Are we letting our athletes return to sports too soon after a serious hamstring injury?
Sustaining hamstring injuries is frequently observed in sports that require sprinting and jumping. A significant concern related to such injuries is the possibility of recurrence. The exact duration it takes for an athlete to return to sports following a posterior chain injury remains uncertain. The recovery process for hamstring injuries greatly varies depending on the specific nature of the injury and the athlete. It is not always straightforward to determine the appropriate time for athletes to resume sports activities. It seems that our current treatment strategies may not be providing athletes with sufficient recovery time. Recent studies highlight a notable risk of reinjury when utilizing the existing return to sports criteria.
After experiencing a significant hamstring injury, one of our primary concerns is the potential for reinjury. When a reinjury occurs, it not only prolongs the recovery process for the hamstring but also raises the likelihood of future injuries throughout the patient’s career. Furthermore, in cases where multiple hamstring injuries have occurred, there is an increased risk of permanent weakness or pain. Rehabilitating a hamstring that has been injured multiple times becomes increasingly challenging.
There may be a potential risk of reinjury if we fail to allow full recovery following a hamstring injury, despite meeting the criteria of normal hip and knee range of motion, return of normal kinematics, proper form, and strength for return to sports.
The latest data indicates that there is a recurrence of hamstring injury.
- at the same site as the original hamstring injury.
- The average time to hamstring reinjury is 60 days.
- The time to reinjury following return to sports was only 4 weeks.
- Reinjury can occur up to 2 years after the original hamstring injury.
- Worst of all… the hamstring injury is often worse by MRI than the first injury.
To reduce the chance of reinjuring the hamstring, it is crucial to prevent the first injury and start following specific exercises and training programs that are effective in decreasing the likelihood of hamstring injury.
There is insufficient evidence to back up the use of static stretching (such as touching your toes) as a preventive measure for hamstring injuries before a match. A suitable warm-up routine involves jogging, short runs, and specific movements relevant to the sport to effectively prepare the muscles.
Research has demonstrated that the Nordic Hamstring Stretch reduces the likelihood of hamstring injury by as much as 60%. Furthermore, strengthening the posterior chain through training has also proven effective in reducing injury risk.
To minimize the likelihood of developing your first injury, it is advisable to incorporate exercising/nordic stretch, based on current research, into your club’s training or skills clinics. If an injury does occur, the athlete must be able to perform the challenging nordic stretch before being permitted to resume sports activities.
Types of a hamstring tear or strain
- Grade 1 — mild injury that heals within a couple weeks.
- Grade 2 — moderate injury that is typically a partial tear in the muscle; patients are likely to limp when walking and will have occasional twinges of pain during activity.
- Grade 3 — severe injury where the muscle is completely torn or a lump of muscle tissue is torn, and can take months to heal.
Causes of a hamstring tear or strain
Running is often the cause of hamstring tears or strains, as it involves stretching the soft tissues and muscles beyond their capacity. Additionally, there are other factors that can lead to such injuries.
- Limited or lack of warm-up before exercising
- Poor muscle strength or muscle fatigue
- Tight hip flexors or weak glutes
- Differences in leg length
- Poor flexibility
Risk factors for a hamstring tear or strain
Individuals with poor flexibility, inadequate strength, muscle fatigue, and improper warm-up are at the highest risk of experiencing a hamstring tear or strain, which closely aligns with the causes associated with this injury.
Additional factors that increase the risk of a hamstring tear or strain involve:
- Age — as you get older, you are at higher risk of a pulled hamstring.
- Previous injury — patients with previous hamstring injuries are at higher risk for a future hamstring injury.
- Certain sports — sports that require sprinting or sudden change in direction put patients at a higher risk for suffering a hamstring tear or strain.
Symptoms of a hamstring tear or strain
Experiencing a sudden and intense pain in the upper leg’s back is the initial indication of a hamstring tear or strain. Such pain can be extremely intense, to the extent that it hinders your ability to proceed with your physical activity.
The symptoms can vary based on the severity of the tear.
- Grade 1 — tightness in the muscle while stretching, inability to fully move your leg from bending to straightened, and inability to bear weight on the leg affected.
- Grade 2 — reduced muscular strength, limping when walking, and pain when bending the knee.
- Grade 3 — a severe, sudden, sharp pain in the back of the thigh, inability to extend the knee more than 30 to 40 degrees, inability to walk without pain, and severe bruising around the impacted area.
Diagnosis of a hamstring tear or strain
When diagnosing a hamstring injury, your primary care or orthopedic provider will conduct a comprehensive evaluation that includes reviewing your complete medical history and performing a physical examination.
During the examination, the doctor will assess the leg’s swelling, tenderness, and range of motion. In cases of moderate tears or strains, the physician might detect a groove in the muscle by touch.
If your provider suspects that you have suffered additional and more severe injuries requiring an alternative treatment plan, they may also request diagnostic testing such as an MRI or x-ray.
Treatments for a hamstring tear or strain
Patients with mild to moderate strains can usually manage their condition at home by following a treatment plan that includes rest, ice, compression, and elevation along with the use of anti-inflammatory medications. Additionally, the patient may be advised to use crutches for mobility assistance.
- Braces — braces can help keep the area stable during the recovery process.
- Physical therapy and rehabilitation — although most hamstring tears will heal on their own, they need special exercises and therapy to return to full function.
- Platelet rich plasma (PRP) injection — a PRP injection can help expedite the healing process by injecting growth factor platelets from the patient’s own blood back into the injured area.
