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Facts Needed to Prevent Hamstring Strains

Once youve experienced a hamstring strain, you wish nothing more than f or it to never have happened or at least f or it to never happen again. T he sad truth behind this desire is that once youve strained it once, it has an increased risk of reoccurring. T his is especially true if youre perf orming any activity that requires hip f lexion combined with knee extension such as sprinting. If youre doing sprints in your program, this can be a very dangerous set up if you have a history of hamstring strains. Once youve pulled a hamstring, you have a risk of injuring it again f or up to a year af ter the f irst injury. T he long recovery period is partially the reason why the recurrent rate of injury is so high. Its important to understand what happens anatomically when a hamstring is strained and learn the most ef f ective way of treating and preventing the injury to limit f uture strains.

Risk f act ors and injury process

Hamstring strains can be the product of a culmination of issues in the leg. T here is evidence that any previous injury to the hamstring, older age, and limited quadriceps f lexibility can all have a role in f uture hamstring strains (4, 5). Limited quadriceps f lexibility when assessed with a T homas test had a higher incidence of hamstring pulls (4). Surprisingly, hamstring f lexibility wasnt one of the f actors that accounted f or hamstring pulls. It also displayed a link in the muscular imbalance between the quads and hamstrings as a leading f actor at play with strains (2). T he overpowered quadriceps increase f orcible extension speed of the leg, which can cause overpulling of the hamstrings, especially when movements powerf ul by nature are perf ormed. When looking into other f actors that perpetuate the problem, some studies f ound that when an athlete is older

in the sport, there is a greater incident of strains (4). T his can be linked simply to the f act that there is more time f or an injury to occur in the athletes playing or lif ting career when compared to the younger athlete. Age alone isnt a determining f actor in the event of a hamstring pull. T he greatest disposition f or a f uture hamstring strain is most related to a previous strain. But what causes the strain in the f irst place? T he injury process f or a strained muscle starts where the swing of the leg ends. When the leg is f ully extended out (like a kick) and absorbing the f orce f rom the swing of the leg, the hamstrings are eccentrically contracting. Lengthening the muscle (specif ically the biceps f emoris) under f orce leads to the excessive pulling on the muscle and can cause strains. Most of these strains happen at the point where your tendon transitions into the actual muscle belly (3). When it is pulled, inf lammation immediately goes to the area of injury to prevent f urther damage and to begin the healing process. Once damage has occurred to the muscle, MRIs have shown that scar tissue can persist on it f or 1223 months (10). T he scar tissue limits the length that the hamstrings can contract. T his is part of the reason why previous injury to the area primes it to be injured again. Considering that hamstrings are so susceptible to f urther injury, a practical and pointed rehabilitation approach to the area is vital f or getting back in the game injury-f ree.

Prevent ing f ut ure st rains

In ef f orts to prevent f uture strains on an injured leg, the quickest way to solve the problem is to get to the source of the issue. Strains occur when the muscles of the hamstrings are f orcef ully eccentrically contracted. Outside of tissue healing with T ENS units, ultrasound, and massage, the f irst step of rehabilitation should be training eccentric contraction of the hamstrings. Exercises such as box depth drops both loaded and unloaded, sled dragging backward, and single leg Romanian deadlif ts are great at accomplishing this task (9). Moving up the kinetic chain is step two of the rehabilitation process. T he hips have a huge role on overall hamstring length. If they are out of alignment (e.g. anteriorly tilted), the hamstrings f unctional length is decreased. Working to reestablish normal hip position helps prevent f uture strains. Exercises such as half kneeling chops, rotating core planks, bowlers squats, and hip neutral ball leg curls are all ef f ective at accomplishing hip alignment (9). Studies have shown that when specif ic core stabilization exercises (such as those listed) were perf ormed with f ocus on proper hip alignment, there was a 70 percent decrease in a consecutive injury of the hamstring when compared to a group that didnt f ocus on hip alignment and strength as a rehabilitation technique (8). T his result was seen af ter one year f rom returning to sport. Hip strengthening and proper alignment have produced impressive results in limiting the risk of consecutive injuries. Correcting muscular strength is only a piece of the puzzle. Controlling how the muscles move can prevent hamstring strains as well. While its important to correct the muscular length and strength of the hamstring, the overall control of the leg and how it reacts can be f actors that need attention as well. It has been shown that having underdeveloped neuromuscular control of the leg can be just as risky in causing strains (1). Rehabilitation techniques that work on correcting the movement pattern of the leg show promise in limiting f uture hamstring pulls. When the leg has excessive movement outside the normal plane of motion when sprinting, the neuromuscular system is unf amiliar with having the muscles in certain positions and a strain can occur. In these unf amiliar positions, muscles arent used to contracting in a specif ic f ashion, and weakness in synergist muscles creates a situation that can overstretch the hamstring and lead to injury.

Vern Gambetta and Benton have advocated a dynamic multidirectional warm up f or years (6). T his wont only prime the body f or the workout, but when agility and dynamic stretches are perf ormed correctly, it trains the neuromuscular system to f ire correctly in unf amiliar positions. Ultimately, this can reduce the amount of strains that can occur over a season or even a lif etime. T he proprioceptive and neuromuscular f iring improvements f rom the use of dynamic warm ups displayed a 36 percent decrease in the rate of hamstring strains in a group of f emale soccer players over a three-year span (7). T hese are extremely positive results f rom just adding in a dynamic warm up. It should be an easy addition to any program to help rehabilitate and prevent strains. Using a well-rounded approach to combating the issue of another injury to the hamstring is the best way to make sure that you tackle the issue f rom all limiting f actors that can cause the problem.

Summary
Hamstring strains can be a very prolonged injury. Once you experience a strain, the risk of injuring the hamstring again is always looming in the f uture. It can be a challenge to return to the f ield or weight room with f ull conf idence in your lower half . T hough it will take time f or the healing process to f ully complete the cycle, the use of specif ic preventative measures can get you back in the game. Focus on strengthening the muscles. In addition, extended proper hip alignment and neuromuscular control of the leg attack the problems directly at the source of injury. Specif ically, this is accomplished with eccentric hamstring exercises, hip stabilization exercises, and dynamic warm ups. T hese are the tools f or a successf ul rehabilitation process that will retard any f uture strains. Take time to throw these f ew things into your training program and they can keep you on the f ield or in the gym. Limiting your time lost will always be the best method f or moving f orward. Goals are never achieved f rom the sidelines.

Sources
1. Cameron M, Adams R, Maher C (2003) Motor control and strength as predictors of hamstring injury in elite players of Australian football. Phys Ther Sport 4:15966.

2. Croisier JL, Ganteaume S, Binet J, Genty M, Ferret JM (2008) Strength imbalances and prevention of hamstring injury in professional soccer players: A prospective study. Am J Sports Med 36:146975. 3. De Smet AA, Best TM (2000) MR imaging of the distribution and location of acute hamstring injuries in athletes. AJR Am J Roentgenol 174:39399. 4. Gabbe BJ, Bennell KL, Finch CF, Wajswelner H, Orchard JW (2006) Predictors of hamstring injury at the elite level of Australian football. Scand J Med Sci Sports 16:713. 5. Gabbe BJ, Finch CF, Bennell KL, Wajswelner H (2005) Risk factors for hamstring injuries in community level Australian football. Br J Sports Med 39:10610. 6. Gambetta V, Benton D (2006) A systematic approach to hamstring prevention and rehabilitation. Sports Coach 28(4):16. 7. Kraemer R, Knobloch K (2009) A soccer-specific balance training program for hamstring muscle and patellar and Achilles tendon injuries: An intervention study in premier league female soccer. Am J Sports Med 37:138493. 8. Sherry MA, Best TM (2004) A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther 34:11625. 9. Sherry MA, Best TM, et al (2011) Hamstring Strains: Basic Science and Clinical Research Applications for Preventing the Recurrent Injury. Strength and Conditioning Journal 33:56 71. 10. Silder A, Heiderscheit BC, Thelen DG, Enright T, Tuite MJ (2008) MR observations of longterm musculotendon remodeling following a hamstring strain injury. Skeletal Radiol 37:1101 09.