Posts tagged hamstring strain
How Painful Should My Physical Therapy Feel After A Hamstring Strain?
hamstring-strain-muscle-pull-recovery

One of the most common questions we receive in our Boulder Physical Therapy practice involves how much pain should be felt with exercise. This is a complicated answer dependent on many factors including but not limited to the nature of the injury. In general, the field of sports medicine is moving away from a purely R.I.C.E. (rest, ice, compression, elevation) approach to injury recovery and has found a progressive, optimal loading approach may be better suited to less severe muscle injury. In fact, within acute muscle strains, exercise has been shown to accelerate a patient’s recovery compared to rest. General guidelines exist on the acceptance of a mild to moderate pain (1-4/10) which stops at the conclusion of exercise in these muscle strains, but a new research study examined the differences between this approach and a pain avoidance approach.

Hickey and colleagues in the Journal of Orthopedic and Sports Physical Therapy randomized 43 men with acute hamstring strains to one of two Physical Therapy groups (2019). Both groups underwent the same bi-weekly progressive rehabilitation program (bridging, hip extension, hamstring sliders, and nordic hamstring curls) but one group was instructed to remain pain free (0/10) while the other was allowed to complete these exercises with mild pain (<4/10). Authors completed a subjective and clinical examination at the start and conclusion of the study period (2 months) and also followed each athlete up to 6 months after their return to play. Authors reported no difference in time to return to play between the two groups, but the athletes allowed to exercise with mild pain demonstrated improved strength and hamstring muscle healing (measured by ultrasound) compared to the pain free group. Authors reported “the conventional practice of pain avoidance during hamstring strain rehabilitation may not be necessary” and instead advocated for an approach consistent with progressive, optimal loading.

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Strengthening Cuts Hamstring Injury Rates In Half
hamstring-injury-prevention-exercise

Hamstring injuries are common and can occur in any sport with any athlete. The three muscles of the hamstring are put through rapid lengthening and shortening contractions making them susceptible to strains or minor tears. Due to the common occurrence of these injuries, it is important to target proper strength and conditioning regimes to decrease the risk of injury to this muscle.

A recent article by the British Journal of Sports Medicine investigated the available research on the effectiveness of hamstring strengthening utilizing the Nordic Hamstring Exercise and its’ impact on injury rates (van Dyk. 2019). The review included over 8,459 athletes and found when the athlete's strengthening program included the Nordic Hamstring Exercises, the risk of injury to the hamstring decreases by 51%. As mentioned by a previous blog, the Nordic Hamstring Exercise recruits the hamstring more evenly with a eccentric contraction (contraction of muscles while lengthening) consistent with the demands of sport.

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Previous History of Hamstring Injury Associated With Reduced Sprint Performance
hamstring-strain-soccer-sprinting

Hamstring injuries are one of the most common injuries in both individual and team sports. In sports such as soccer and football these injuries involve a traumatic pull of the muscle while sprinting or accelerating. After the initial healing phase athletes must rehabilitate the injury with Physical Therapy exercises to regain optimal muscle function and reduce their risk for future injury. Hamstring injuries often become recurrent if strength is not normalized along the hip, knee, and ankle muscles along the back of the leg. A new article highlights how these injuries also limit performance in sprinting trials.

hamstring-injury-soccer-treatments

Roksund and colleagues studied professional soccer players and collected data on previous hamstring injuries, as well as, each athlete’s strength, flexibility, aerobic capacity, and sprint performance (Front Physiol. 2017). Of the 75 athletes included in the study, 16% sustained a hamstring strain over the previous 2 years. The previously injured athletes demonstrated a significant loss of velocity during a 40 meter sprint test, as well as, a drop in performance over repeated sprints compared to their healthy peers. Interestingly, measures of flexibility, strength, aerobic capacity, and maximum power was not significantly different between groups. Injured athletes are encouraged to work with their local Physical Therapist to accelerate their recovery from muscle strains and eventual return to sport.

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Nordic Hamstring Exercise Shown to More Evenly Recruit Hamstring Muscles
Photo Credit: Jospt.org

Photo Credit: Jospt.org

Hamstring injuries are a common sports medicine injury treated in our Boulder Physical Therapy practice.  These injuries can be placed in two categories: acute trauma often related to sprinting and cutting movements or repetitive stress and overload to the hamstring often found in athletes with weak gluteus muscles.  In our previous blog posts, we have described the importance of gradual loading of the injured hamstring to promote an optimal healing (remodeling) response, as well as, utilizing a hamstring strengthening program to reduce the risk of future hamstring injury.  A recent article sheds light on common exercises used to strengthen the hamstring and how these different exercises target the 3 muscles which make up the hamstring.

Messer and colleagues studied the hamstrings of active women without a history of lower limb injury (JOSPT. 2018).  All participants underwent a MRI both before and after performing eccentric (lengthening) contractions of the hamstrings on both of the exercises pictured above.  Muscle activation levels were calculated based on changes between the two MRI images.  The authors reported both exercises targeted the inner (medial) hamstring muscle, but the commonly utilized nordic hamstring exercise more evenly recruited all 3 hamstring muscles.    

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The Impact of Hamstring Flexibility on Hamstring Injuries

In our prior posts on injury prevention in sports we have highlighted the importance of training volume management, balance training, and strength training.  Of all the training options, strength training is the most important due to its' ability to cut an athlete's risk of injury in half.  Despite the evidence many healthy athletes focus a large percentage of time on static stretching either before or after practice.  With time being a finite question we must ask if stretching reduces injury risk.

A large prospective study in the American Journal of Sports Medicine was conducted on the impact of hamstring flexibility on hamstring injury incidence in 450 high level amateur soccer players (Huisstede et al. 2016).  The athletes' hamstring flexibility was assessed on the sit and reach test prior to the start of the season.  The athletes were then followed for 1 year to determine the incidence of hamstring strains.  5% of the athletes sustained a hamstring injury during the season, but the authors noted no significant relationship between flexibility and risk of injury.  

Athletes are encouraged to focus their sports preparation on proven injury reduction programs involving strength training, eccentric hamstring loading, and proprioception training.