Recurrent Hamstring Strains – Why do I always pull my hamstring?
James Grierson - Sports & Exercise Physiotherapist
The hamstring muscles consist of 4 muscles, with the long head of biceps femoris being the most commonly injured because of its long lever arm, involvement in multiple joint kinematics and muscle architecture.
Each AFL club can expect an average of 6 hamstring strains per season, with a recurrence rate of around 13.5% per strain. This recurrence rate has been as high as 40% at the elite level in the last 20 years. (Orchard et al., 2013).
At the local or amateur level, recurrence rates are likely higher due to:
Lack of access to good rehabilitation
Poorer monitoring of load by coaches / player
Less time and emphasis spent on strength work / injury prevention
So why do we see so many recurrent hamstring strains? The answer can be summed up in this sentence:
“Hamstrings are dangerous for sport and sport is dangerous for hamstrings”
So what should your sports physiotherapist be watching with you for each hamstring injury? Especially if you have had a recurrent injury. We have summarised what to do in 6 key points:
Accurate Diagnosis: Not all hamstring strains are the same. We need to nail down the location, size and contributing factors to the strain to appropriately plan out timeframes.
Low Eccentric Hamstring Strength: Eccentric hamstring strength decreases with injury and is often severely impacted by a strain. This needs to be rehabilitated over time and exposed regularly. It is essential that exercise choice is pertinent to injury location and translate into specific sport performance.
Overload Running Program: Running is an extremely effective rehabilitation tool however needs to be gradual and progressive, especially at high speed. GPS units are a great tool to assist with this however not essential as we can provide specific running protocols incorporating acceleration and sprint speeds.
Neurodynamics / Flexibility: This includes both the nervous systems ability to mobilise and muscle flexibility
Neuromuscular Control / Biomechanics: The way you sprint, accelerate, bend and jump can all be trained to optimise performance and limit hamstring stress. There can be specific biomechanical faults that have not been corrected and will affect hamstring firing capacity.
Appropriate Time to Return to Play: This last point is essential. You should only return to play once you have appropriately reached objective markers and proven you can tolerate full game loads. It is important to take out the guess work and utilise objective markers like maximum speed, exposure to all sport specific activities and strength testing.
It is imperative all of these points are addressed! If one is missed it can be the downfall in your rehabilitation and leave you susceptible to a recurrent strain.
If you have had significant time off of sport because of recurrent hamstring injuries during this season or previous years the off season is the best time to focus on improving hamstring strength and preventing injury. See a qualified sports physiotherapist at WA SportsMed to take you through an individualised injury prevention program that keeps you on the park for the full season performing at your peak.
Orchard JW, Seward H, Orchard JJ. Results of 2 decades of injury surveillance and public release of data in the Australian football league. Am J Sports Med 2013; 41:734-741.
How to prevent ankle injuries in basketball
James Grierson - Basketball WA Physiotherapist
Ankle sprains are the most common injury in basketball, representing nearly 15% of all injuries sustained in the sport and taking an average of 19 days to return to sport. (Drakos et. al).
There is large variation in severity across different ankle sprains and numerous factors that can impact the average time it takes to recover fully. They can range from a low grade singular ligament injury to a combined injury to numerous structures across multiple joints with an accompanying fracture.
Some of the factors which may influence recovery times are:
Presence of a fracture or bony injury
Coexisting high ankle or “syndesmosis” injury
Grade of ligament damage
History of ankle or other foot injuries
Over half of all ankle injuries sustained are a repeat incident meaning that they have previously occurred (Drakos et. al.) Here are the best ways to prevent, reduce severity and recurrence of ankle injuries:
Utilising functional supports like an ankle brace and semi-rigid or rigid ankle strapping has been proven to reduce first time and recurrent ankle injuries (Vuurberg et. al). There has been no evidence to suggest that one of strapping or a brace is more beneficial in preventing injury than the other, and choice should be determined by the individual.
Coordination and balance or “proprioception” training have been shown to prevent recurrent ankle sprains (Vuurber et. al.). When exposing people with recurrent sprains to proprioceptive training their risk of lateral ankle sprains returned to normal levels. Proprioceptive training improves joint position sense which decreases injury risk. Strength work and training specific landing strategies help to prepare basketballers for the demands of landing repetitively for up to 12 months after injury. It’s therefore important to maintain your program even after you are back to sport.
There is low evidence regarding the use of footwear to prevent ankle injuries, although choosing footwear that is supportive and comfortable has been proven to prevent lower limb injuries. It is important to consider if any other foot inserts such as orthotics may lift your foot too far into inversion which may expose the ankle to increased stress across the lateral structures.
It is very important that you have your ankle injury assessed by a qualified sports physiotherapist to determine your prognosis as well as implement proven rehab and prevention strategies. Contact one of our sports physiotherapy experts to prevent future ankle injuries.