Where To Start With A Hamstring Injury

Posted By: Andy Barker

Despite all the research and advances in technology and medicine, hamstring injury incidence rates in most sports is very similar to what it was 20-30 years ago.

So clearly, we are getting something wrong.

And it’s not just an issue in sport.

Increasingly more patients are seeking care for hamstring injuries in private practice clinics and hospital outpatient departments.

Injuries like hamstring tendinopathies are become more prevalent in non-sporting patient groups.

You might see this injury in an active individual like a runner…

…or in patients in manual jobs like builders, who are required to repeatedly forward flex…

…or even sedentary populations, like those that sit for long periods of time, in cars and offices, where this prolonged sitting is causing compression to the hamstring tendons and in turn an injury.

For most therapists, muscle injuries weren’t something that were covered in great detail at University.

So, it is not surprising that as a New Grad you might feel under equipped to manage a hamstring injury, or other soft tissue injures to the calf, groin or quad.

Are you confident in your assessments to differentiate between a hamstring muscle, tendon or nerve injury?

Would you know how to manage each of these different issues?

Do you know what objective markers to use so you know your patient or athlete is ready to progress to the next stage of rehab?

Don’t worry if you don’t…

This blog post will help you and by reading this post you will have a better understanding about;

– How to differentiate between a real hamstring injury and a sciatic nerve problem.

– Why stretching can be a waste of time and in some cases detrimental to your patient or athletes injury.

-How you can start the rehab process as soon as possible after injury and why doing this will help reduce pain and improve patient function much quicker.

Make Sure It Is A Hamstring Injury…

This may sound a little daft.

But, there are different hamstring injuries.

And these injuries require a different approach to their management.

This is NOT an exhaustive list by any means but a hamstring injury could include an injury to the hamstring muscle, the hamstring tendon, or you could get hamstring symptoms as a result of an irritated sciatic nerve.

So first things first, you need to know what you are dealing with.

Your subjective history will go along way in helping you to do this.

For example…

Your patient might describe symptoms like pain that extends below the knee or into the buttock, which would raise suspicion that there might be a neural component to this ‘hamstring’ injury.

What those symptoms feel like, their mechanism of injury, prior history of lower back pain would also help you work out what type of ‘hamstring’ injury you are dealing with.

If you did suspect a neural component then you could test this out during your objective assessment, using neural based testing, like a straight leg raise or a slump test.

This would help you to determine whether or not you have a neural issue.

Having good palpation skills will allow you to differentiate between a tendon or a muscle injury.

But, this relies on one big factor…

…you need to know your muscle anatomy.

Stop Stretching It!

Very few people actually have ‘tight’ hamstrings.

The feelings of ‘tightness’ and actual hamstring tightness are very different.

In most cases a restricted or ‘tight’ hamstring is just protective tone and the inability to stretch the hamstrings, is the result of the body stopping you stretching.

For example…

A patient might describe a feeling of ‘tightness’ during a standing forward flexion test or when you test hamstring muscle length on the bed.

But they actually have good range of movement.

Foam rolling, massage and stretching can often be very effective and ‘change’ muscle length quickly, however, these methods often only cause short lived changes.

These methods are effective because they ‘desensitise’ the muscles and allow them to stretch, but because they are not the real problem, then the muscles quickly tighten back up.

So that begs the question…

If the hamstrings are not tight – then why stretch them?

We know the hamstrings need to lengthen and stretch for sure, otherwise movements like putting your socks on or picking something up from the floor would be impossible…

…but just maybe they don’t need to stretch as much as you might think.

Additionally, with an acute hamstring injury, the last thing thing you may want to do is stretch them.

After an injury, we want new tissue to be laid down, as part of the healing process, so often a period of ‘immobilisation’ is needed.

Excessive stretching won’t help this new tissue to be laid down and whilst it might seem advantageous to get someone moving, it might actually cause you more harm than good in the long run.

So what should you do instead?

Load The Hamstrings Early

With any injury, we want to try load the injured tissue as soon as possible.

Clearly, there will always be exceptions to this rule, for example if a patient is in a cast, post fracture or surgery.

But most injuries, the hamstrings being a great example, we want to load them early and in doing this, it can help patients and athletes progress much quicker.

I use a lot of isometrics early with the patients and athletes I work with and teach these same techniques to therapists in my New Grad Physio Membership.

They are super simple, but really effective for hamstring injuries and the principles can be applied to other soft tissue injuries like the calf, groin or quad or even injuries to the upper limb.

A large body of evidence supports the use of isometrics to reduce pain, this is why they are often a staple of most tendon rehab protocols.

If we can reduce pain, this will help early walking and a faster return to activities of daily living and allow you to progress your patient to more meaningful rehab much quicker.

The more active you can get your patient as early as they can post injury will also help limit de-conditioning and losses in muscle strength, size and endurance.

Doing nothing and ‘resting’ for a few weeks won’t help.

Isometrics are great because you don’t need any equipment and you can modify the force from 1-100% of a patients maximum.

You can easily alter the position of any isometric exercise to find a variation that your patient can perform comfortably, even from day 1 of their injury.

This can help them to reduce pain, limit de-conditioning and help them progress to high level rehab like squats, leg presses and lunges much quicker.

Key Points

Make Sure It Is A Hamstring Injury: Use your subjective and objective assessments to differentiate between hamstring injuries that involve the tendon, muscle or the sciatic nerve.

Stop Stretching It!: Avoid stretching with new injuries and if stretching and other methods like foam rolling and massage are only giving short term relief, then it is likely that something else is causing this problem and the muscles are not ‘tight.’

Load The Hamstrings Early: Use isometrics early to reduce pain, improve function and process to more meaningful rehab exercises much quicker.

Andy Barker

The New Grad Physio Mentor

PS. Do you struggle with hamstring injuries or the management of other soft tissue injuries like the groin calf or quad?

I’d love to hear what you struggle with and to help you out overcoming the problems you have with soft tissue injuries, to give you greater confidence with your assessments, treatments and rehab.

Email me at andy@newgradphysio.com and I’ll let you know how to do this…