HOW DO HAMSTRING STRAIN OCCUR?

WHAT SHOULD YOU DO IF A HAMSTRING STRAIN OCCURS?

• Apply the RICED procedure...

•	ALWAYS seek the advice of a medical professional for an accurate diagnosis.

WHAT REHABILITATION SHOULD FOLLOW A HAMSTRING STAIN?

The following recommendations serve as a guideline only. Always seek the advice of a medical professional for a rehabilitation program specific to you and your injury.

Range of motion

•	Restoring normal range of motion will allow proper function of the hamstrings.
•	Stretching the hamstrings will help to restore the length of the muscles. This will reduce the risk of further injury and assist performance
•	Initial stretching should be limited by pain. Longer stretches (10 to 20 seconds) held at positions of greater stretch should be performed as comfort permits
•	A level of flexibility equal to or greater than the opposite leg is desirable before return to competition
•	Continued stretching during the season will help to maintain flexibility.

Cardiovascular fitness

•	Keeping fit will ensure a more comfortable return to training and competition
•	Over-exertion or continued activity while fatigued could lead to further injury
•	Non-weight-bearing activities such as swimming, cycling and arm ergometry (grinding) are good options at the beginning of rehabilitation.

Strength

•	Strengthening the hamstrings and other lower limb muscles is essential to restore proper function in the lower limb
•	Pay particular attention to developing a good strength balance between the quadriceps (front thigh muscles) and the hamstrings
•	Strengthening of the gluteus maximus (buttocks) and gastrocnemius (long calf muscle) is also important
•	Holding the leg in a fixed position for 10 to 20 seconds (isometric exercise) is safe until the wound is significantly healed and also prevents muscle wasting
•	As improvements allow, active (self-movement) and functional strength exercises should follow
•	Some strength exercises also need to be performed as the muscle lengthens (eccentric work) and/or at fast speeds to gain improvements
•	Strength can be measured by contracting against resistance provided by another person. Ask them to make a comparison of strength between legs.

Psychological status

•	Reduced confidence following a hamstring injury may prevent an athlete from attempting movements that will assist in full recovery (e.g. striding at full speed or accelerating rapidly while running)
•	Gradually attempting more difficult agility tasks and setting realistic goals and time frames may help to rebuild sporting confidence
•	Return to competition is not advised until an individual has 100% confidence in their playing ability.

Sport-specific rehabilitation

•	Speed training is the most important part of sport-specific hamstring rehabilitation as hamstring injuries usually occur during sudden explosive accelerations
•	Backwards running should be introduced between jogging and speed training
•	Gradually increasing straight line (forward) running speed (e.g. from 1/2 to 3/4 to full pace) and then introducing curves and bends work will help the scar become accustomed to rapid and multi-directional stresses
•	Adding rapid accelerations and decelerations, changes of direction (cutting at 45° and 90°) and jumping will also make the training more specific to sporting activity.

Ensure you are completely rehabilitated before returning to competition to minimise the risk of re-injury.

		POST-INJURY •  Have swelling and pain settled? •  Is stretching pain free? YES	NO	CONTINUE RICED TREATMENT If swelling and pain persist, consult a medical professional for further assessment and treatment
		BEGIN RANGE OF MOTION EXERCISES •  Gradually increase stretching •  Weight-bear as comfort permits BEGIN STRENGTH EXERCISES •  Isometric contractions

CAN YOU •  Contract hamstrings against resistance without pain? YES

NO

CONTINUE TO IMPROVE STRENGTH AND MOVEMENT

PROGRESSION •  Maintain stretching •  Gradually increase weight then speed as pain allows - focus on lowering the weight •  Balance on one leg •  Wobbleboard

MAINTAIN FITNESS Pain-free stationary cycling, swimming, pool running. Full weight-bearing

CAN YOU •  Contract hamstrings against resistance without pain? •  Achieve a full stretch? •  Balance on injured foot for an equal amount of time as the other foot? •  Demonstrate reasonable strength? YES

NO

CONTINUE TO IMPROVE STRENGTH AND MOVEMENT

BEGIN FUNCTIONAL EXERCISES •  Jogging when pain-free •  Acceleration/deceleration drills •  Jumping, hopping, twisting, figure of eight running

MAINTAIN FITNESS Jogging when pain-free, stationary cycling, swimming, pool running. Full weight-bearing

CAN YOU •  Run forwards and backwards? •  Slow down and stop suddenly? •  Jump and hop? •  Run up and down hills? •  Cut to the left and right at speed? •  Complete all exercises with 100% confidence? YES

NO

CONTINUE TO IMPROVE AGILITY AND SPORT-SPECIFIC SKILLS

RETURN TO TRAINING

MAINTAIN Fitness, Range of motion, strength, proprioception

HOW CAN YOU REDUCE THE RISK OF RE-INJURY? ALWAYS seek the advice of a medical professional before returning to sport. Inadequate rehabilitation and a premature return to sport will increase the risk of re-injury. •  Continue stretching and strengthening exercises as part of a normal training routine •  If there is pain during activity, stop and apply the principles of acute care (i.e. RICED) •  A neoprene sleeve can be worn to support the hamstrings and keep them warm during activity •  A thorough general body warm-up should be followed by stretching and a sport-specific warm-up. Stretching should also be performed after exercise •  Fatigue is a major contributing factor towards hamstring strains. Maintaining high levels of cardiovascular fitness and muscular endurance can help to prevent premature fatigue •  If hamstring strains continue to occur or if pain is persistent, consult a medical professional for advice on other possible contributing factors.