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Hamstring injury: Diagnosis and Rehabilitation

Either you’ve experienced it yourself, or if you are an avid sports viewer, you would have no doubt have seen the terrible moment when an athlete grabs for the back of their thigh. Accelerating, high-speed running, jumping or kicking frequently precede failure within the hamstring muscle group, which consists of the biceps femoris, semitendinosus and semimembranosus muscles. It is this mechanism of injury that is the reason for it being such a common occurrence across many sporting pursuits.

Hamstring injury continues to be responsible for the greatest cost in terms of missed games for players in the AFL. Often occurring when the hamstring is experiencing eccentric loading, slowing the swinging leg when kicking, picking up a ground ball or being pushed when kicking are common mechanisms for injury in AFL footballers. Although this number has been consistent over the years, what we now see is that the incidence, or number, of hamstrings at each club, is reducing, as is the recurrence rate of hamstring injuries. A reason for this may well be that the diagnosis and management of hamstring injuries have evolved, and we are now considering aspects of a hamstring injury in far greater detail.

Diagnosis involves an in-depth subjective assessment coupled with an objective clinical examination. In the assessment, a practitioner will form an impression of the extent and severity of the injury, the likely structures involved and the potential mechanisms leading to the injury, in addition to potential risk factors that may have contributed to the injury. Additional investigation may be considered, to enhance the clinical picture further, as the anatomy of the hamstring group has become better understood through the ongoing development in MRI imaging.

Identifying the anatomical site of the hamstring strain has an impact on the design of a rehabilitation program. Ranging from an avulsion (pulling off) or rupture of the hamstring tendon, injury of the intramuscular tendon, strain at the muscle-tendon junction or myofascial tearing – each scenario may result in a different path to recovery. The most common muscle within the hamstring group to be injured is the biceps femoris. Recent research aimed at identifying the best exercises to target the biceps femoris has enabled more specific exercise prescription, although there is no definitive, gold standard exercise, it does demonstrate that a complete rehabilitation plan should contain exercises that target all areas of the hamstring. An extension to this is then to consider the rest of our kinetic chain and rehabilitate movement in a functional manner. The cornerstone of hamstring rehabilitation, particularly for running sports, is a graded running program. Documented by Graham Reid in 1991, this running program has since been adapted and modified worldwide and is integral in developing the speed and acceleration components necessary for a safe return to play, and to help prevent recurrence.

As in most situations, prevention is better than cure. Elite sporting teams may utilise a series of tests and monitoring methods to prevent the occurrence of hamstring injuries, but quite a lot of these can be implemented for any active sports enthusiasts to help reduce the risk of getting injured. It may just pay off if it means you get to play that Final, score that winning goal or hit the slopes before all of the snow melts away. At Olympic Park Sports Medicine Centre, our physiotherapists are experienced in assessment and the management of hamstring injuries, and are skilled all phases of rehabilitation from the acute post-injury phase, through to the return to sport and injury prevention phase.

Learn more about Lachlan Fooks and his work as a Sports Physiotherapist at Olympic Park Sports Medicine Centre and Collingwood Football Club at http://opsmc.com.au/person/lachlan-fooks/ or call 1300 859 887 to book an appointment. No referral is required to see Lachlan. 

References 

24th Annual AFL Injury Report: 2015. Melbourne: AFL Doctors Association, AFL Physiotherapists Association, AFL Operations Department, 2016

Bourne, MN., et al. (2016) Impact of exercise selection on hamstring muscle activation. British Journal of Sports Medicine. (In Press)

Opar, DA., et al. (2015). Eccentric hamstring strength and hamstring injury risk in Australian footballers. Medicine and Science in Sports and Exercise, 47(4), 857-65

Reid, G. (1993). Accelerated rehabilitation program. National Annual Scientific Conference in Sports Medicine, Melbourne, October 26-31.

Sherry, M. & Best, T. (2004). A comparison of two rehabilitation programs in the treatment of acute hamstring strains. Journal of Orthopaedic and Sports Physical Therapy, 34, 116-125.

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