing phase. Most commonly it concerns the long head of the biceps femoris, usually on the muscle-tendon transition towards the buttock.
Type 2 hamstring injury occurs with muscle lengthening such as a sliding, split, or a high kick. Type 2 is often localized close to the ischium involving the tendon of the semimembranosus.
The involved tissue can suffer a grade 1 (strain), 2 (partial) or 3 (complete) rupture.
Physiotherapy for hamstring injury
There is not much scientific evidence to base the management of hamstring injuries on. Much of the approach is based on clinical experience and knowledge of anatomy and biomechanics. A clear structure and progressive loading is important.
Pain-free mobility and strength are build up. Relevant is that all factors that can have an influence on (re-)occurence, such as synergetic and counteracting muscles (muscle length, coordination as well as strength), ankle, knee and SI malalignments, restrictions in any relevant connective tissue and muscle weakness in the whole kinetic chain are targeted.
For example, the less your glutes do in hip extension, the more the hamstrings will have to compensate for it. The weaker your abs and hip flexors are, the more likely your hamstrings will notice since they act on the other side of the hip joint. It should be noted that muscle ruptures often occur in muscles that run over multiple joints, which makes coordination more complex. The hamstrings are partly dependent on other muscles, so apart from optimizing the hamstrings, we should also focus on the rest.
In progressive training schedules, it is important to also start running and build up speed and direction/ball contact as soon as the before mentioned conditions allow this. It is a challenge for both patient and therapist that you should be able to assume that after a rehabilitation your system is optimized to withstand all angles and positions again that your sport requires. This includes -but is certainly not limited to- the well-known Nordic curls.