Hamstring injuries, tears and strains are one of the most common sporting conditions. And even worse; they have one of the highest re-injury rates.
We see plenty at Sport & Spinal Physiotherapy. They occur most commonly during sports that require high speed, agility and explosive power.
In this article I will discuss hamstring tears, the best way to rehabilitate after a tear and decrease your risk of injury.
Anatomy of the hamstrings
When we talk about hamstrings we actually refer to three main muscles:
- Biceps Femoris: this is the most lateral (or outermost) muscle of your hamstring
- Semimembranosus: one of your medial (or innermost) hamstring muscles. It lies underneath:
- Semitendinosus: the other medial hamstring. This almost lies on top of your semimembranosus
Types of hamstring injuries
Usually a hamstring tear occurs during:
- Sprinting: either during high speed running or during the acceleration/deceleration phase (think of any team sport or track and field)
- Stretching: usually during activities like kicking (think AFL), splits position (think dancers) or during a gliding tackle (think soccer).
Of the three muscles mentioned above the most common to tear during sprinting injuries is your biceps femoris. And your semimembranosus is most common during stretching injuries.
When do hamstring injuries occur?
During sprinting your hamstrings produce a huge amount of force when your foot is in contact with the ground to propel you forward.
You can sometimes injure you hamstring here as you propel forward and have the extra external force of the ground.
However, it more commonly occurs during the later part of the ‘swing phase’ of your sprint.
During this period your knee is extending (straightening) but your hamstrings are trying to contract and shorten in preparation for you foot to strike the ground.
Both these actions are happening very quickly, creating a large amount of pull on the hamstrings.
Why hamstring injuries
Hamstring injuries can happen for a whole number of reasons. Some of these include:
- Increasing age
- Ethnicity (Aboriginal and African athletes are more prone)
- Decreased hamstring flexibility.
- Decreased hamstring strength (especially when compared to quadriceps strength)
- Fatigue (most hamstring injuries occur at the end of a game)
- Poor warm-up
- Previous injury
- Neural tension
- Previous ACL repair which used a hamstring graft
Prevention is best to avoid hamstring injuries!
Hamstring re-injury rate is a massive complication of an initial hamstring strain. 50% of re-injuries happen with the first 25 days of returning to sport. Therefore, a long-term hamstring “rehab” program is of vital importance in those sports where hamstrings injuries are high and for any individual that has previously had a hamstring injury.
Current best research has been shown that hamstring strength programs focusing on eccentric strength is the best.
What is Eccentric Strength?
You can strengthen muscles while they are lengthening, shortening or while being stationary.
Eccentric Strength: this refers to strength training while a muscle is lengthening.
Concentric Strength: this refers to strength training while a muscle is shortening.
Isometric Strength: this refers to strength training while a muscle IS NOT changing length.
A good example is a bicep curl;
The eccentric phase is while your lowering the dumbbell and your bicep is lengthening.
The concentric phase is when you’re pulling the dumbbell to your shoulder and the bicep is shortening.
An isometric example would be if you held the dumbbell at a 90 degree angle.
The Best Hamstring Strength Exercises for Prevention of Hamstring Injuries
1. The Nordic Hamstring
Begin in kneeling, dig your toes into the ground and have your feet anchored down (either by a team-mate or a bar etc.). Keep your hips straight and keep tall throughout the entire movement. Slowly lower your whole body down toward the ground for a count five seconds. Once all the way down on the ground push yourself back up to the starting position with your hands. Or bring your body back to an upright position without using your hands.
*Disclaimer: this is HARD. Watch Simon complete a Nordic hamstring here.
To make it slightly easier and build up to the above you can start by using more hip flexion. Watch here:
A good aim for these would 3 x 5-6
2. Arabesques (also known as single leg stiff leg deadlifts; what a mouthful!)
Begin without weight. Stand with both legs under your hips and then transferal your weight to one leg and keep a gentle bend in this knee. Start hinging at your hips keeping your trunk straight while at the same time sliding the other foot back as if you were kicking something behind you. Imagine a straight line from your head to the foot in the air. From here, keep everything straight as your return back up to an upright position.
Aim for 3 x 10 and lower reps if adding weight.
Start in an upright position with one hand holding onto support and legs slightly split. Place all you body weight onto the heel of one leg with your knee slightly bent. Glide the leg without weight on it backwards. This will need to be performed with the gliding leg on a slippery surface. (For example wearing a sock on tiles or a slide board).
A good aim for these would be 3 x 6-8
4. Long Lever Bridges
Lie on your back and place one foot on a bench, keeping the knee slightly bent. Push up through your heel to lift your bottom off the ground. Return your bottom back to the ground with control.
Aim for 3 x 10-15
Other Tips to Prevent Hamstring Tears
1. Keep your Lumbar Spine Mobile
Lie on your back, keep one leg straight and bend the other up. Use the opposite arm to the bent knee to pull it across your body. Try to keep your shoulders flat so the movement is coming from you lumbar spine.
2. Keep Glutes Flexible
Lie on your back. Bring your knee to your chest, place the same side hand on the outside of your knee. Place your other hand on top of your foot. Pull your foot towards your chest and push your knee across to your opposite shoulder.
3. Keep your Nerves Gliding Smoothly
Sit on a table or a chair with a rolled towel underneath your knees. Sit slumped with your head down towards your knees. Lift your head and at the same time pull your toes back towards you and straighten your knee. Hold for 1-2 seconds. Then bend your knee, point your toes and let your head drop down.
Hamstrings injuries are common and can present in many different ways. If you are suffering from any form of hamstring pain call us at Sport & Spinal Physiotherapy on 62624464 to book an appointment today.