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Recurrence of a hamstring strain is incredibly frustrating, not only for the injured person, but also to see as a physiotherapist! A hamstring strain may reoccur if a person suffers a worsening of their original strain, or otherwise, another area of muscle along the muscle/group becomes injured. Commonly this occurs when the person is just getting back into training or attempting to return to their previous sport. It is disappointing to see as a physiotherapist since often re-injury is preventable with good management. Different outcomes will depend on factors such as the degree of the initial injury, its location (i.e. muscle versus tendon) as well as personal and external variables, however, general guidance can be provided for optimal rehabilitation.
Best tips for best rehabilitation and avoiding re-injury:
- Progress your hamstring through a series of exercises aiming to achieve full concentric/eccentric strength, dynamic muscle length, power and plyometric ability (strength with speed), and endurance, before considering returning to sport and sport specific drills. See Dynamic Stretches
- Ensure your hamstring has been rehabilitated through sport-specific tasks, when it is appropriate to do so. Exercises need to consider the location of the injury in the hamstring, stage of injury, and the multiple functions of the hamstring muscle. Your hamstrings will work hard when you are speeding up and slowing down from a run, stopping quickly, kicking a ball, bending forward from the hips (e.g. picking something up), and control twists and turns of the leg when you are moving at quick speeds. As such – the muscle group needs to be trained well to be able to cope with these activities for a successful return to sport. Even if your main sport is running, your hamstring should still be progressed to be able to tackle less frequent tasks with confidence for best function.
- Perform a graded, specific running programme which is best advised by a suitable physiotherapist. This should incorporate graduated progressions of running distance for endurance, sprint exercises, forwards/backwards/sideways and cutting movements, and stop-start work. Hamstring strains most commonly occur during quick acceleration or deceleration – and therefore this needs to be trained back for the tissue to be able to cope with this, under high repetition/load.
- Return to sport gradually! Make sure you progress back carefully towards a previous level of activity/intensity. The tests we can do for a hamstring in a physiotherapy clinic and even outdoors assessment are only one level of assessment. Fatigue has big implications for muscle. Only when you can manage full training sessions at 100% intensity over the week, then consider playing or running at a competition level. And even then, only playing only part of the first game back rather than the full game is best, since you will likely be working a lot harder in this situation! De-conditioning occurs from not playing sport in a while, and this may be when you are more prone to injury.
- Listen to the muscle. The helpful thing about a hamstring strain is that it often gives you big clues as to how it is going, and when it might be about to restrain! If the muscle or group feels tired, or like it is “tightening”, or “about to go”, then stop! It is at a high risk of reinjury at this point. “Pushing it” has a high chance for reinjuring the torn tissue or injuring healthy hamstring tissue from overload.
- Address any contributing factors. Common culprits which contribute to hamstring strains include biomechanics and imbalances about the spine, pelvis, hips and legs. For example, players of kicking sports may have imbalances from constant rotational forces in one direction, influencing pelvic/hip stability. Optimising core stability and glute/hip timing/power and balance with specific exercises is important to prevent overwork through hamstrings. Neural tension through the injured tissue or from tight associated hip/back structures can also increase the likelihood of restraint and there are treatments/exercises available to help this. Read more
- Maintain good hydration and nutrition throughout your rehabilitation, and use good recovery practices, for optimal muscle tissue healing and recovery.
If recurrent hamstring strains are a problem for you, seek advice from a good physiotherapist to help answer any questions and assess for any contributing reasons that may be leading to re-injury, as above.