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HAMSTRING INJURY MANAGEMENT AND REHABILITATION

Updated: Jul 7




Hamstring strains are one of the most commonly seen injuries in the football codes. Depending on their severity, they can be rather debilitating. The return to sport process involves a number of stages off and on the field and it starts from the moment an injury is sustained!


Acute management of a hamstring injury should include the ‘RICE’ and ‘NO HARM’ principles:


  • Rest, Ice, Compress, Elevate (RICE)

  • NO Heat, Alcohol, Running, Massage (HARM)


Try to follow these principles in the first 48 hours of your injury to promote early tissue healing


The typical goals of rehabilitation include:


  • Performing exercises as close to pain-free as possible

  • The safe return to repeated high-speed running and direction changes

  • A progressive return to play


Early-stage rehab focuses on promoting tissue healing while avoiding provocative activities and performing low-load and functional exercises. Some examples of these exercises include:


  • 2 leg bridges – lying on your back with your heels on the ground and knees bent to 90 degrees, push your hips off the ground so you form a ‘bridge’ at the top, slowly lower back down

  • 2 leg squats – slowly squat down (45-90 degrees) with both heels on the ground and your trunk as upright as possible, return to the starting position

  • Heel dig holds – lying on your back, dig your heels into the ground and hold for 5 seconds at a time. Repeat at different angles of knee flexion

  • Lower load eccentric hamstring exercises can then be implemented into our rehab. Askling et al. (2013) found that implementing these low load eccentric or ‘lengthening’ exercises into hamstring strain injury rehabilitation decreased the time to return to sport by 45% when compared to conventional rehab exercises. These include:

  • The ‘Extender’ – maximally flexing your hip, and extending your knee to as far as tolerated/as close to pain-free as possible  repeat

  • The ‘Diver’ – standing on the affected leg, slowly hinging at your hip to bring your trunk as close to parallel to the ground as possible then slowly return to the top  repeat

  • The ‘Glider’ – the affected leg is on the ground where the unaffected leg is on a slide-board, we hold on to a stable surface and slowly slide our unaffected leg back as far as our stance (affected leg) comfortably allows, slowly glide back to the starting position; using your arms to assist  repeat


The Nordic hamstring exercise is a high load, knee-dominant, eccentric hamstring exercise. This exercise has been found to reduce hamstring strains by up to 50%. This exercise is typically seen in the later phases of rehabilitation or used in an injury prevention program.

Although strength is an important factor in our rehabilitation, returning to play from a hamstring strain is usually guided by our reintroduction to running and training. Given high speed running is one of the most common mechanisms for hamstring strains, a gradual return to running, and high-speed running is integral to returning to play.

It is recommended you seek guidance with your rehabilitation from one of our Physiotherapists. We can provide you with a strength and running program, along with a plan for returning to training and subsequently play, to get you back to your desired activity or sport.


References:


· Whiteley et al. (2021), Aspetar

· van Dyk et al. (2019)

· Askling et al. (2013)


Created By:

Luke Chetcuti

Body Fit Physiotherapy North Adelaide

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