Tis spring season, which means it is time for the sprinters and soccer players to come out of the woodwork, and hamstring strains to come right out with them! This is a fantastic and very prudent question as most of our school-based runners are getting into Track season.
Management and prevention of hamstring strains has actually undergone quite a fair amount of change over the last 5-10 years with some new information now somewhat changing how we approach this injury. Hamstring injury management was actually a pretty big topic at the World Indoor Track and Field Medical Symposium that I was fortunate enough to attend last week, so I will definitely give you some of the best and up-to-date knowledge from those presentations below. Among many other great speakers, I was fortunate to hear Holly Silvers-Granelli, MPT talk about knee injuries and hamstring injuries and Brian Heiderscheit, PT, PhD talk about his specific work with runners and hamstring injuries.
When do hamstring injuries occur?
This might seem like an inconsequential question, but it actually affects treatment and prevention of injuries quite significantly. For a long time, it was often assumed that hamstring injuries occurred as the foot was on the ground – usually when it was in the early phase of “pulling” the body over the planted leg; however, most evidence is indicating that is usually not when the foot is on the ground at all. Instead, most hamstring strains occur during “terminal swing” as the hamstrings works hard to decelerate the leg from swinging forward. As our speed increases, the hamstring has to work much harder to decelerate due to the velocity at which the leg is moving forward. This somewhat explains why hamstring injuries tend to be very speed dependent (i.e. typically don’t see injuries happening on hill sprints, longer tempo runs, or even power hamstring lifting movements). So, the injury occurs most often when the hamstring is doing eccentric work (strongly contracting as the hamstring lengthens) right before the foot strikes the ground.
How are hamstring injuries treated?
Often we find good ideas for preventing injuries when we find the most effective treatments for the injuries after they occur. This is not always the case and certainly is not a “gold standard” for injury prevention, but it certainly can give some guidance.
Traditional treatment of hamstring injuries for quite a long time was largely range of motion (ROM) and concentric strengthening-focused with a very gradual and slow return to running/sports. Below is an idea of how it might have looked 10 years ago … obviously this is a generalization
- Early rehab would often consist of rest, ice, and gentle motion work like heel slides and light stretching along with some form of massage work
- Mid stage rehab would consist of increased strengthening such as bridges, ball bridges, stool scoots, therapy band knee flexion, stomach knee flexion, and maybe a few exercises like deadlifts or step ups if you were a bit lucky in clinic choice or therapist
- End stage rehab would continue progressing strengthening and add in a gradual return to running program with speed work being the last component added
Progressive treatment of hamstring injuries really takes into account how the injury occurs and the demand of returning to a sport with the demands as described above
- Early rehab might include stationary bike, side shuffles, grapevine/carioca, fast foot stepping, planks, and single leg balance work
- Mid stage rehab might include bridge walkouts, windmill touches, lunges with trunk rotation, single leg small range deadlifts, and early return to running
- End stage rehab might include A skips, B skips, accelerations, single leg bridges, drills for sport, Nordic hamstring drop-curl, eccentric therapy band swing cycle work