Hamstring Strains: Update On Rehab
With Tim Lowcock, Northern Pride Physiotherapist
The hamstring strain…. an extremely common injury in field sports such as Aussie Rules, Rugby League, Rugby Union. As a result, there is a large body of evidence we can draw upon to make highly informed and evidence based decisions on treatment, exercise prescription and most importantly return to play.
Through past research, we have found that the biggest risk factors for hamstring injuries are previous injury and age. Recently, new evidence has come to light about an important factor influencing the risk of incurring an injury.
Research suggests that there is one factor which can reduce the incidence of hamstrings strains more than any other. What is this magical cure you ask?
In the past, eccentric exercises have been a part of the rehab, but only until recently have studies discovered they are the best type of exercise to prevent and reduce the risk of hamstring strains. Eccentric hamstring strengthening alone has proven to reduce the risk of a new hamstring injury by 60% and prevent recurrent hamstring strains by up to 86%.
What does eccentric mean?
Eccentric movement is where a muscle is lengthening under load. Examples of eccentric movement are when stepping down a step your quadricep is lengthening to control your descent down the step. Your hamstrings work eccentrically when you are sprinting and are working extremely hard during deceleration or slowing down. That is why they are so common in field based running sports where these activities are performed regularly
What are some Eccentric exercises for the hamstrings?
One of the most common exercises out there is the Nordic hamstring Exercise (see pic below). This exercise targets the lower hamstrings (closer to the knee). To address other areas of the hamstring, exercises such as a Romanian Deadlift (RDL), or the 45 degree hip extension, allow you to work the upper portions of the hamstring, to get the entire muscle as strong as possible.
Nordic Hamstring Exercises Romanian Deadlift (RDL)
45 deg Hip Extension
Other considerations for rehab
I believe there are definitely a few other facets of rehabilitation that you need to consider, to get you back on the field quicker, and prevent you from being injured again:
- The glutes – both the glutes and the hamstrings are hip extensors. If the glutes are lacking strength, then the hamstrings have to make up the deficit. This leads to over load and eventually injury. Increasing the strength of the glutes can go a long way to unloading your hamstrings. This is a whole other topic and I’ll endeavour to elaborate on this further in the future in another blog post.
- In the end stages of rehab, some high speed running, deceleration and aggressive change of direction has to be incorporated and well tolerated. This will allow the tissue to prepare for what it is going to have to endure in competition.
In summary, increasing eccentric hamstring strength is an excellent way to reduce the risk of new and recurrent hamstrings strains. But remember:
- There is no one specific exercise that can do this, but a number of different exercises that can target different areas along the hamstring muscle.
- These exercises should be prescribed at the appropriate stages of your rehab, your physio or exercise physiologist is the best person to advise you when this may be.
- In the end stages of your rehab you should be completing high speed running, deceleration and aggressive change of direction without issue before returning to competition.