HAMSTRING STRAINS
Sports Injuries and returning to sport: ham string strains
In this article we review a common type of sports injury – hamstring strains. The following are a few tips on returning to sport after injury. Please note that these tips are only general and are not a substitute for seeing a trained health professional. If in doubt about the severity of an injury you should see your doctor or physiotherapist for an assessment.
A strain is a tear of the muscle, in this case of the hamstring muscle, which can range in severity from mild to very severe, which involves a complete tear of the muscle. We will review the severity of the injury, which has a direct bearing on the recovery time, as well as causes, treatment aims and specific types of treatment.
1. SEVERITY OF INJURY:
Grade 1: this injury involves some tightness in the back of the thigh with mild swelling and difficulty in running at full speed. Recovery time is from one to three weeks.
Grade 2: is an injury in which walking is affected, the area is tender when touched and it is painful when bending the knee against resistance. Recovery time is from four to eight weeks.
Grade 3: with this injury you may need crutches to walk because pain is severe and there is considerable weakness of the muscle compared to normal. There is noticeable swelling and bruising within 24 hours. Recovery time is from three to six months and may also require surgery.
2. CAUSES:
Hamstring injuries are typically caused by deficiencies in the muscle’s ability to ‘absorb shock and rebound’ during running, as well as poor intermuscular coordination and eccentric strength. Other factors include: poor running technique, lack of warm up, overtraining, fatigue, lower back pathology and the quality of playing surface (e.g. slippery). So in order to prevent hamstring injuries you need to make sure that you properly address the abovementioned factors.
3. TREATMENT AIMS:
Reducing pain is the first step of treatment. Improving any muscle range of motion is important, while strengthening is introduced a bit later into the healing process. Treatment may also focus on the lumbo-pelvic region (lower back and pelvis) if these are thought to be contributing to the injury. Specific aspects of a person’s desired sport may be focused on next; these include speed, proprioception, agility and balance.
4. TYPES OF TREATMENT:
Initial treatment: RICER
RICER is an acronym for Rest, Ice, Compress, Elevate and Referral and is used as a general guide to soft tissue management. The injury should be rested to prevent further damage. It should then be iced (no longer than 20 minutes at a time), compressed (firmly, but not to completely prevent blood flow) and elevated (above the level of the heart) to reduce excess swelling and limit blood flow to the area. Referral to a health professional is then recommended for optimal recovery, especially if the injury appears moderate to severe.
Rehabilitation: Stretching and strengthening
These are two important components to most injury rehabilitation programs. Nonaffected muscles and joints can be targeted immediately, so long as pain is not produced in the affected area. For example, although the hamstring may still be recovering, ankle and lower back exercises can be safely performed.
Gentle stretching and light strengthening hamstring exercises should then be added to
the program, in order to regain full function of the injured muscle and the hip/knee. This is also important as it helps align the scar tissue that forms during the normal healing process.
5. Additional treatment modalities:
Ultrasound, electrical stimulation, including SCENAR therapy (which delivers short pulse electronic stimulation), heat packs and soft tissue massage are just some of the treatments that can aid in the recovery from this type of injury. Equipment such as foam rollers, therabands (i.e. exercise bands ideal for strengthening and rehabilitation), ankle weights and Swiss balls are just a few of the potential tools that may be utilised. Your physiotherapist can advise what is most appropriate for your specific injury and the exercise program which has been designed for you.