The Hamstring Strain by Helen Cooke

Picture the scene…Saturday morning. It was a late one the night before and your head but also your legs are feeling heavy. You are determined to make that touch rugby practice but despite the mad dash you miss the warm up. You wiggle your arms at the sideline and then power onto the pitch to join a team. There’s no waiting on the wing, you see the gap and sprint at full pelt to make the cut…OUCH! There is a searing pain in the back of your thigh. The dreaded hamstring strain.

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Hamstrings are those muscles that run down the back of your legs and are commonly injured in many sports. This means that they are often overlooked until it’s too late. You only need to have watched Paul O’Connell’s agonising collapse during this year’s Rugby World cup match or Asafa Powell end his 100m London Olympics at 60m to discover how common hamstring injuries in sport can be. As I write, Liverpool striker Daniel Sturridge finds himself with yet another hamstring strain. So what are the chances of you having one? What happens when they tear and what can you do to reduce your risk and optimise a speedy recovery?

The Hamstring is made up of 3 muscles. The action of these muscles is to bend the knee and extend the hip. To tear a hamstring you usually have to be sprinting hard or trying to slow down rapidly, changing direction sharply or kicking something…this is almost certainly how you’re expected to move during a OE touch rugby session!

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It is partly due to the hamstring anatomy that lends itself to the risk of injury. The 3 hamstrings control movement at 2 big joints, the hip and the knee. When muscles have to simultaneously control movement at 2 joints they are more at risk of injury. It is also believed that hamstrings usually tear just before your foot touches the ground – this is when your hamstrings act as a brake to slow you down. At this stage the hamstrings are also at maximal length, with the knee out straight and therefore produces a great deal of tensile strength in the muscle. If it reaches a critical limit then it will tear.

Hamstring strains are classified into 3 different types depending on the extent of damage to the muscle.
Grade I: It is often a cramp or stretch like niggle felt when the hamstring is stretched or contracted. These are tricky little buggers and will come on when you are running but you may be able to run through it. Usually requires 2-3 weeks of recovery.
Grade II: Usually immediate pain and more serious than a grade I. This is between 3 and 6 weeks of recovery.
Grade III: Paul O’Connell. Serious. It can feel you’ve been shot. The rehabilitation time is around 3 months.

If you have any doubt or suspect a strain then go and see a physio for some advice and treatment. Firstly, follow the RICE protocol: rest from running; ice regularly for a week or so; compression with a tubigrip and elevate. DO NOT STRETCH – you cannot treat a hamstring injury by stretching. Once the healing phase is complete then the physio will pace you through a tailored rehab program to help you return to sport with minimal risk of re-injury.

There are a mix of factors that may contribute to the risk of injury: cold muscles and fatigue (most hamstring injuries occur at the start of activity or towards the end of a match when tired); poor strength ratio between glutes, quads and hamstrings; posture; lack of hip flexor and quad flexibility and poor technique or core control. Most of the above can be addressed with a few specific exercises but an important point to remember is that the One Element training sessions have been developed to reduce the risk of muscle injuries.

Perhaps you’ve missed the OE training so here are a few ideas for exercises:
1. Lunges: Take a moderate step forwards then lunge down ensuring the pelvis does not twist and avoid arching the lower back. Allow the back heel to lift and keep the front knee in line with the 2nd/3rd toes. Return to the start position by pressing through the front heel. This will strengthen quads, glutes and hamstrings.

  1. Double-leg deadlift/forward lean: Stand with feet shoulder width apart. Slowly hinge forward from the hips without letting the back bend until you feel a gentle stretch in the back of the legs. Imagine the back of your legs lengthening as you lean forwards, folding forwards at your hips. Return to an upright position creating the movement from your hips and not you spine. This can be progressed to one leg. Most of the leg muscles will kick in to stabilise the leg.

  2. Foam Roller: use this to roll the painful spots…front of thigh, the side of the thigh, hamstrings and the calves are likely to have a few juicy areas needing release!

  3. WARM UP: some good suggestions – heel kicks, dynamic lunges with arms up, alternate lunges, sideways and backwards running, high knees. Add direction changes too. Accelerate and decelerate. It is best to start any running from a slow jog and over the warm up build it into some sprints.

If you find that symptoms aren’t resolving then you need to consider a few other similar presentations. You may need to see a physio to assess whether it’s a neural issue as sciatic pain can mimic a hamstring injury. Pain from the lumbar spine can also refer into the hamstrings. If it is a tendon issue then this will also need to be treated different. If in any doubt then don’t let the symptoms linger and seek advice from your physio.

To sum up, prevention is better than cure so warm up properly before training. This is especially important if you think you can bosh out a quick game of touch at the weekend without any prior warm up!

Helen Cooke is a physiotherapist with Six Physio www.sixphysio.com