Rehab for hamstrings
Okay so last blog we covered how to prevent hamstring injuries – but what if its too late and you already have an injury? How do we go about rehabbing hamstring injuries?
Hamstring injury and reinjury rates remain high in the population. This is thought to be due in part to the failure of rehab plans, and poorly defined levels for individuals to return to activity. Research is ongoing and recommendations for rehab continue to be updated.
To plan decent rehab we have to understand what we are trying to achieve. The obvious goal here is to achieve healing. Muscle healing is defined as a reparative process which involves formation of scar tissue. This process can take between 6 weeks to 23 months and is broken down into 3 phases:
- Destruction – this includes myofibres rupture and necrosis, haematoma, and the initiation of the inflammatory process
- Repair – phagocytosis, connective tissue production and revascularisation
- Remodelling – scar organisation, neo-myofibre maturation and recovery of functional capabilities
In an ideal world we want to stimulate regeneration whilst minimising scar formation. As with all musculoskeletal injuries, hamstring injuries will be multifactorial. Preceding factors to injury can include function of muscle, anatomy, genetics, muscle strength etc.
When designing a rehab protocol for hamstring injuries, I will often include the following elements:
Eccentric contraction of the hamstrings is high during the sprinting cycle especially at the terminal swing phase. Eccentric deficits and asymmetries have been associated with future reinjury. The ability of the hamstrings to produce high eccentric forces can lower the risk imposed by non-modifiable factors such as increasing age and previous injury history.
It is also important to increase the strength of the fascicle when in a lengthened position. Injury to the hamstrings can result in a change to the muscle architecture which can lead to fascicle shortening. Increasing the fascicle length may protect against future reinjury by shifting the angle of peak torque to longer muscle lengths.
Exercise example: Nordic Hamstring Curls (NHC)
The contractile element of hamstrings remain relatively isometric at the end of the swing phase. Isometric contraction reduces the mechanical work done by the contractile component of the muscle fascicle, increasing the spring-like behaviour of the tendon during the stretch-shortening cycle (it is worth noting here that more evidence is still required to confirm these processes).
Developing fatigue resistance during the isometric is also important to prevent reinjury. Strength training whilst under fatigue can have a positive effect on hamstring function.
Exercise example: Single leg Roman chair hold
Hamstrings perform a stabilizing role on the pelvis via attachments to the sacrotuberous ligament. Different planes of movement of the trunk will need to be targeted.
Sagittal plane: Leg lowers
Coronal plane: Prone hold with arm lift
Frontal plane: Single leg squat
Transverse plane: Pallof press
Weakness or reduced activation of gluteus maximus has been identified as risk factors for hamstring injuries. It is also worth considering the possibility of femoroacetubular impingement (FAI) as this can be high in athletic populations and one of the most common symptoms is a reduction in hip flexion. A reduction in hip flexion can lead to rotation of the pelvis which places more stress on the hamstrings.
Exercise example: Step ups
Sounds simple enough, right?!
Obviously, the exercises given here are only examples and could change, dependent on the severity of your symptoms, the muscle involved and your sport (if any). If you have sustained a hamstring injury and you are unsure of the best way to rehab it then I should suggest getting in touch and I’ll be happy to help!
I would love it if you would like, share and leave me a comment if you found this helpful/interesting!
PLEASE NOTE: This information is designed to be purely educational and should not be used in replacement of medical advice.
MacDonald et al. (2017). Hamstring rehabilitation in elite track and field athletes: Applying the British Athletics Muscle Injury Classification in clinical practice
Small et al. (2009). Effect of timing of eccentric hamstring exercises during soccer training: Implications for muscle fatiguability.
Timmins et al. (2016). Architectural changes of the biceps femoris long head after concentric or eccentric training.
Valle et al. (2015). Hamstring muscle injuries, a rehabilitation protocol purpose.