Searching for solutions to the footballers arch enemy. The dreaded “hammy”.
When I was asked to provide a football based article for this website, it didn’t take long to come up with a topic that most people in the football would have come across numerous times – hamstring strains. These injuries seem to attack an alarming number of our players, and the horror stories and magic cures find their way into the media through the course of most seasons.
Facts from the Research
Between 1997 and 2002, the AFL medical association conducted a review of injuries in the country’s premier AFL competition. The research showed that 13% of injuries sustained by players were to the hamstring. This equated to a rate of 6.1 hamstring injuries per team, per year and a loss of 20.8 games per year. When these games lost are from the leading players in the side, this figure can be the difference between finishing top four or missing out on the finals.
Fortunately, this knowledge has lead to a gradually lower injury rate in recent years, and a steady decline in recurrence of injury which was at 33% at the time of the study.
The important thing for Physio’s and Sports Med practitioners is to focus on having a thorough understanding of what is going on with an injury and applying a scientific approach to treatment. In the end, most injuries will respond well if treated correctly, so the main battle is getting your players understanding the need for appropriate management of their injuries.
Where are the hamstring muscles?
The hamstrings is a group of three muscles situated at the back of the thigh. They are the biceps femoris, semitendinosus and semimembranosus. The biceps makes up the outside part of the muscle group while the other two are on the inside. All the muscles come from the ischial tuberosity which is the bone that we sit on and attach into the tibia and fibula.
The biceps has a double nerve supply, which leads to one theory about injury to this muscle, with the suggestion that if both nerves don’t fire at the same time an injury can occur. All three muscles are involved with pulling the hip backwards and bending the knee.
What is a hammy tear?
Muscle strains are divided into three grades. A grade one injury involves a minor degree of damage, grade two injuries see more fibre damage as a partial tear, while grade three describes a severe or complete tear.
Players describe hearing or feeling a “pop” in the posterior thigh with swelling and bleeding developing on the first or second day. On assessment, muscle strains are diagnosed by finding one or all of palpable tenderness, decrease in stretch range of motion and a decrease in strength of the affected muscle.
What do I do next?
The first 48 to 72 hours following injury are some of the most important. Players, trainers and physiotherapists need to have a commitment to correct management in the first few days to accelerate rehab and recovery.
So, make sure you follow the important principles of good injury care by doing the following:
1) Follow the RICE principles
F Rest the injury – using crutches may be helpful
F Ice – 15 to 20 minutes every 1 to 2 hours
F Compression – bandage or stocking
F Elevation – can be difficult unless you are in bed
2) Avoid the HARM factors
F Heat – don’t heat the area as it causes more bleeding
F Alcohol – don’t drink alcohol as it increases bleeding
F Re-injury – be prepared to rest the area to avoid re-injury
F Massage – early massage can cause further damage
3) Sub-acute care –
supervised by a physiotherapist
F Begin massage, ultrasound, stretching, bike and pool after day 3
F Progress to strengthening work at day 6
F Light running can usually start at the end of the first week
F A functional running program is vital for full recovery
Recurrent or Difficult Hamstrings
There are a number of factors that can lead to ongoing problems with a hamstring injury. These are the frustrating ones that don’t respond to treatment initially and we need to look at other issues. Some of the most important factors to consider include: referred pain from the low back, adhesions of the sciatic nerve and its surrounding sheath, abnormal quadriceps power and postural problems including muscle tightness and weakness around the pelvis.
It is important to consider the lumbo-pelvic region and its stability. Programs like Pilates, Yoga and Swiss Ball regimes can be helpful in establishing excellent core stability.
Prevention of injury is always better than trying to find a cure. Appropriate training programs seem to be vital in preventing injury including components of flexibility, functional strength, correct running training and core stability.
During the driest time in recent history in Victoria we have seen an increase in injury due to hard grounds and muscle fatigue in the heat. Watering grounds when able and providing adequate hydration for players are important. Consider the extra cost of providing sports drinks for players before, during and after games as an investment in decreasing gun players missed game time.
I would also recommend compressive sports garments such as Skins or LineBreakers to provide support and prevent injury.
The Last Word!
The first and most important thing to remember with hamstring injuries is to address the basics of injury management initially and then seek qualified care from a Physio or sports medicine professional. They can look at some of the associated problems and guide you through a correct rehab program.
Don’t rush your return. There has been a gradual decrease in re-injury in the AFL as clubs show a more conservative approach to getting players back on the park. The 21 day rule before returning to sport is a good guide, however more time may be required and advice is recommended.
For further information contact Matt. Clark MCPhysio at [email protected]