How Sports Physiotherapy Can Help You Recover From Hamstring Injury
Sports Physiotherapy is a specialist area of expertise and knowledge to help you recover quickly and efficiently from hamstring injuries.
22% of professional soccer players suffer from this injury every year and this continues to rise by 4% annually, due to higher match demands on the body (2).
Another challenge for Physiotherapists is to prevent reoccurrence of the injury. Between 12-33% of players tear their hamstrings again within a year of recovering from the previous one (7).
Read on to find out how you can recover from the condition and how to prevent it from happening again.
What is the problem with hamstrings?
The hamstrings cross 2 joints; the hip and knee joints (see diagram below). This causes increased stress and strain compared to other muscles that cross only 1 joint.
During running they are placed under great load eccentrically when the foot is about to touch the ground during the swing phase. Then during the stance phase when the foot is in contact with the ground, they are placed under concentric load. It is during the eccentric contraction that most injuries occur.
How bad is the injury?
A Sports Physiotherapist will be able to diagnose your injury by carrying out a clinical examination. A MRI scan is usually not required as a physical examination is just as reliable. A graded system is used to diagnose and plan treatment:
Grade 1 – Minor Strain: micro tear or no tear of the muscle
Grade 2 – Moderate Strain: muscle fibres are partially torn
Grade 3 – Severe Strain: muscle fibres are completely torn
It is also important to note the location of the tear. The middle or belly of the muscle will repair quicker than the tendon, and the slowest area to heal is where the tendon attaches to the bone.
How long will it take to recover?
The average return to play times in professional soccer for the different grades of injury are:
Grade 1 – 18 days
Grade 2 – 24 days
Grade 3 – 60 days
It is important to note that these are average times (3).
Some people will recover much quicker or longer than that stated.
What can I do to optimise recovery?
The secret to a full recovery is to have flexible and strong hamstrings. Tight and strong muscles will increase injury, as does flexible but weak muscles.
Thanks to the hard work of researchers, we have evidence to guide our selection of exercises so that you can return to performing at your best.
It has been shown that the inclusion of 3 eccentric type exercises reduced the time to return to play by 37 days, when compared to a standard hamstring programme (1). The following pictures illustrate how to do them and the sets and reps prescribed.
‘The Extender’; hold and stabilise the thigh of the injured leg with the hip flexed to 90 degrees and then perform slow knee extensions to a point just before pain is felt. Do twice daily, 3 sets of 12 reps.
‘The Diver’: stand on the injured leg and and keep your knee slightly bent. Then reach forward as far as you can, while keeping your spine straight. This should be performed slowly, once daily, 3 sets of 6 reps.
‘The Glider’: place a towel under the foot of your non-injured side and hold onto a support. Slowly slide your non-injured leg backwards and and stop at the point of pain if you have any. Then using your arms and not your injured leg, return to the starting position. You can progress this exercise by increasing the gliding distance and speed. Do once every third day, 3 sets of 4 reps.
It has also been shown that adding the following core stability exercises to a hamstring programme will enhance your return to play (6):
- Front plank
- Side plank
- Plank with rotation
This makes sense when considering the hamstrings attach to the pelvis, thus contributing to lumbar and pelvic strength.
We have previously discussed that hamstring flexibility is just as important as strength.
You will typically carry out stretching exercises as part of your recovery.
However, your Physiotherapist will be able to further improve muscle length by 10 degrees through mobilising the lumbar spine (5).
This involves applying pressure to each facet joint for 30 seconds.
More advanced exercises
Finally, as you begin to progress through the different stages of the rehabilitation process, your Physiotherapist will introduce more advanced exercises such as a progressive running programme and Nordic hamstring curls.
The video below from Aspetar Sports Medicine Hospitalillustrates this exercise.
Nordic hamstring curls are often prescribed in professional sport and these are found to reduce hamstring injuries by a massive 70% in soccer (4).
From what we have discussed, it is imperative to start your rehabilitation exercises immediately within a pain-free state. This will optimise the healing process and speed up your return to play. The key to having hamstrings fit for sport is to have flexible and strong muscle fibres.
As the healing process progresses, the exercises should become more advanced. This will prepare your body for returning to sport and reduce the risk of the injury happening again.
Not only are hamstring specific exercises useful for recovery, they play a major role preventing them in the first place and should be incorporated into your team’s warm-up.
You can find out more about our Physiotherapy services here or give us a call on 07400661126.
1. Askling, C.M., Tengvar, M., Tarassova, O. and Thorstensson, A. 2014. Acute hamstring injuries in Swedish elite sprinters and jumpers: a prospective randomised controlled clinical trial comparing two rehabilitation protocols. British Journal of Sports Medicine, 48(7), 532-539
2. Ekstrand, J., Walden, M. and Hagglund, M. 2016. Hamstring injuries have increased by 4% annually in men’s professional football, since 2001; a 13-year longitudinal analysis of the UEFA Elite Club injury study. British Journal of Sports Medicine, 50, 731-737
3. Hallen, A. and Ekstrand, J. 2014. Return to play following muscle injuries in professional footballers. Journal of Sports Sciences, 32(13), 1229-1236
4. Petersen, J., Thorborg, K., Nielsen, M.B. Budtz-Jorgensen, E. and Holmich, P. 2011. Preventive effect of eccentric training on acute hamstring injuries in men’s soccer: a cluster-randomised controlled trial. The American Journal of Sports Medicine, 39(11) 2296-2303
5. Szlezak, A.M., Georgilopoulos, p. Bullock-Saxton, J.E. and Steele, M.C. 2011. The immediate effect of unilateral lumbar z-joint mobilisation on posterior chain neurodynamics: a randomised controlled study. Manual Therapy, 16(6), 609-613
6. Sherry, M.A. and Best, T.M. 2004. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. Journal of Orthopaedic and Sports Physical Therapy, 34(3)
7. Van der Horst, N. Backx, F. and Goedhart, E.A. 2017. return to play after hamstring injuries in football (soccer): a worldwide Delphi procedure regarding definition, medical criteria and decision-making. British Journal of Sports Medicine, 51, 1583-1591