Hamstring injury rehabilitation

We've covered in an earlier article on ways to prevent a hamstring injury. So if you've been one of the unlucky (or under-prepared!) ones who have had a hamstring injury, what is the best thing to do? With a thirty percent recurrance rate of hamstring injuries, best practice management first time is vital.

As little as 15 years ago, rehabilitation for hamstring injuries was often along the lines of massage, hamstring strength and hamstring stretch exercises. Unfortunately it isn't as simple as that! The hamstring activity is related to the muscles above (hip, 'core' muscles), the muscles below (calf), as well as your brain 'remembering' how to run. If any of these three things are not addressed, the risk of a subsequent injury is much higher.

There have been only two high quality (randomised controlled) trials looking at hamstring rehabilitation!
The first is from 2004 and the USA. Athletes with hamstring injury were given either

the 'traditional rehabilitation' (stretching, strength exercises and exercise bike), or
the 'PATS' (Progressive Agility and Trunk Stabilisation) rehabilitation program, which involved quick turnover drills, basic 'bridge' or 'plank' exercises, and some arabesque/balance type exercises.

The results were remarkable - the re-injury rate in the PATS group was only 10%, while the stretch and strengthen group had a reinjury rate of 55%! Furthermore, the time to return to sport was less with the PATS group (average 22 vs 37 days)
The second trial is more recent, from Sweden. This study used track and field athletes only, which makes quite valuable given the maximal nature of sprinting and the high hamstring injury rates in this sport.
The two groups were:

the 'L' (lengthening) protocol - 3 exercises using eccentric hamstring loading
the 'C' (conventional) protocol - 3 exercises using conventional exercises such as hamstring curl.

Again, the results were significant. The return to sport time for the 'L' protocol was 28 days compared to 51 in the 'C' protocol. The re-injury rate was 2 (of 28) in the C protocol, and 0 of 28 in the 'L' protocol group.

So what do we take away from this?

First time hamstring injuries should use some eccentric exercises as part of their rehabilitation, as well as some activities that include quick movements and muscles above and below the hamstring.
Of course it's not all that simple! Otherwise we wouldn't see a high recurrence of injuries like we see in AFL. Recurrent injuries are trickier to treat, and other individual factors such as lumbar spine pathology can impact on recurrence. The best approach is individualised but incorporating some of the research findings above.

References:

Sherry and Best, 2004

Askling, 2014

Aidan Rich is an APA Sports Physiotherapist at Advance Healthcare Boronia. He has an interest in sports medicine, particularly hip, groin and tendon pathologies. You can find more on Aidan or our practitioners page, on his website, on Google+ or LinkedIn