The fast facts:
- Hamstring injuries are common in a variety of sports
- In professional soccer, 12 - 16 % of all injuries are hamstring injuries
- in 75% of all cases it involves the biceps femoris
- Within two months, 12-25% of those with a hamstring injury re-injure the hamstring
- No clear criteria exist as to when sport can be safely resumed
- Sports resumption should therefore be an informed choice where multiple factors must be viewed
Anatomy and function of the hamstrings
The hamstrings are a group of muscles at the back of your thigh. This muscle group runs from your ischial tubercle to both the inside and outside of your knee. The hamstrings are active across two joints, the hip and the knee. Because the function of the hamstrings is dual, the risk of injury is also greater.
The different types of hamstring injury
A hamstring injury is one of the most common non-contact injuries in various sports. We can classify hamstring injuries into two different types. This classification is made based on the mechanism of occurrence.
A type 1 hamstring injury results from injuries resulting from a sprint or peak load on the muscle group. Besides sprinting, other examples include: jumping, hurdling in athletics or a deadlift in powerlifting. When we look at sprinting, we see that this injury often occurs in the moment when the foot is just about to hit the ground. At this stage in the sprint pattern, the forces are the greatest. The muscle is now firing at maximum but also needs to brake eccentrically to maintain good control of the knee and position of the foot on the ground.
- 12-16% of all injuries in professional soccer are hamstring injuries
- 75% of the cases involve injury to the biceps femoris
A type 2 hamstring injuries are injuries where there is a lot of stretch on the muscle. We often see this in gymnasts or dancers. This happens when the hip has to bend to the maximum and the muscle stretches excessively. In most cases, this is a less painful injury but the recovery time is often longer because the injury is in the upper part of the hamstring toward the tendon. This type usually involves injury to the semimembranosus.
Gradations of muscle injury
With a muscle injury, we use different degrees. Namely, it is possible that there is only muscle pain or a mild strain. But it is also possible that there is a muscle tear or even a complete tear.
- 1A Fatigue of the muscle which can result in muscle strain, usually due to overuse or exercising on a different surface.
- 1B Muscle pain, generalized muscle pain of the adductors, usually caused by powerful moments of braking during sports.
- 2A Muscle injury due to radiating pain from the low back
- 2B A local neuromuscular dysfunction of the muscle
- 3A Minor local muscle tear less than 1 muscle bundle
- 3B Medium-sized muscle tear, multiple muscle bundles involved in the injury
- 4 (Sub)total muscle tear, avulsion fracture
- Muscle contusion due to severe collision with outside person or object
Risk factors for getting a hamstring injury
There are several known risk factors for developing hamstring injuries:
- A previous hamstring injury
- Reduced strength of the hamstrings relative to the quadriceps
- Older age increases risk of hamstring injury
- Fatigue during sports
- Reduced neuromuscular control
- Reduced control of the pelvis/low back
How is a hamstring injury diagnosed
A discoloration may be seen on the back of the leg. In addition, the picture is confirmed by pain on tightening, stretching and palpation of the hamstring. Additional examination is often not helpful in a hamstring injury. The chosen treatment will not change much, if at all. However, an avulsion fracture should not be missed.
An avulsion fracture occurs particularly after an accident where the knee is forcibly extended and the hip flexed. An example is slipping with your leg forward. There is blue discoloration of the back of the leg in all cases. There is also substantial pressure pain on the sit bone. When there is an avulsion fracture, there is no tension felt from the tendon that attaches to the sit bone. In this case, an MRI or ultrasound scan is necessary.
Physical tests for a Hamstring injury
Often the diagnosis is already fairly clear when there is discoloration. To confirm this suspicion, several physical tests are performed where the recognizable symptoms are provoked.
Strength test of the hamstring
The hamstring provides knee flexion and hip extension. These two directions are therefore tested by the examiner. The test is positive when there is recognizable pain.
Stretch and palpation of the muscle group
With the knee in an extended position, the hip is flexed. When there is recognizable pain, the test is positive. When there is a grade II hamstring injury, it can be observed at the site of the tear.
The different stages in the treatment of a hamstring injury
Successful rehabilitation consists of several stages and steps. Good strength, coordination and optimal movement patterns are necessary to safely return to your sport.
Adjusting the (training) load
In this phase, we focus primarily on symptom reduction. There is often swelling, pain and reduced mobility of the hip and knee. Therefore, it is important to regain good control over your movements in the hip and knee. After a hamstring injury, we often see a change in the walking pattern. So it is important to quickly regain proper function of the muscle.
Strength and coordination phase:
In this phase, there is more of a build-up in strength. How quickly this is built up depends on the reaction of the hamstring to the given load. Because the risk of a new hamstring injury is high after a previous injury, it is extremely important to make a lasting build-up in strength and coordination of the hamstring. and the rest of the chain. Often this is vastly underestimated and the chances of re-injury are greater than intended.
The final phase focuses particularly on maximum strength, jumping power and explosiveness. This is all necessary to quickly change direction within your sport. Competitive fitness is also worked toward so that you can continue to perform under fatigue. The quality of movement must remain good under these conditions. One of the most important pillars are high intensity runs, it is seen in the literature than individuals sprinted significantly less often hard after a hamstring injury, if they did there was a greater chance of a relapse/re-injury. the importance of a good build up in high speed sprints is therefore extremely important.
The timing of resuming sports remains a difficult decision. This is because there is no clearly proven criteria exist for sports resumption. Wanting to restart too early often leads to a new injury. In all cases, the athlete must be able to sprint painlessly, tighten the hamstring maximally and perform sport-specific skills (shooting a ball). In addition, a dosed build-up in training must be made before (league) matches can be resumed.
Rehabilitation at Physio Fitaal
During rehabilitation, small or large setbacks can always come your way. Especially in certain phases, things will go slower than you thought beforehand. Patience is necessary. Our specialists will guide and motivate you as much as possible during this process. Fysio Fitaal works with specialists in the field of sports rehabilitation. Through this combination of expertise, extensive facilities and passion for sports, you have come to the right place.
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