Matt Wallden | Hamstring Strain
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Hamstring Strain

Hamstring Strain

Not again!

Hamstring strain is not only the most common injury across all sports, but also the most recurrent.  Your biggest risk factor in getting a hamstring strain is having a history of hamstring strain! In other words when you’ve had it once, the chance of recurrence is high. But why is this?

Figure 1: Research shows your biggest risk of getting a hamstring injury is if you’ve already had one before…

“Scar tissue” is often given as the reason for recurrent hamstring strain, but there is a slight issue with laying all the blame on scar tissue; as most other muscles strains are rarely recurrent… so, surely, if it was scarring from an initial tear, any and all muscles that tear would be prone to recurrent tears?

Well, the most common answer in the research on this topic seems to be that scar tissue may form in the muscle compromising the strength and flexibility of the hamstring – making it more likely to tear again. Luckily, there are many things you can do to help your hamstring recover well and minimise scar tissue formation; from optimising nutrition, to massage, to a soak in the bath and just moving!
Figure 2: Here you can see how the weight of the head, arms and trunk (HAT) drops downward when the foot strikes the ground in running or jumping, while at the same time, the ground reaction force (GRF) travels up the leg and they meet at the pelvis. The effect of this mechanical loading (due to the natural curve in the low back and the positioning of the abdominal organs) is to tip the pelvis forward. This forward tip is resisted by the lower abdominals, the glutes and the hamstring muscles (orange dotted lines).

However, recurrent hamstring injury was the area I did my Master’s research on, and it seems that there are many potential reasons for this risk of reccurence. For example, the hamstrings are part of a key stabilisation mechanism of the pelvis during walking and running, so if there are any issues at the pelvis, such as restrictions where the pelvis meets the spine, or compromised function of other muscles that stabilise the pelvis, then the hamstrings may be at greater risk of injury or re-injury.

The bigger question, really, is why did the hamstring muscle get injured in the first instance? A common scenario is that the lower abdominal muscles work together with the hamstrings to counteract the effect of gravity, which is always attempting to tip the pelvis forwards. If, for some reason, the lower abdominal muscles are deconditioned or inhibited (as can happen with a history of low back pain or with certain conditions affecting the organs, such as IBS or PMS), this can increase risk of injury in the first place.  Of course, if these possibilities are not assessed for, or addressed (ie if the hamstring is just rubbed, stretched, strengthened to aid recovery), then the original cause has not yet been tackled and repetitive injuries become more likely.

There are many possible drivers of hamstring strain, and commonly it will not be just one driver that causes the injury but, more likely, the combination of many smaller factors that end up creating a large overload on the muscle. Here are a list of some of the areas I would assess and address if someone comes to see me with a hamstring injury – and especially if it is recurrent:

  • Foot mechanics
  • Motor control at the hip
  • Lumbo-pelvic mobility and stability
  • Movement strategy (eg quad dominance)
  • Shoulder function
  • Head posture
  • TMJ (jaw joint) function
  • Physiological load (overall stress on the body)
  • Nutrition
Figure 3: This is an example of some factors considered in a recent paper on Hamstring Muscle Injury Risk Factors (from Buckthorpe et al. 2018. Recommendations for hamstring injury prevention in elite football: translating research into practice. Br J Sports Med)

In my webinar, called “The Hamstring Insight“, I go into more detail on a number of these mechanisms and include 2 papers that I have written on the topic as freebies! The contents of these papers and webinar have been presented to the rehabilitation teams at all of the Premiership and other professional football teams in the UK, and I have consulted for several of these teams to share these insights.

If you’d like to learn more about these potential contributing factors or to assess them in your own body, I have put links in the bullet point list above which should allow you to learn more about how to optimise your function.

There is also lots of great free information about hamstring rehabilitation and recovery in my FC2O Podcast with Peter Horobin on the topic [LINK].

If you’d like to book an appointment for consultation, or to contact me with any questions, please email me here. If you’d prefer to do as much as you can yourself (which I encourage), I have provided several resources above, and more insights into calculating the overall stress on your system – and what to do about it – can be found here [LINK].

Good luck!

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