Help! I’ve Hurt My Hamstring Again

My bestfriend did their hamstring earlier this year, then half way through rehab went for a sprint and re-injured it and now I'm the blame that they haven't healed enough :( .

If you want to be a physio be prepared to be blamed all the time by your friends for their injuries.

This one is dedicated for them, Please read this....

Background:

Hamstring strains are among the most common sports injuries and are challenging to treat due to their high recurrence rate. They account for 12–16% of all athlete injuries, with reinjury rates reported as high as 22–34%. Recurrent strains often result in more time lost compared to first-time strains. To reduce this recurrence rate, it is essential to identify and address potential risk factors. Although many studies focus on these risk factors, there is limited high-level evidence identifying them and providing effective rehabilitation strategies. This clinical commentary aims to examine the risk factors contributing to the high recurrence rate and propose a unique rehabilitation strategy to reduce reinjury.

Rehabilitation Guidelines

Normalization of Strength/Length Curve Protocol

Phase 1 Goals:

1. Protect healing tissue.

2. Minimize atrophy and strength loss.

3. Prevent motion loss.

Protection:

• Avoid excessive active or passive lengthening of the hamstrings.

• Avoid antalgic gait pattern.

Ice: 2–3 times daily.

Therapeutic Exercise (Daily):

1. Stationary bike.

2. Submaximal isometric at 3 angles (90°, 60°, 30°).

3. Single-leg balance.

4. Balance board.

5. Soft tissue mobilization (STM)/Instrument-assisted (IASTM).

6. Pulsed ultrasound.

7. Progressive hip strengthening.

8. Pain-free isotonic knee flexion.

9. Active sciatic nerve flossing.

10. Ice with sensory electrical stimulation (e.g., Conventional TENS).

Criteria for Progression:

1. Normal walking stride without pain.

2. Pain-free isometric contraction against submaximal resistance during prone knee flexion (90°) manual strength test.

Phase 2 Goals:

1. Regain pain-free hamstring strength, progressing through full range.

2. Develop neuromuscular control of trunk and pelvis with progressive increase in movement speed.

Protection:

• Avoid end-range lengthening of hamstrings if painful.

Ice: Post-exercise, 10–15 min.

Therapeutic Exercise (5–7 days/week):

1. Stationary bike.

2. Treadmill at moderate to high intensity.

3. Isokinetic eccentrics in non-lengthened state.

4. Single-limb balance windmill touches without weight.

5. Single-leg stance with perturbation.

6. Supine hamstring curls on Swiss ball.

7. STM/IASTM.

8. Nordic hamstring exercise.

9. Shuttle jumps.

10. Prone leg drops.

11. Lateral and retro bandwalks.

12. Sciatic nerve tensioning.

Criteria for Progression:

1. Full strength without pain during prone knee flexion (90°) manual strength test.

2. Pain-free forward and backward jog at moderate intensity.

3. Strength deficit less than 20% compared to uninjured limb.

4. Pain-free max eccentric in a non-lengthened state.

Phase 3 Goals:

1. Symptom-free during all activities.

2. Normal concentric and eccentric hamstring strength through full range of motion and speeds.

3. Improve neuromuscular control of trunk and pelvis.

4. Integrate postural control into sport-specific movements.

Protection:

• Train within symptom-free intensity.

Ice: Post-exercise, 10–15 min, as needed.

Therapeutic Exercise (4–5 days/week):

1. Treadmill moderate to high intensity as tolerated.

2. Hamstring dynamic stretching.

3. Isokinetic eccentric training at end ROM (in hyperflexion).

4. STM/IASTM.

5. Plyometric jump training.

6. 5–10 yard accelerations/decelerations.

7. Single-limb balance windmill touches with weight on unstable surface.

8. Sport-specific drills incorporating postural control and progressive speed.

Criteria for Return to Sport:

1. Full strength without pain in the lengthened state testing position.

2. Bilateral symmetry in knee flexion angle of peak torque.

3. Full range of motion without pain.

4. Replication of sport-specific movements at competition speed without symptoms.

Recovery from a Hamstring Tear or Strain

The first phase of recovery focuses on reducing inflammation in the injured muscle. The second phase aims to restore normal blood flow to the affected area. The final stage involves repairing the muscle, allowing the person to return to daily activities.

Mild to moderate (grade 1 or 2) tears or strains can heal within three to eight weeks with consistent home therapy. Recovery from a grade 3 hamstring tear or strain may take up to three months.

Returning to sports before the injury is fully healed can lead to more severe injuries.

Conclusion

Hamstring injuries often recur due to subsequent weakness in the muscle's lengthened state. Incorporating lengthened state eccentric training in rehabilitation may reduce reinjury rates.

This work is accumulated and praises the works of:

• Heiderscheit, B. C., Sherry, M. A., Silder, A., Chumanov, E. S., & Thelen, D. G. (2010). Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 67-81. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362981/

• Pathways Physiotherapy. (n.d.). How to Rehab Your Hamstring Injury. Retrieved from https://www.pathwaysphysio.com.au/blog/how-to-rehab-your-hamstring-injury/

• Mercy Health. (n.d.). Hamstring Tear or Strain. Retrieved from [Mercy Health](https://www.mercy.com/health-care-services/orthopedics-sports-medicine-spine/specialties/knee-leg/conditions/hamstring-tear-strain#:~:text=Mild%20to%20moderate%20(grade%201,can%20cause%20more%20severe%20injuries.)

• mTrigger. (n.d.). A Smarter Way to Rehab Hamstring Injuries. Retrieved from https://www.mtrigger.com/a-smarter-way-to-rehab-hamstring-injuries/

• YouTube. (n.d.). How to Rehab a Hamstring Strain. Retrieved from https://m.youtube.com/watch?v=QvV3GZ2uuNk