Hamstring injuries: Why do they keep happening?

Your hamstrings are one of the most utilised muscles in sporting activities and in most of your everyday movements. When hamstrings become injured, it can feel like a long road to recovery due to the fact that they can be injured time and time again.

So, how can I fix my hamstring injury? And how can I stop it from happening again?

First, let’s get an understanding of the anatomy of the hamstring. The hamstrings consist of three muscles: biceps femoris, semitendinosus and semimembranosus. Those muscles are attached from the bottom of your pelvis, known as the ischial tuberosities (also known as your “sit bones”) and attach onto the side of your knees. These attachment points enable the hamstrings to extend your hip and flex your knee. 

So, when we think of why hamstrings are so important in sporting activities, it’s because they allow us to run, jump and squat freely – in addition to many other movements.

Now that we understand a bit about the hamstring anatomy, let’s look at injuries.

Have you ever felt a sudden, sharp pain at the back of your thigh when running or playing sport? Was there a popping or tearing sensation? If you have answered yes, it’s likely that you have strained your hamstring muscle.

There are two types of hamstring strains:

Type I occurs mostly in kicking sports, in sprinters, jumpers and hurdlers. The muscle commonly affected is the biceps femoris muscle. They tend to happen when hamstrings are at their most vulnerable- just before your foot strikes the ground, as they work to decelerate the swinging leg.

Type II commonly occur in dancers and gymnasts and affect the semimembranosus muscle and occur when it is excessively stretched.
There are various risk factors for hamstring strains, including hamstring weakness, decreased flexibility, muscle imbalances and a history of hamstring strains or other lower limb injuries. 

How do physiotherapists treat hamstring strains?

Like any acute sporting injury, there are three phases of healing: the inflammatory phase, the reparative phase and the remodelling phase.

During the inflammatory phase, you should follow the RICE principle: Rest, ice, compression, and elevation. For example, you are applying ice for 10-15 minutes using a cold pack every 3-4 hours for the first few days until pain settles. This phase's length depends on the severity of the injury but typically lasts 3 to 7 days.

During the reparative phase, it is important to begin working on mobility, control, and strength. Some examples are provided below:

Mobility
When you first strain your hamstring, it is likely to be painful if you stretch it. It is important to avoid any excessive or aggressive hamstring stretching in the early days. A better way to mobilise it is to perform a dynamic exercise. You can do this by laying on your back, holding the back of your thigh with your hip bent to 90 degrees, and then straightening your knee to the point just before pain is felt. 

Control
It is important to have good control around your pelvis for optimal functioning of the hamstrings. A great beginner exercise is to practice tilting your pelvis forwards and backwards while laying on your back. A more advanced exercise that requires exceptional lumbopelvic control is the Nordic curl. This exercise is recognised as one of the best exercises to strengthen the hamstrings and prevent injury. 

Strength
Strengthening is an essential component of the rehabilitation and prevention of hamstring strains. As most hamstring strains occur when the hamstring muscle is lengthened, it is, therefore, useful to strengthen the hamstrings in the same way. Eccentric hamstring bridges and the “Glider” exercise are great examples of this.

In the remodelling phase, sport-specific drills are introduced to ensure a safe return to activities. 

Examples of these might be drills to optimise your deceleration if you’re a sprinter, or safely landing if you’re a football player.

**Please note that all hamstring strains are unique in their type and severity, and it is advised that a Physiotherapist guides you on the best place to start. **

So why do hamstring injuries keep happening?

One of the main reasons that your injury might keep coming back is because you might not be ready to return to your specific sport, at least not just yet!

A lot of progress is made in the reparative stage, as the strength and mobility in our hamstrings return. However, a lot of patients stop at the reparative stage because they feel confident in making a return to sport and it’s at this point injury reoccurs.

Although your hamstrings may feel capable, they might not be ready to help you decelerate from a sprint, or to help you jump off one leg and this is where injury can reoccur.

The remodelling phase is arguably the most important stage in returning to sport as it follows a return to sport program that allows your hamstrings to fully adapt to the dynamic movements required of them while doing sports.  

If you plan on making a return to sport, your program should be performed under the guidance of a professional physiotherapist as it gives you the best opportunity to stay healthy and in action!

If you’re managing a hamstring injury, book in with Back In Motion so we can help you get back to doing the things you love!